During my very initial exposure to a clinical setting at medical school, I met a patient who had a lot to teach me about diabetes, the physical and psychological effects of living with multiple cancers, and, most importantly, the fighter mindset.
This experience was part of a longitudinal case study I have to do, where we see a patient multiple times throughout the year in order to follow their illness journey. It allows us to see continuity of care, as we observe the way their management changes and get a real insight into how they feel about their care. It is a good opportunity to not only understand the science behind their illness and how they respond to various treatment, but also to put yourself in the patient’s shoes and see what it’s like for them to live with the illnesses they have. Therefore, you develop your skills of empathy through seeing the person as a whole, and how every aspect of their life is affected, from the physical effects of a tumour to the psychological effects of taking many tablets a day.
Before I spoke to my patient, I made sure to brush up on the clinical skills that I had studied in one of our modules during the first term of university: ‘Introduction to clinical practice’. These sessions were very useful as they taught us the basics of an effective consultation.
Some of the lessons that I took with me to the consultation was:
Empathy - you can only truly understand your patient if you put yourself in their shoes and try to see things from their perspective. Remember, they are the ones in pain, and are depending on you and looking to you for help.
Listening skills - it is important to let the person in front of you know that you are listening to them. Simple things like saying ‘Hmm, I see’ and nodding your head every now and then reassures your patient that they are being listened to. Moreover, eye contact is very important to show the person in front of you that you are interested in what they have to say.
Encourage the patient - history taking is the conversation you have with a patient to obtain as much information as possible about what's going on. It is a doctor’s first step towards reaching a diagnosis and so it is important to be open and encourage the patient to tell you as much as they can. This includes details about their symptoms, if they've experienced it before, what other conditions they have, and so on.
The best way to approach the history taking is to let them lead. For example, if you start your consultation by asking your patient what problem they’re facing and all they say is ‘I just can’t sleep at night’. Of course, you want to know more, but how do you go about this? Well, there are two options. Either you begin asking them questions straight away to get a full picture, or you simply say something like: ‘Tell me more!’. This allows them to tell you what they think is most important and explain their views of their illness, and then you can ask them more focused questions.
The biopsychosocial model of health - this was something we learnt about during the first week of medical school. The biopsychosocial model of health, developed by George L Engel, states that health should be viewed as a combination of biological characteristics such as genetics, psychological aspects such as emotion and behaviour, and social aspects such as employment, housing situation etc. This model expands on the biomedical model, which states that illnesses are only a physical problem, which is of course, too simplistic.
Now, having gone through my notes, I felt more prepared to meet my patient.
Mr X was a man who had diabetes, prostate cancer and eye cancer and as a result had completely lost his right-sided vision.
During my consultation with him, I incorporated all the different techniques I had revised, by introducing myself, asking open questions and ensuring my body language reflected my interest and care. I would follow-up what he'd said with further questions which demonstrated my active listening. This led to him being happy to share issues that were personal and sensitive to him, and made me feel like we were building rapport that will only be developed further when I see him again next month.
Through talking to him, I was able to reflect on his health journey and how he got to where he is. I learnt that illnesses aren’t always associated with lifestyle factors. This is an assumption that many of us make - but it is not always the case. Mr X explained how he had been leading a very healthy life, which included riding a bike every morning, and that he’d done everything to remain fit. He even read up about diabetes in his early 20s and mentioned that he had done everything to make sure he didn’t develop it, and yet he had still managed to develop diabetes! This led me to research diabetes further, and the genetic factors associated with it. I realised that patients have so much to teach us, if we are willing to really listen and learn from them.
Moreover, I made it a point to tell Mr X that I found his attitude inspirational, to which he responded: ‘Well, you have two choices: you can either give up or carry on. I choose to carry on’. Those words have really stuck by me, because if someone who has, amongst other things, completely lost their vision in one of their eyes and says ‘Well, I do have another eye which I can see through’ then what excuse do I have to not be grateful and have a positive outlook?
There are endless lessons that medical students can learn from patient interactions, and this isn’t limited to the science behind their illnesses. Sometimes, we learn life lessons too.
Author: Sana Khan
Editor: Latifa Haque