So at SUNY Downstate, we have a course called Essentials of Clinical Medicine (ECM) that basically focuses on the social aspects of being a good physician. That includes developing good communication and the ability to respond correctly to a patient's culture, values, race, ethnicity, and anything else that makes the patient unique. It's also the course that teaches us how to take a patient's social history: age, where they live, career, financial status, insurance status, relationships, religion, diet, etc. Over the past weeks, we've had small group discussions in which we discussed our own experiences with our doctors and what we liked and didn't like. We also discussed different ethically challenging scenarios.
Recently, we've gotten into doing standardized patient (SP) interviews. For those unfamiliar with SPs, they are actors who are specially trained in acting as patients, sometimes as a patient with nothing out of the ordinary, but also sometimes as patients with a deep and complicated story and personality. For our ECM small groups, each of us have taken turns being the medical student interviewing and SP to acquire a brief patient social profile. One student sits in a chair facing the SP sitting across from him while the rest of the small group sits at a distance to observe. This setup is definitely very artificial, but it is a safe place to at least go through once the motions of talking to a patient and getting peer feedback!
So this week was my turn, which was during the third of three ECM meetings dealing with standardized patients, so I did have a chance to see a number of other interviews by my peers play out. With past patients, the interviews went very smoothly. The patients were very talkative and were relatively enthusiastic about sharing their stories and concerns. We had learned in lecture that one very important thing to do was to show empathy and reflect to the patient that we were listening and were trying to understand each of their feelings. It also helps to repeat to the patient what you just heard, to show them that you are indeed listening attentively (at least enough to briefly repeat what they just said to you!) Actually, learning about all this has given me a whole new perspective into why my primary care doctor always seemed to like asking me about school, and things I enjoy doing, and how I was doing with my friends. Before, I always thought they were just being nice and were interested, but those are actually important health related questions! Activities you do gives the doctor insight into the amount of exercise you get. Relationships gives the doctor insight into the level of social support that you have, and that can definitely play a role in your health too!
So back to the interview. I started with a basic, "Hi Ms/Mr. So and So, I'm Calvin Kwong. I'm a first year medical student and I'm here to take a simple patient profile. Basically, I would like to find out a little more about you and relay this information back to the doctor so that we can get a better sense of who you are and serve you better. So, can you tell me a little about yourself?"
The patient we got this week as exceptionally more quiet than the patients from the last two weeks. I got through my agenda pretty quickly, which was to get information about her age, diet, exercise, work, insurance, religion, and a few other things. It was known that each patient had a secret "agenda" or reason for coming in that needed a little (or a lot) of probing to discover. This was supposed to help us develop our ability to adapt to each patient and to see really how we can best connect with them. I blew right through all the points needed on the patient profile, but couldn't pick up any cues that may show that there was anything deeper to know in any particular area! Eventually, I just gave up, recapped to the patient what I had learned about her, thanked her, and concluded the interview.
Apparently I had missed a lot of visual cues and didn't see that the patient was abnormally distressed (looking down, worried facial expression). I thought the patient was being quiet just because she was a quiet person, but I guess not.
In regards to my own evaluation of the interview, I was happy about being able to get through all of the points on the list of details to get about the patient. I do admit that that was too much of my focus, and even caused me to not exactly pay attention to what the patient was actually saying in response to my questions. With that, I obviously wasn't thinking much about paying attention to any signs in her body language.
Part of what caused this is that this whole setup was so artificial. I knew the patient wasn't real, people around me who already knew the whole story were sitting and watching, and I also knew that whatever I found out about the patient actually was not going to have any impact on her health whatsoever.
Either way, I feel like it was a helpful exercise. Whether or not I really made the mistakes I made just because of the artificial nature of the setup, I was able to be reminded about somethings that I should consciously remind myself to do when I do a real patient interview. Two of those of which were: 1) be in the moment and listen to what the patient is actually saying instead of being focused on what to ask next, and 2) pay attention to the patient's body language (which could be just as, if not more revealing about the patient and what they're feeling).
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