Patient contact

[beacon123]

I am in my first clinical year as a medical student. It is really the first time we have been 'let loose' on the wards. I have enjoyed learning about physiology, pathology, investigations and treatment as I really like the puzzle solving side of medicine.

However I have been struggling with the patient communication side of things. My medical school pride themselves as producing the best communicators. I do not mind seeing patients, but i do get anxious especially when it's a little awkward or when a consultant or peers are watching.

I have recently received a piece of feedback - 'you don't seem very interested in what the patient has to say' which got me thinking. I did not feel disinterested at the time, however I don't seem to get the same pleasure as other students when I do help someone. Instead I get an excitement when I figure out what the diagnosis is, or understanding the pharmacology of a complicated drug.

I am just questioning whether medicine is for me, and if I could do anything to change? (however I am kind of stuck in the course due to student debt).

Has anyone else been in this situation?

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[OrthoTraumaMD]

Like everything else, effective communication takes practice. Search YouTube for videos, there are a ton specifically geared for this.


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[STcmOCSD]

There are specialties available in which you spend all day finding a diagnosis and spend little time interacting with patients (I.e. radiology). For long term perhaps a career in a speciality like that may suit you better.

In the meantime, try to mimic the actions of your colleagues. Watch how they interact with patients and see what makes them relate to the patient. Then mimic those things.

 

[Donald Juan]

Keep working on it. After poor interactions ask yourself if you could have handled it better or done something different. Like said above, recognize the things people senior to you do that make pt interactions more productive. Also, realize it will get easier when you have an MD next to your name and you actually have some confidence to manage a pt. Try to relax your nerves in the meantime by recognizing that everybody was a nervous med student once who looked stupid or got shaky in front of a patient because of nervousness.

 

[Agent Michael Scarn]

I did not feel disinterested at the time, however I don't seem to get the same pleasure as other students when I do help someone. Instead I get an excitement when I figure out what the diagnosis is, or understanding the pharmacology of a complicated drug.


Has anyone else been in this situation?

A doctor I know said something very similar to me once. He started IM residency, and then realized he enjoyed the diagnostic challenge more than the clinical follow-up and treatment. He is now a nationally-respected pathologist. Different strokes for different folks.

Get through your clinicals, and be sure to rotate on rads and path, because both are awesome specialties.

 

[W19]

You can become a pathologist or radiologist...

 

[Crayola227]

there are things you can do that might either increase your interest or help you fake it

things I have done, and I tended to get very high marks on the patient interest side of things, and some of it was just how I hold myself, really

anything you do where you are leaning towards the patient, head in hand(s), can help. I tend to lean on a table with my elbow head in hand, or cross my legs and do that

nod and go mm hmm, moments to say, "wow," I tend to raise my eyebrows at certain points

ironically if you are listening watching for moments appropriate to do this stuff, you will actually listen closer and appear to be listening closer,

also, it depends on how good you are at this, I have always used a clipboard and pen to take notes, but you have to be really good at managing eye contact if you do this

people have all sorts of opinions on this, and it's not always practical to do this, but at least the way I did it, overwhelmingly I was told this made me seem uber focused on what the patient was saying, and given that you're always going to be taking notes one way or the other, EHR or paper, people told me paper allowed more eye contact and "felt" more invested than me on the computer

this might not be efficient for you since you have to put stuff in the computer, but it worked for me

 

[Crayola227]

also, you will learn to direct the conversation more for the data YOU want, not just the patient rambling, that does 2 things, makes you more invested in listening for answer because you are trying to get what you want, and makes you get the data you need which does help you for dx which does interest you

 

[JB50]

Keep your chin up! You toss a lot of medical students in a real life patient room and 75% of us sweat on the spot. Clinical experience/patient contact is not a prerequisite for medical school. It's foreign to like 85+% of students. It comes with time.

 

[Doctor-S]

Here are some other suggestions:

* Use body language and facial expressions that reassure your patients you are engaged/attuned with them (e.g., good eye contact, no yawning). This also means taking your gaze away from an electronic display screen and looking at your patient from time-to-time (your patient is probably already looking at you - especially if you're entering notes on a computer or chart). As mentioned by some other SDNers, you can mimic different communication methods and listening techniques (bedside manner) displayed by clinicians who are experienced communicators. Practice will help you become a better communicator, over time.

* Please show empathy; greet your patients by their preferred name. Do not appear disinterested, insensitive, bored or impatient. After all, if the patient was one of your own loved ones, how would you want your loved one to be treated by a physician?

* Good listening skills are important for many reasons. So, listen to your patient; and maintain reasonable eye contact. [Note: it is advisable to be aware of certain cultural sensitivities (e.g., direct eye contact might be misinterpreted as "not comforting" or intimidating to some cultures or certain populations)].

* Pay attention to your patient's unspoken "cues" (e.g., fearful facial expressions).

* Allow your patient to "be acknowledged, understood and heard" by you. Listening attentively can lead to improved patient satisfaction and increased treatment compliance. You can improve your attentive listening skills by actively listening to your friends, family and other students, in your daily life.

* Take the time to formulate your thoughts/opinions before impulsively blurting-out something to your patient. It's challenging to rescind poorly-formulated blurt-outs and this can lead to patient dissatisfaction, anxiety, confusion and silence.

* Try to ask open-ended questions: they can be used to glean useful diagnostic information. If you don't have the time to ask open-ended questions, try to ask more specific questions that will help you obtain additional diagnostic information.

* At the end of the consultation, it can't hurt to ask, "do you have any questions for me?" - especially if your patient is clearly anxious/fearful.

At this stage in your education and training, you're still learning ... and encountering ... and experiencing ... and doing. There are many new things to learn/encounter/experience/do as an MS1. Give yourself some time. You'll be fine.

 

[Brahnold Bloodaxe]

Of course patient contact sucks, that's why being a doctor is considered to be a job, for which you are paid a pretty decent salary (until the tidal wave of nurse practitioners being minted overwhelms the job markets that is).