Competency: Patient Care
While I didn’t know much about the oral presentation of a patient coming into medical school, I was pretty sure I was going to be good at it. Presentations on episodes of Gray’s Anatomy didn’t look very hard and years of public speaking in church and time on the stage as an actor had, over the years, helped me become comfortable speaking in front of others.
One can imagine my frustration, then, when despite learning to take detailed patient histories and even gaining a good foundation of hematologic illnesses and drugs, I continued to struggle month after month of my first few years of medical school.
An early example of this was my attempt to present the case of a woman with thrombocytopenia secondary to her hematologic cancer. Weeks of struggling with the oral presentation of patients had left me determined to get it right. I started preparing long before I knocked on the patient’s door. I looked up her cancer as well as common associated symptoms. I learned the indications and even some side effects of every drug she was taking. I learned about her social history and much more in hopes of being able to present a detailed history to the attending physician, Dr. Andritsos.
The interview with the patient went as planned and when the time came to present, I moved through a prepared list of bullet points in a rather long, but comprehensive oral presentation that I was proud of. Then came the response from Dr. Andritsos: “Your forgetting something.” Flustered, I looked through my organized bullet points and confirmed I’d gone through each element of the history, physical exam, labs, and assessment/plan. I looked back up at Dr. Andritsos with a blank stare. “Did you ask about bleeding?” she asked. I hadn’t. While I had gained useful information about side effects of medication, stress levels, and some recent mild illnesses, I had missed the very “heart” of the visit. Dr. Andritsos taught me that day that a patient presentation is a story built around one or a select few problems that serve as its heart. Furthermore, while my limited experience sometimes requires me to present more information than an experienced resident, I learned that finding that heart would help both me and the physician to focus on what is most important and thus provide the best care possible. I saw evidence in my evaluations that I was improving in the ability to glean the most important information in each visit as seen in this comment from my family medicine Longitudinal Practice preceptor during my second year:
This comment from an evaluation during my third year suggested continued improvement. However, it also highlighted another area of growth that I had been working to cultivate that gives an entirely different–but equally important–meaning to the “heart” of a patient visit: empathy.
The evaluator references a patient who had undergone a full pelvic exenteration procedure. We had been struggling to control her pain, but after an early morning visit, I sensed that there was more going on. I took some time after the day was over in the ORs to go see her. It took some time, but by sitting at her level and explaining I wanted to take some time just to talk, she broke down in tears and shared some of the anxiety and loneliness she was feeling as well as some misunderstandings of her care. We formed a bond of trust that helped me to better care for her over the course of the week I cared for her.
I have learned through these experiences that while it is essential to identify the most important issues at hand to effectively treat a patient, it is empathy for the patient that breaths life into the encounter and allows complete understanding of their needs as well as the rapport to fully address their needs. As I move forward into a time when I will be treating patients daily as a physician, I will seek to identify the problem at the heart of each patient visit, but also cultivate ever growing empathy that will make that “heart” beat.