Medical students spend a lot of time in hospital, trying to see all cases, examine all patients, hear every murmur and stitch every wound.!! We intend to learn more and practice more, which means we cut hours from our social life and we prefer to spend this time with the Patients rather than Family and Friends!! When we encounter patients for History or Physical, we aimed to apply what we’ve learnt and hone our clinical skills, and most of the time we go deep in this that it might cloud our mind and attitude, and we forget that the patients should be on top of our priorities…. This bring the issue of How a Patient-Student Interaction should be?! is there any Rules or Ethics a med-student should know about when s\he meets a patient?! or is it left to the personal judgment?!!
A lot of articles and discussions have been made regarding “patient- physician relationship”, yet still little has been said about the students encountering patients. Patient-Student interaction should not be and can’t be under the umbrella of “Patient-Physician Relationship”, because regardless to the similarities there are huge differences.The Patient-Physician Relationship is a bi-directional relationship, where a patient expects the correct treatment and best management, and the physician expects compliance and honesty from the patient, it’s a long profound relationship based on mutual trust, confidentiality and respect!! But this is not the way in Patient- Student interaction, it’s more to be a uni-directional, we see patients not to diagnose or treat and the patients are not expecting anything from us, and this relationship may not last more than 15 or 20 min!
What I’m discussing here is about what I’ve seen and encountered through clinical Clerkships, we have been taught strictly that respect, permission and privacy of the patient are Fundamentals, but in the Ward, there are more than that to consider. I think our interaction with the patients is the core of practicing medicine, and considering the patient’s state and feelings should not be shadowed by our ambition to learn and practice..
There are some issues a medical student need to appreciate, such as assessing the patient’s state, before start taking history or physical, is he in pain, just had a bad news or even if he’s busy or sleeping, it’s not appropriate to ask a patient who is in pain or who is devastated by a bad news to allow you to take a history or examine him. Most of the time, it is the first time we see this patient, and to create a ground to stand on is always helpful, so instead of starting the talk by “ what’s bring you to the hospital?” a smile, a jock or maybe a little chat about the weather or any other topic, would not make the patient feels like you are questioning him. showing support and care, or asking if he needs anything “maybe an extra-pillow, or opening the window” , would make the patient be grateful and willing to help you . From what I’ve experienced, Listening is your wining card especially with old patients, some would complain about the health care and health care providers, some would tell you the story of his life, and they would appreciate someone to listen, maybe doctors do not have that much time, but we do. Furthermore,we usually examine patients as group of two or three, and sometimes it takes more than one attempt to elicit findings, this could be painful or uncomfortable to the patient, so just asking for permission is not enough, we need to be sure that the patient agrees, and he’s comfortable all the time..
Some patients have concerns about their health condition, and they might ask us about their progress or lab results. we face that a lot, and we become in awkward situation dealing with their concerns, the best way to deal with this is to tell them that they should ask their treating physician as he knows better, we are not allowed to tell them any information as we are not treating them, but we can always reassure and give them hope. On the other hand, some students might discuss the patient’s disease with other colleagues while still in the patient room, and that might has a negative effect on the patient.
Through our clinical training we meet a variety of patients, and we need to find our way to work with each one of them, and a balance between what we want from the patients and what they need from us is the corner stone in our training. William Osler said “ For the junior students in medicine and surgery it’s a safe rule no teaching without a patient for a text, and the best teaching is that taught by the patient himself “, patients are our main source of learning, they can teach us even more than a textbook, and to get the maximum of this valuable source, we need to promote our interaction with them…