Medical Student Perspective: Bedside Manner
A recent conference on the topic of hospital and patient safety addressed the theory that medical students are often the most vigilant because they know the least in a room full of residents and attendings. I identified with this, because the desire to absorb as much information as possible in any patient interaction is a common theme among medical students. This was further embodied by a recent patient interaction that I had.
A 46-year-old African American woman with a medical history of hypertension and chronic left hip pain had been in the hospital for three days since presenting to the emergency room with persistent abdominal pain that was associated with vomiting and diarrhea. Computed tomography revealed fluid filled loops of small bowel, which was probably caused by a mild ileus or gastroenteritis. A right adnexal cyst had also been found incidentally and was evaluated by a gynecology consultant. Pain management, whom she had seen on an outpatient basis, was also consulted for her chronic left hip pain.
I met the patient on her second day of admission and took note of how friendly and appreciative she was of our care. But the following day, I had noticed a change in her affect and lack of communication during rounds. The patient always had a family member in the room, even at 7:00 a.m., but today she was alone. She mentioned that she did not want to see anyone today. A consultation mix-up had resulted in the patient going two days without seeing pain management. The attending went through a routine physical examination and discussed that the gastrointestinal work-up had come back negative, her symptoms were most likely due to viral gastroenteritis, and she could go home either that day or the next. The plan was to advance her diet before discharge. Suddenly, the patient began crying and said that she was upset and didn't want to see any family or friends.
The attending, slightly taken aback, asked her a couple more general questions and said that we would return soon; then, along with the chief resident, two interns, and myself, we walked out. A quick deliberation between the attending and chief resident about the merits of consulting psychiatry ensued outside of the room. I had been told to find some tissues for the patient because there were none in the room. I returned to the room, handed the patient the tissues, looked her in the eyes, and held her hand. The total exchange lasted for a couple of minutes, and I just let her talk. The combination of hip pain, abdominal pain, and three full days in the hospital had begun to take a toll. At the end, she looked at me and said thank you. I left the room to find the rest of my team already discussing the next patient.
One benefit of being a student is that you experience a wide spectrum of personalities and approaches to patient care from different attendings and residents. One question that I constantly find myself asking in difficult situations is whether I would have handled it any differently if I were the attending. After some reflection, I realized that all the attending needed to do was sit down and talk to her for a couple of minutes and reassure her. Fast-paced rounds can transform patient interactions into transactions rather than real conversations. This was an experienced physician with excellent medical skills and knowledge, but he failed to see the patient's vulnerability and frustration. Was a psychiatry consultation necessary for this patient? This was a possibility, but it missed the point.
As medical professionals, we sometimes forget that being in a hospital is not a joyous experience. In fact, for the majority of patients, it is the last place that they want to be. This subtle point can often get lost in translation because many of us spend more time in hospitals than our homes. A hospital stay can be a roller coaster of emotions; although this is not necessarily our job to manage, we should acknowledge the strain that a hospital stay can put on the psyche.
When seeing patients, I remind myself how I feel when I am sick. Reflect on a time when either you or a loved one was very ill-the vulnerability that one feels is incredible. There is no clear demarcation as to when patient care becomes too personal. Many argue that personal feelings can cloud sound, independent medical judgment and end up having a detrimental impact. These are important points to be cognizant of during patient care, but many of us can be a bit more personal without compromising patient care. The humbling ability to heal also bears a great deal of responsibility, to constantly remind oneself that behind every hospital gown is a human being. The humanistic aspect of medicine is the main reason that many of us chose this profession, to care for the weak, defenseless, and vulnerable.
Medical students are often the least knowledgeable persons in the room. Yet, we can sometimes perceive the heightened emotion in the room, not because we have a sixth sense but because it is our role to be hypervigilant. This ability is present in all physicians, but it requires us to put ourselves in our patients' shoes. Eye contact, reflective listening, and exhibiting emotion can go a long way to strengthen the sacred and personal doctor-patient relationship. In other words, bedside manner.
Brendan Keleher, MS III