Introduction to Clinical Medicine: Starting Medical Students to "Walk the Walk"
A physician taking a medical history is a dynamic process and is not simply the physician, as a stenographer, listing data in a chart but should be perhaps the beginning of a therapeutic relationship between the physician and the patient. But for it to be truly therapeutic it also has to be a humanistic relationship in which the patient is a subject and not the object of some medical application.
In the first year "Introduction to Clinical Medicine" at the medical school where I teach, I start out at the very first day of what will turn out to be the career long path of becoming and then being a physician emphasizing this principle. Students on this first day are very uncertain about their role, their responsibilities as a medical student and they are apprehensive interacting with a sick stranger. Issues come up and as facilitator of a group of 6 students we encourage them to "let their hair down" and be open in expressing their concerns to me and the group. Often the issues deal with emotions both on the part of the patient but also frequently on the part of the student. Identification with the situation of the patient, though a valid mechanism for being able to express to the patient true empathy, nevertheless can lead to worry, depression and anxiety on the part of the student if the identification is related to similar ages or similar personal or family diseases.
This identification has disrupted some interviews to the extent that the student can no longer continue talking with the patient because of emotional upset.
What we present the students on the first day, before the first patient interview is an important to facilitate their further functioning. There is much to talk about especially from those facilitators who have had years of experience with all sorts of patients and illnesses. In my opinion, it takes more to help these students through this experience than from an academic professor of communication. You have to have "walked the walk".
To give you an idea of situations which students do face in their first days with a sick stranger, I put together for them a quiz which I usually present, not to grade but as a takeoff for further discussion. Pretend that you are the student and decide which response would be most appropriate and beneficent for the patient. I'll give you my answers later in the Comment section of this thread. In the meantime, I would be interested to know how you would answer the questions if you were a brand new first year medical student who never performed a medical interview on a sick stranger.
By the way, I am off tomorrow to do exactly what I have been writing about on this thread with two groups of first year, first day medical students tomorrow. ..Maurice.
Introduction to the Interview by Maurice Bernstein, M.D.
1. You enter the hospital room of a 44 year old white male who has crumpled Kleenex scattered over the floor and who is coughing. What is the first thing you would say to him? A. “Why are you coughing?” B. “Why did you come to the hospital?” C. “Who are you?” D. “Are you in any pain?” E. If none of the above, what would you say?
2. You enter the hospital room of an elderly white man and there is a bad odor in the room. What should you do first? A. Ignore the odor completely? B. Immediately say to the patient “What is that bad smell?” C. Leave the room at once and call the nurse. D. Without disturbing the patient, during the interview attempt to identify and find the source of the odor. E. Go to the window and open it.
3. Your instructor has assigned you to a 31 year old white female. Moments after the instructor leaves and you are alone with the patient, she yells at you “Get out! Get out of here!” What is the first thing you should do? A.Turn and leave the room immediately without saying a word. B. Sit down on her bed. C. Say to her “I am
a first year medical student. Why did you say that?” D. Attempt to hold her hand. E. Say to her “Don’t say that. I was told to interview you.”
4. You enter the hospital room of a 55 year old black female who is moaning in apparent pain and after you introduce yourself what are the next words that you speak? A. “Do you hurt?” B. “When did you come to the hospital?” C. “Are you married?” D. “What is the matter with you?” E. You speak no words but immediately leave the room and call a nurse.
5. You enter the hospital room of a young woman about your age who was assigned to you by your instructor. You observe that she is weeping. What would you do next? A. Leave the room and tell your instructor that you are only a first year medical student and that you don’t know enough to help her. B. Leave the room at once without discussing what you observed with the instructor. C. Identify yourself and then hand the patient a Kleenex from the box on her bed table. D. First ask “What brought you here to the hospital?” E. Leave the room at once and call a nurse.