Posted on September 11, 2018 at 12:31 PM
By Kihyun Kwon
It was an eventful start to the morning. My attending saw the first patient, who voiced murder ideation towards her unfaithful husband. I imagined myself being taken aback in a troublesome situation like that. I was still in a state of shock when my patient arrived. The clinic schedule had no regard for my emotions and gave me the most difficult patient I ever came across.
The nurse came back shaking her head and said, “The patient will not talk or make any eye contact.” The preparation notes I took earlier said she was a college student with Autism spectrum disorder, depression and anxiety. Never having had any interaction or personal experience with autism, I was nervous. My attending offered to see the patient with me, but I took the initiative to interview by myself. The patient was lying on the examination table playing on the phone while her mother greeted me. I introduced myself to the disinterested patient; I was utterly ignored.
I asked the mother about the patient’s history.
“How has she been doing?”
“Have her symptoms improved?”
Talking about the patient in her presence without actually conversing with her felt awkward. Answers that the mother gave seemed impersonal, and I could not empathize with the information especially with the patient being engaged in her phone.
I wasn’t sure if it was out of annoyance, or concern, but I started directing questions toward the patient.
“How is therapy going for you?”
“Are you still having nightmares?”
The patient continued to play games as her mother answered. Although I wasn’t able to get a response from the patient, I was satisfied with my attempt at an interaction. While asking these questions, something from my preparation note stood out: the patient wanted to become a doctor.
“Congratulations on graduating from college recently. What’s your major?”
That one word felt like the biggest accomplishment. I continued to push her and was able to get decent amount of information from the patient. Even though I was not able to satisfy my thirst for eye contact, I returned to my attending with a sense of triumph.
After presenting, I followed my attending into the patient’s room with a pompous smile; I left with humility. The way my attending guided the interview to extract every detail from her history while also addressing the patient’s emotion was flabbergasting. I was so shocked to see so many words and tears oozing from the same phone-fiddling patient. I felt let down by the patient because she did not reveal information to me. I was angry at the mother for answering my questions instead. I was discouraged by my inability to connect with the patient. In addition to addressing the patient directly, my attending forced the patient to sit up to participate in the interview about her well-being and even scolded her to get necessary answers. As the interview progressed, my attending asked questions that I did not even think about and questions I was too afraid to ask. My attending waited patiently for answers and listened intently. When needed, empathy was shown with each response. It was as if my attending enchanted the patient with a spell; the patient wasn’t the same girl that I interviewed.
Through these series of questions, genuinely listening to the patient, and displaying empathy, my attending was able to impart her sincere concern for the patient and obtain the patient’s trust. Only now as I reflect back am I able to realize how my attending took over the interview; during real time, everything was a blur and I just stood and watched with a stunned expression as my attending figured out that the patient suffered from PTSD from childhood rather than being depressed or anxious. As I sat down to write her note, I wondered what would have happened if she met “future me” as her physician. She probably would not have gotten a proper diagnosis, the necessary care, or the necessary inter-connection with her physician.
This was a humbling experience. I learned that no matter how much I know about different pathologies, I still need to develop the ability to connect with patients. Watching my attending dig through her arsenal of communication techniques was an amazing learning opportunity for me.
The day was chaotic with mixed emotion. Shocked, confident, humble, discouraged, relieved, and hopeful. I felt hope when my attending gave me credit for presenting the history needed to direct the conversation. I was glad to have taken the initiative to see the patient initially and to have experienced interviewing a difficult patient by myself. Although uncomfortable, I will continue throwing myself into difficult situations. With the help of experienced mentors, we can turn failure into learning experiences to improve as a physician. After all, it is not my current daily disappointments that matter but the skills I can bring to my future patients.
KiHyun Kwon, MS, is a fourth-year medical student at Herbert Wertheim College of Medicine, Florida International University. He is planning on pursuing diagnostic radiology with the goal of specializing in interventional radiology in the future . . . .