Everybody gets nervous at the doctor’s office. Physicians ask all sorts of personal questions about what people eat, how much they drink, and how things are at home. Even questions that would seem completely harmless in another context — such as how work is going, or what hobbies a person enjoys — seem surrounded by hidden meaning and purpose. After all, who doesn’t want to “pass” their annual checkup?
Part of this feeling is surely a product of the medical culture, where the paradigm of clinical practice is that the history — everything that a patient tells us — is the starting point for every diagnosis and treatment we offer.
As medical students we're taught in first year that every single question that is asked is done so for a reason and can provide helpful information. Even in popular culture, this is portrayed to an extreme in TV medical dramas such as House, where a random detail of a patient’s personal life often provides the single “breakthrough” clue that suddenly allows the medical team to solve the mystery and save the patient’s life. With all of this, it's little wonder that patients often feel pressure to present themselves in an idealized way.
Paradoxically, now that I’ve been on the other side of the exam table, I can say that one of the most beautiful aspects of health care is actually the lack of judgment inherent in our profession. Our jobs require us to become skilled at taking care of people, confidentially, without judgment, regardless of background, socioeconomic status, substance use, or even criminal record. As such, the ability to gain the trust and confidence of any patient, regardless of their circumstance, is one of the most challenging, but also most important, skills that we can develop in medical school (and beyond).
So, although all of the questions may not always feel comfortable to the patients, as physicians, it’s part of the job — and part of a job in which we've seen it all, from the highest highs to the lowest lows. To put it simply, people are imperfect. Believe me when I say that medical students (and doctors) are imperfect, too, in both our personal and professional lives (like most people, we can probably all do a little better with our diet and exercise).
To provide the best possible care for our patients, the bottom line is that establishing a strong, effective relationship with a patient requires that we collect information without making it feel like the only thing we're doing is collecting information. In other words, after the first year of medical school, we have the odd task of relearning how to have a conversation with another person. Surprisingly, it's harder than it sounds.
Stanford Medicine 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.
Nathaniel Fleming is a fourth-year medical student and a native Oregonian. His interests include health policy and clinical research.
Image by qimono
