The Real Patient

Sunday, February 12, 2017

Wearing my white coat with my stethoscope hanging around my neck, I knock. I introduce myself while going through a checklist in my mind: say hello, ask how the patient would like to be addressed, start with the chief complaint.

The encounter flows smoothly. We glide through the history of the present illness covering the onset, severity, and duration while I also acknowledge the pain he is experiencing. We jump into his past medical history, which leads directly to the medications he is on and his allergies. Afterwards, we talk about his family. I empathize when he shares how his father passed away.

We don’t linger, but instead move on to discuss his job, where he lives, and the stressors in his life. I then ask the pointed questions about his alcohol, tobacco, and drug use before ending my history with a review of systems.

We are about to continue to the physical exam before a voice comes over the speaker telling us time is up. We should begin giving feedback.

In the safety of the Kanbar Simulation Center, the first year medical students have spent the past six months building our repertoire of clinical skills. We have treated standardized patients with heart attacks, collapsed lungs, seizures, and inflamed gallbladders.

The end of January offered a new component to the Clinical Microsystems Clerkship (CMC) – the beginning of the clinical preceptorship. We would finally start working with patients at Lakeshore Family Medicine Clinic. On our first day, my faculty coach paired me with another medical student to take a patient’s history. He was going to conduct the interview and I would observe.

We stood outside the door with our stethoscopes hanging around our necks and knocked. We said hello, found out how she would like to be addressed, and asked about her chief complaint – she was feeling sad.

The encounter stopped flowing smoothly from there. The story that unfolded was one of loss. We listened as she told us of the onset, severity, and duration of a different kind of pain. Stilted questions were asked, and kind statements were made, but the long pauses still invaded.

I sat there. Stunned. This was grief.

As I observed, my peer continued. He respected the patient’s pain and did not look away from it. With empathy and professionalism, he stumbled through the history of the present illness and began taking her family history before our coach stepped into the room and finished the appointment.

That day we met the real patient, and the encounter was messy in a way one with a standardized patient could never be. I feel privileged to be able to do it again and for years to come.