Third year in medical school has been a blast. I didn’t expect anything else honestly. Finally, I was getting to play doctor. I was getting to take care of the diseases I had only read about. Now I had the opportunity to carry out the diagnosis and treatment plan.
But surprisingly, while playing doctor has been fun, it’s not the center of what’s made third year so great. Instead, I found that the interactions with my patients have made the experience so memorable.
I’ve waited a while to write such a post. Sometimes lacking the knowledge and experience in medicine can overshadow our strengths. If there is one thing I’m good at, it’s getting along with a wide variety of people. During my third year, I’ve honed in on this skill to maximize my interactions with my patients. In this post, I’ll share the techniques I use to make every patient interaction a potentially memorable one.
Make it Clear You Care:
This seems obvious but try to observe how often it’s missing from your clinical duties.
How many times does a patient get reminded they’re being taken care of? How often does someone update them on a test result or a treatment plan? Are they getting our full attention if there’s a more complicated patient on our team? How much time are we spending at their bedside actually talking to them?
As a med student, I have certain things I aim to accomplish in each initial encounter. I want to leave the room making sure the patient knows I care about them.
First, I introduce myself and what my role is in their care. I make sure they know my name and not just my face. And since my name is difficult I know a patient tried to remember it if they call me anything remotely close.
I explain to them that they are my patient. Thus I will check on them in the morning, during rounds, likely in the afternoon, and any other instance they need me.
Second, I explicitly say, “I’m the med student on the team, which means, out of everyone else, I will have the most time with you. Please let me know of anything we can do to better take care of you.”
This statement is powerful because you’re making it evident to the patient that you care. They may not take you up on your offer. That’s okay. But they may also use such a statement to tell you about small things (minor symptoms, emotional distress, life stories, etc.)
Patient care begins by caring for the patient.
They Are Your Patients:
We’re always told during our clinical years that we should know our patients better than anyone else. Take this to heart.
Know what other diseases your patient has. Your attending may not always remember and look to you to know.
Do you know what the ejection fraction of your heart failure patient is? Do you know the last A1C on your diabetics? What’s the baseline creatinine in your chronic kidney patients? Make sure you nail such things down and know them off the top of your head.
In addition, know the plan of your patient better than anyone else. While you may not be at the level to come up with a complete plan, make sure you know it once it’s finalized. Make sure you write it down.
Then consistently follow-up if the plan is being carried out. If a specific test or imaging study hasn’t been ordered, remind your resident or (if you’re allowed) pend the order in yourself.
Sometimes the residents/attendings may forget the small elements of the plan. If the patient has 10 things to take care of, repleting their electrolytes may not top the priority list. Make sure priority #1 is just as important as priority #10.
Address Them (and their Loved Ones) By Their First Name:
I’ve found this to be very effective. Sure we often are accustomed to referring to our patients as Mr. and Ms. (Insert name here), but our patients often aren’t.
As long as the patient appears comfortable and the age gap isn’t too large, I call my patients by their first name. To add a little bit of formality I still keep the Mr. or Ms.
This is just a small step to create a more comfortable environment in a situation that’s not very comfortable.
Know More Than Their Past Medical History:
Every patient has a PMH but do you know their past history? What do they do? Who do they live with? What kind of things do they enjoy?
By no means do you have to be able to write a biography on them by their discharge. Still, know your patients outside their electronic medical records.
I had a patient recently who was very pleasant the first few days. Then suddenly he appeared agitated and indifferent when the medical team came in. After taking more time to talk to him I found that he was quite active in the community. Staying in the hospital was keeping him from doing community service during Thanksgiving.
Once I understood his passion for community service, his anger and frustrations appeared valid. I conveyed this to our team and surely our plan of care and urgency for him shifted so he could leave to do what he loved.
I didn’t expect this patient to be so involved in the community. What else didn’t I know. After an afternoon of chatting, I found that he was a retired AP math teacher and now traded stocks on a daily basis. He would just be another patient I might soon forget if I hadn’t talked to him about him.
These are the neat elements about our patients we don’t get to learn about if we just focus on their medical symptoms.
You don’t need to learn everything about during your first interaction. Just build on your foundation of who that person is with every encounter.
It goes back to the first point, make them feel like you care. Ask them what they care about.
Make Sure They Know As Soon As You Do:
During my internal medicine rotation I felt like I was on a Hem/Onc service. Many of my patients either had or were diagnosed with cancer.
For the cases where the patient didn’t know their diagnosis, there was always a sense of tension in the air. Cancer is never a word anyone wants to be associated with.
To ease the tension of my patients and their families, I would often say that, “They would know as soon as I did”. Whenever I had an update (good or bad), they would also be informed shortly after.
My patients were thankful for this. Often it was the unnecessary delay in receiving information which bothered them vs. the information itself. My cancer patients often knew they were about to undergo intense treatment, they just wanted to know as soon as possible.
Use this sense of urgency for everything. If a patient has an important lab test, fill them in on its result. What does it mean? Is it significant and does it change their course of treatment?
If a patient asks you a question you don’t know, first tell them you don’t know. Then go find the answer and give them an update.
If a patient goes in for a procedure, be one of the first people to check in on them afterward.
Earlier this year I wrote a post about the power of fake confidence. It’s continues to be at the core how I get through rotations.
You won’t know everything. Your patients don’t expect you to. What they do need, however, is someone who will serve as their advocate and their emotional stronghold.
There’s this interesting idea in medicine about waiting for Superman. Often our patients are the head of their families. They’re indestructible in the eyes of their loved ones. They’re forced and are used to remaining strong. But when a health crisis hits, they feel like they’re losing control.
Your patients will yell, cry, become depressed, and/or indifferent. That’s okay. Reassure them that they don’t need to be Superman while under your care.
They will apologize and feel guilty for being difficult or emotional. Reassure them that it’s our job to take care of them, not the other way around.
Understand that it’s a privilege to serve as such a role in a stranger’s life. Don’t take this lightly.
I consider this post to be the most important in my entire blog. Developing good rapport can overcome other shortcomings in your knowledge and experience. The latter will come later anyway. It’s much harder to address any poor habits we develop regarding patient interactions. Start early and now on developing your bedside manner. Hopefully, there’s something in this post you’ll take away and add to your arsenal.
If there is something specific you’d like me to address in a future blog post, comment below or email me at [email protected]
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If you’re a first or second-year medical student wanting guidance on how to succeed in medical school, read my book, The Preclinical Guide. I provide all the tips I wish I knew day one of medical school. Check out the book here.
Until next time…