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“Us” and “them”: Losing the patient perspective

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

holding hands - smallThis past Saturday, I received a call from a close friend from college that went something like this:

Friend: “Hey… so I’m in the ER right now, and I didn’t know who else to call.”
Me: “WHAT?! OH MY GOD WHAT HAPPENED?!”
Friend: “They think I have appendicitis.”
Me: “Ohhhhh – oh my gosh, thank goodness. I thought it was something really bad.” (nervous, relieved laugh)
Friend: “Wait, why are you laughing? I'm freaking out right now. What if my appendix explodes inside me? I’m so scared.”

A flush instantly spread across my face. I felt terrible.

In my head, appendicitis was relatively low on the list of all the possible horrible things that could have happened to my friend. I knew it was a common condition, that an appendectomy was a straightforward procedure, with minimal risk, and that of all the body parts to lose, the appendix wasn’t the worst by far.

When my friend mentioned that he might have appendicitis, my mental reaction was to think of all the factors that go into that diagnosis, and I was bursting to ask if he had guarding or rebound tenderness, and if the doctor’s said anything about McBurney point. (Side note – I’m currently studying for Step 1 - not that that excuses my impulse to run through a mental illness script). When that flush washed over my face, it was because I was shocked at myself: Why did I not – first and foremost - put myself in his shoes and try to feel the same pain and panic he was feeling?

I immediately apologized – again and again and again. Over the next few minutes, he asked me questions about appendicitis, how likely it was that his appendix would rupture, and more. At the end of the phone call, we had made plans to meet the next day, after his surgery, and my friend was calm. I, however, felt unsettled, and so guilty.

At our “Transition to Clerkships” retreat this past Friday, we sat in small groups and reflected on our individual hopes and fears for clinics. One of my fears was that I might become jaded or desensitized to patients’ conditions and not react with the empathy my classmates and I have cultivated and practiced so carefully. This incident with my friend brought that fear to the forefront of my mind.

I think that in many ways, it is a blessing for a physician to be somewhat desensitized to human suffering (after all, I can’t be fainting all over the place, can I?). But I also think there’s value in reflecting on how we can work to retain and prioritize that element of emotion that makes us human and that makes a doctor someone who is kind and trustworthy. As I move into clerkships this June, I sincerely hope I’m able to find that balance.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by george ruiz

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