Developing Connections with Patients

1.1 Approach the care of patients as a cooperative endeavor, integrating patients’ concerns and ensuring their health needs are addressed

 

I knocked on the door and slowly opened it to find my patient feeling very unwell. It was the first day of my third year, and I was working on the gynecologic oncology service. The patient frantically told me that she was nauseous, so I hurriedly searched the room for an emesis bag. I couldn’t find any in her room, so I told her I would be back in one minute and walked out into the hall to look for help. I crossed paths with a PCA, and I frantically told her the situation. She smiled and took me into the supply room to get some emesis bags as well as some towels and a change of sheets for the bed. We returned to find my patient vomiting all over herself and the bed. I froze. I didn’t know what to do. This was not how I had envisioned the start of my clinical years. I expected to feel confident and helpful, not unnerved and lost. Together the PCA and I helped to clean her up. We called her nurse who gave my patient her antiemetics. Later, when I saw her on rounds, I was pleased to see that she was in good spirits and feeling better. She had been readmitted after a total pelvic exenteration for treatment of her cervical cancer due to some issues with her midline incision. While admitted, she was dealing with a lot of pain, and still recovering after her surgery.  In the afternoons, I would chat with her in her room and take walks around the hall with her. I was in awe of her strength daily. She had gone through so much already, and she was determined to keep pushing to get better. Her daughter had just purchased a house down south by the beach. Her goal was to get strong enough to go spend some time down there with her family, relaxing by the water.

Over the two weeks, I was on service, I was able to watch her improve bit by bit, but not without a few setbacks. She was having increasing pain at her incision. The team was concerned about would dehiscence. As my residents examined her wound, I stood by her side as she squeezed my hand in hers and apologized for any pain she was causing me. At that moment, I couldn’t help but to think back to my first day of the rotation and how helpless I felt when she needed a hand to hold. She was still in the hospital on my last day on the gyn onc service. I wished her well and said goodbye before I headed home for the weekend. She was hoping to be discharged sometime next week and told me that our walks out in the hall helped her prepare for her walks on the beach.

My time taking care of her taught me a lot about the doctor-patient relationship. For patients, it is less about being perfect and having every answer. It’s more about spending time with them and showing you care about their lives beyond their disease. They want to know you’re working hard to find the answers, even if you don’t have them instantly. This was a lesson I wanted to carry onto all of my rotations and to every patient, I had the privilege of interacting with. I wanted to keep working on my communication skills and building connections with patients and members of the healthcare team as well.

Fast forward to my sub-internship during my fourth year. I was again on the gynecologic oncology service. It was July, so the residents were getting accustomed to their new roles, and the interns were figuring out how to be residents. I was applying everything that I had learned over the past year. I was able to find supplies in the JIT room. I knew how to get around the hospital. If a patient needed an emesis bag, I would know where to find one! Over the course of my sub-I, I was able to form connections with many of the patients on the service. There was one patient in particular with who I was able to form a strong bond. She had recurrent vulvar cancer and had an additional vulvectomy and reconstruction that required the assistance of plastic surgery. She had skin grafts harvested from her bilateral thighs, and she was in a lot of pain. Each morning during our pre rounds when we came in as a resident team, she was always so happy to see us. She would ask us each about ourselves and told us how she had been overnight. When my intern and I would go check on her in the afternoon she would talk to us about her favorite bands, including Queen, and her husband. This was during COVID, so her husband was only allowed to come up and see her during limited hours. As part of her post-op care, she wasn’t able to get up and walk around until 5-7 days after her surgery. She was sharing feelings of how she was feeling depressed not being able to move, so we consulted music therapy for her. She loved when they would come by to see her and she thanked us endlessly for placing the consult. Finally, when she was allowed to weight bear, she could only take five steps at a time. She could only get up with the help of PT, which was very limiting. During my time on my surgery rotation, I saw beds in the SICU that tilted up that allowed patients to stand while being in bed. With the help of the nursing team on the floor, we were able to special order her one of those beds. She was able to stand up with an assist from the nurse or PCA and didn’t have to bend at the waist which made things much easier for her.

https://www.youtube.com/watch?v=-b0tEjzf9fo

On the day she was going to be discharged, she thanked our team endlessly for all that we had done for her. She complimented my intern and me to our attending and said how wonderfully we had treated her and always came to check in with and talk to her. I was very moved by her reaction to what we had done for her. I thought I was simply doing the right thing for her. Trying to make her life in the hospital a little brighter, and I was able to have a huge impact on her life. Below are comments from my sub-i rotation.

This time around on the gynecologic oncology service, I was able to anticipate the needs of my patients. I was more familiar with the hospital and the resources available, and I was able to access them for my patients. I did all of this while trying to remember the importance of connecting and finding common ground. I tried to get to know the patients on the floor on a deeper level than their diagnosis and potentially complex cancer history. On one of the later rotations of my fourth year, I had evaluators comment on my ability to build rapport and communication with patients effectively.

Throughout medical school, everyone has told me that as a medical student you have the most time to connect with and get to know patients. As a resident, you are much busier. You have many more responsibilities and patients that you’re caring for. During intern year, and beyond, I’d always like to continue to ask patients that I come into contact with something that they enjoy doing, their favorite food, what shows they’re watching, or even a recent book they’ve read. Each week during intern year I’d like to learn fun facts about or hobbies of 7 patients that I take care of that week.

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