How Can I Become More Comfortable With Patients?

Daniel J. Egan, MD

Disclosures

December 22, 2009

Question

It is hard for me as a young student to interview and examine patients. I feel like I am intruding into their personal world without having a lot to offer them, given my limited knowledge base. Do you have any advice?

Response from Daniel J. Egan, MD
Associate Attending Physician, Department of Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY

First of all, I commend you on recognizing a level of discomfort with what you are doing. In medicine, we tend to normalize things that would not be considered normal anywhere else. Early on in your training, you are more likely to recognize and be uncomfortable with what the rest of the world may consider "abnormal."

There is a unique and relatively rapid transition that occurs as you become a medical student. Most schools have now introduced a clinical exposure to some degree early in training. In the setting where I work, first-year students shadow me and begin interviewing patients as part of the Fundamentals of Clinical Medicine course. Just a short time ago, these students were regular college students; suddenly, after putting on the white coat, they have taken on a very different role.

Your statements raise several issues. The first is the basic difficulty in examining and interviewing patients. You are suddenly prying into the history (both previous and present) of these individuals. We frequently label patients by their diagnoses (eg, the "chest pain" in room 2; "stroke" in room 7). However, behind each diagnosis is a person with a medical history, a social history, and family members who care about them. You are expected to ask questions about all of those things, and in return, you have an expectation that the patient will share his or her answers with you. But what if the patient has a question for you about his or her illnesses or history? You should understand that it is okay to tell the patient that you do not know. A good rule of thumb for your entire career in medicine is that making something up is never the right thing to do. Explain that you are still in the process of learning, and you will find out and get back to your patient.

You use an interesting word when you say you are intruding. In some ways, your interview is an intrusion into intimate and private details of a person's life, but certainly your physical examination can be intrusive. Reading this made me immediately remind myself that this is truly what the privilege of being a physician (or physician in training) is all about. We put on a white coat, or merely introduce ourselves as doctors or student doctors, and patients share very private details with us. Additionally, they allow us to examine them to try and determine the etiology of their symptoms. It truly is an honor and a privilege, and sometimes it takes the novice to remind us of that. You are correct. It is an intrusion. However, the bigger picture is that the intrusion is necessary to get at the greater good, which is the successful diagnosis and treatment of your patients.

So, let me congratulate you. You are truly a grounded person who has not yet forgotten the humanity in medicine. Please try to remember this feeling from time to time as you move forward in your career. Although we play a certain role as physician, our patients are people as are we. The physician who does not forget his or her roots, recognizes each patient as a unique individual, and remembers that this is an honor will serve his or her patients better.

With time, your feelings will change. Some things will always seem a little strange but likely more "normal." This is neither good nor bad, just part of the process. I hope you can remember asking this question in the years to come.

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