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Lessons from the parking lot: How roles in medicine define relationships

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

I was about halfway through my family medicine rotation, and I felt like I was hitting my stride. It was almost the end of the day on a Thursday, and I only had one patient left to see – I’ll call her Mary. Mary had a complaint of hearing loss but was otherwise healthy.

I had seen patients with similar issues during the rotation, and I was confident that this encounter would go smoothly. Of course, I was often uncertain about the best way to treat patients - but I came to learn that what was more important was that I established good relationships with them. Even though I always introduced myself as a medical student, many patients assumed I was a doctor and treated me like one. They told me their problems and asked me questions about how to solve them. I was happy to have these conversations: I felt like I got to know my patients and was able to help them.

So as I knocked on the door to see Mary, I expected to have a productive encounter - and I did. There are a lot of possible causes for hearing loss, including serious neurologic disorders and systemic syndromes, but one common cause of hearing loss is glaringly simple: earwax build-up. I looked in Mary's ears, and sure enough, there were balls of wax sitting in the canals.

As I explained this to her, one of the medical assistants came in to complete the process of flushing her ears and getting the wax out. Afterwards, Mary and I talked briefly about some of the things that could have led to the buildup.

Mary was deeply appreciative throughout the encounter. Even though she had a relatively simple problem, she constantly thanked me for helping her out as we wrapped up. Since she was the last patient of the day, I left the exam room, gathered my things, and headed out of the clinic. My ego was riding high because she had been so effusive in her praise.

Then, as I was pulling out of the parking lot, a car cut me off. When I looked, it turned out the driver was Mary! She honked as she drove by, and then for good measure, she rolled down the window and flipped me off.

I’m fairly sure Mary didn’t realize I was the driver that she had just cut off. Regardless, my initial response was something along the lines of comical outrage. I had just helped her! We had bonded! How could she do that?!

After I got over my outrage, I mostly felt surprise. She had been so polite and deferential in the office, but she was apparently filled with road-rage out here in the real world.

Although I think back on this experience primarily as an amusing turn of events, it led me to a few interesting realizations. Environment and situational context play a huge role in how people act and the persona they project (the Stanford Prison Experiment is one of the best examples of this phenomenon). And the doctor’s office is a very insular environment.

As a result, even if we develop a strong relationship with patients, we don't necessarily develop an accurate understanding of their life outside of the doctor’s office. This doesn’t mean that patients are lying to us. But we need to realize that the way they interact with us might be different from the way they interact with the rest of the world.

In a broader sense, the experience underscored the fact that as we move into the role of “doctor,” the way people see us will change. Doctors often tell stories of family and friends asking them for medical advice. We will increasingly occupy a role in which people defer to our judgment, regardless of whether or not we have anything useful to tell them.

Being a health-care provider defines us in ways we may or may not expect. Sometimes it means that people will turn to us when they’re sick and in need of help. And sometimes it means we’re that much more surprised when someone cuts us off in the parking lot.

Akhilesh Pathipati is a third-year medical student at Stanford. He is interested in issues in health-care delivery.

Photo by Jim Pennucci

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