Posted October 5, 2010 by
We have a weekly course called Patient-Doctor, in which we interview patients at our school’s teaching hospitals to learn how to take a medical history and present clinical cases orally and in writing. We also try to incorporate the idea of “patients as people,” inquiring about their social support networks, hobbies, work, or other meaningful components of who they are.
What we can’t do in the least is help them medically. They know more about their illnesses than we do.
On one of my first sessions, I interviewed a middle-aged man who experienced acute episodes of debilitating pain in his abdomen, most likely from complications stemming from his gastric bypass surgery a decade ago. The pain was bad and always there, he said. When it was particularly severe, he couldn’t do much other than lie down, and his dog would lick his hand until he’d feel better again (he lived alone). He had been forced to retire from a job he loved.
I had twenty minutes to take a brief history: his present symptoms, what he thought caused them, how long they lasted, and how they affected his life. He opened up to me in a way that even surprised my preceptor, freely admitting that he had been a heavy drinker and smoker.
As our minutes together ran out, I thanked him for his time and sharing his story. My hand was proverbially on the doorknob when he asked me, “Do you want to listen to my heart or lungs or something?”
I’m not sure why he asked. Did he think I had more authority or qualifications than I actually did? Did he want to help me learn better? Or did he just want me to stick around longer, to talk, to listen, to understand?
When I told him unfortunately I couldn’t do that, he said he understood and told my preceptor that he should send other students in if he wanted.
At the time, I was too wrapped up in my own thoughts about how I would present the case to think much about the patient after I left his room. Later, when I presented his case, I was concise. I stuck to the organized structure of a medical history, throwing in a few personal facts as per the formula to make this patient come alive to my audience. Then my assignment was over. My brief relationship with this man was over.
Hours later, I couldn’t sleep. I wondered how he was doing. He was still probably experiencing some form of pain right then. Quality? Severity? Worse? Better? How? Why?
I felt an intense sadness that I would probably never be able to know how he felt again. I couldn’t listen to his heart or lungs, but could I… “something”? The thought flitted through my mind that perhaps I could email my preceptors and ask if I could visit this man again. No interview pad, no scripted questions, no rigid time restraints. But a mixture of timidity, discomfort, and a fear of doing something outside protocol got the best of me. Would such a request sound inappropriate and naive? I wrote a draft of this blog post and tried to get back to sleep. Perhaps writing that email instead would have been a more fruitful and less self-indulgent endeavor.
When the gentleman asked me that question, he needed help. He was looking directly at me, earnestly, waiting for me to do something. I thought I couldn’t do anything. I was not qualified.
Now I wonder if I could have qualified in a different way, had I seriously explored possibilities beyond strictly medical help. Maybe my attempts would have failed; maybe there was policy prohibiting me from visiting again. I still do not know. I should know now though, because I should have asked then. Next time I will. I’m just sorry it will not be for this particular man with this particular pain.