First Lesson

Aoki, Katherine

Two weeks into my clerkship rotation in family medicine, I found myself preparing to start a stretch on hospital service. I was ready for a challenging new experience, but felt a thrum of anxiety in my stomach. Clerkship is a pivotal point in a medical student’s career. It is when, released from the confines of the classroom, we encounter the realities of patient care and begin to discover the types of physicians we will be.

Having observed several of my teachers, it seemed to me that there are doctors who genuinely care about patients, doctors who like patients, and doctors who appear to have few feelings regarding patients at all—treating the person who is suffering as a bodily extension of disease. I often wondered how this last category of doctors became so numb. Surely they were once just like my classmates and me, enthusiastic students driven to help people. Why do some doctors harden their hearts while others, after long careers, approach each patient with empathy? And what kind of doctor would I turn out to be?

She was my first patient. Admitted from the ER the previous night, she had presented complaining of abdominal pain and hematemesis. I could not garner much more than her medication list as I scanned her chart. Since she was my sole charge, I went into her room, ready to spend all of the time in the world with her.

When I walked in she was reclined on her bed, relaxing in the sunlight that shone through the window. I introduced myself, asked her what had brought her in, and we talked and laughed for an hour. An elderly European woman with a direct, mischievous manner, she was sharp as a tack and enjoyed talking. I let her meander, picking up points of note and asking questions here and there. She told me about the pain that precipitated her visit, about her home life with her son and granddaughters. She described chronic aches in her knees and hips, and a headache, which had plagued her for many weeks after discontinuing several medications.

After our talk, I listened to her heart and lungs, and then performed a thorough examination of her abdomen. I departed, confident about my initial assessment, telling her I’d check back in the afternoon.

Over the next several days I kept a close eye on her. She was getting better, but each day she complained of her headache. In the morning I would hear reports of dismayed nurses, of her son calling the hospital, of doctors confronted. She was kind to me, but she wanted something stronger for her head, that she expected injections of some sort in her forehead to alleviate her pain. I tried to explain that the headache was likely due to the changes in her medications, a lack of sleep, and neck pain. She remained wholly dissatisfied, and told me so each time I dropped in.

By my fourth day, with a lengthening roster of patients to care for, I was finding her complaining increasingly disheartening and her questions more and more burdensome. My visits to her bedside became less frequent. I began to think that nothing short of a miracle would appease her.

Eventually she was ready for discharge. I spent the afternoon sorting out her paperwork, and in the early evening her son and granddaughters arrived to collect her. As she prepared to leave she said, “I know I can be a real pain, but you were lovely, so thank you for taking care of me. But …” Her face darkened. “I was here five days, and never once did someone fix my headache.” I apologized, acknowledging that we failed to make it any better and recommended that if it persisted upon her return home she follow up with her family doctor. She nodded, unimpressed, and left with her family.

I returned home that night deflated. I convinced myself that her expectations had been too great, that I must harden my heart and let go of my misgivings. In the ensuing days, I found myself taking less time with patients, avoiding eye contact in the halls, being more directed and efficient with my questioning. Just two weeks into my clerkship and I already felt a little numb inside.

Feeling lost, I called up my mentor—a doctor whose patients would stop him in hospital hallways years later to thank him for his service. He was the type of doctor that I had once set out to be, but now I wondered if I ever could. I asked how he faces the onslaught of unmet expectations and time constraints without feeling exasperated.

A pause met me on the other end.

He explained that he often deals with patients who come to him saying, “Fix me.” “These patients have seen specialist after specialist only to be told, ’I don’t know why you have x but it’s not an infection’ or ’it’s not an autoimmune condition‘ or ’it’s not a structural problem‘ etc. With everyone saying what they can’t help and no one saying what they can help, patients feel abandoned.” “But,” he continued, “what I’ve come to realize is that what many patients really want is to feel that their complaint is heard and acknowledged.” He went on to explain that we often don’t have many miracle cures, but what we do have is the skill to listen, to touch and to reassure.

I could appreciate how he translated his philosophy into practice: At each visit, my mentor listens to the patient, then inspects, palpates, and percusses the location of his or her ailment. Then he spends time (precious time) talking to them about both what it is not, but also what it is, and how to manage it as best as we can. It is not until then that the patient appears to feel that their complaint has been given the attention it deserves. And that’s when I realized that perhaps this is what would have made all of the difference to my patient. I had listened to her, I had acknowledged her pain, but I had not spent time talking about what it likely is and what it is not and how we, together, would manage it.

And so as I prepare for another shift at the hospital, I am faced with a choice. I can ease my work by hardening my heart and shielding myself against the suffering of others. Or I can set myself the challenge of being the doctor my patients need me to be. That doctor will do her best. She will keep an open heart. She will not be able to treat every ailment or alleviate every symptom, but she will listen to and try to meet the needs of the person who depends on her.

The measure of a good doctor is not always his or her ability to fix patients, or to address the demands of a disease, but to listen, to touch, and to comfort. It is to move from merely treating an illness toward helping to heal a person. And so I thank my patient for her lesson, and my mentor for his reminder.

Theme: Health Care Delivery | Prestation des soins de santé
Theme: Patients | Patients
Theme: Physicians | Médecins
Theme: Relationships | Relations
Theme: Teaching and Learning | Enseignement et apprentissage

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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