Resident and Student Voice
The Patient/Medical Student Relationship
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Am Fam Physician. 1998 Apr 1;57(7):1693-1694.
Visiting the doctor can provoke anxiety. No one likes waiting in that sterile, rubbing-alcohol–scented room for the doctor to magically appear. But for a few, the experience is made atypical. To these patients, the doctor announces, “I have a medical student here today and I was wondering if he could see you first and then I'll come back.” Most patients just nod their heads, assenting as all good patients do when their doctor says anything. Before they realize their folly, a young, shy medical student in a crisply pressed white jacket pops his or her head through the door. “Hi, I'm the medical student. My name is . . .”
For the past four years, I have been that timid medical student. Soon, my status will change to “doctor.” And, as much as I am looking forward to moving up to a position that finally musters some respect, I already get nostalgic for the “medical student.” “Hi, I'm the medical student.
My name is Angelo. What can I do for you today?” The patient was 50-something, an obese man taking medication for hypertension. This was his six-month check-up, and he had no complaints. I went through the typical queries: diet, weight control, blood pressure monitoring, medication side effects. He denied any problems, and his physical examination was normal. I told him that I would report to the doctor and that we would both return.
He livened up and started asking questions about my background, my hobbies and whether I had a girlfriend. I answered his questions, adding that I had recently broken up with my girlfriend. He took an unusual interest in that topic and, in a “guy-to-guy” way, expressed sympathy that I had to look for another mate.
“Ah, yeah, I guess so,” I responded. His voice became tense, and I sensed something was amiss. “Is there anything else you want to discuss?” He looked around the room, then down, then at me, and told me that he was impotent. For 30 minutes, he recounted two years of frustration and embarrassment over his problem.
I told him impotence was a common problem and that his hypertension and medication may contribute to it, and we discussed treatments. Then I asked him why he decided now was the right time to tell a health professional. “Well, you're a young, nice guy and understand the importance, ya know?” he responded.
I didn't attribute much importance to the “young, nice guy” part until the end of the day, when the doctor and I met to discuss our patients. We both had seen similar hypertensive patients, and we both had asked the same questions about sexual dysfunction, but my patients were more likely to discuss their impotence. Why?
I was much younger than the doctor—is it easier to talk with a younger person about a stigmatized issue? Is it a factor of time? I could spend much more time with my few patients than could the physician with his quota to meet. Or is there something qualitatively different about talking with a medical student who views each patient with a fresh eye? It was still early in my career as a medical student, and the jury was out.
“Hi, I'm the medical student. My name is Angelo. What can I do for you today?” This patient was a slim, meticulously dressed, 60-year-old professor who presented for follow-up after a change in his heart medications. The interview was nothing out of the ordinary—standard questions and a clean bill of health.
“So, where are you from, son?” he asked. I told him that I had grown up in Brooklyn, where coincidentally he had lived for many years. We reminisced about the hours spent at Grand Army Plaza Library and the eclectic collections at the Brooklyn Museum. At this time, he remarked about the neighborhood going downhill—using a strong racial slur.
Stunned, I didn't know what to say. He stood up and said “Thanks for the check-up and chat. It brought back so many memories.” Before I could say another word, he was out in the lobby.
How does one chart such an observation in the past medical history? I wasn't sure what to say to the doctor. At the discussion at the end of the day, the doctor said “Oh, I see you saw our famous college professor. Isn't he priceless?” He said this with affection and without irony. I found it difficult to believe that the patient had ever made such racist statements to the doctor. So why did he decide to inform me? Was a medical student less threatening a confidante? As a result, I had a very different and perhaps more accurate portrayal of the patient than did the doctor. It made me wonder if all patients present distorted views to their doctors, offering more acceptable portraits. What information would I lose when I crossed the line from student to doctor?
“Hi, I'm the medical student. My name is Angelo. What can I do for you today?” This patient was another 60-ish male, heavily accented and Italian. He was at the clinic for a preoperative examination before colonoscopy. During the ritual history, discussion of medication use and allergies, we started talking. As I performed the rectal examination, the patient asked, “So doc, whereah ya from?” I asked him to relax, and also mentioned that I was from Brooklyn.
In a loud voice, he yelled, “Hey paisan, easy does it. I coulda sworn a thousand Greeks were behind me!” I finished the examination and filled out the paperwork. “You speak any Italian? I know ya docs are busy butta your grandparents would turn in thea graves if they knew that you no speak Italian,” he commented. I smiled, nodded and said goodbye.
When God gave out Mediterranean features, he spared me none: olive skin, wavy black hair, brown eyes, and even a Roman nose. A guy from Brooklyn with a name like Angelo has to be Italian (unless of course, you're Greek and drop the final “s” from “Angelos” so people don't think there is more than one of you). I laughed for some time thinking of how my grandparents were already turning in their graves.
What is it about talking with a medical student that makes people more comfortable to say things they don't normally divulge to their physicians? Is it merely an age difference? I don't think so. Is it the innocence and naiveté that can be so endearing in medical students? Is it the extra time students can spend to forge a better relationship? I don't have any answers, but I'm worried that Dr. Angelo may never truly know his patients the way medical student Angelo once did.
This quarterly department features essays written by medical students and family practice residents. Contributing editors are Amy Crawford-Faucher, M.D., a family practice resident at the Fairfax (Va.) Family Practice Residency Program, Sumi Makkar, M.D., resident representative to the Family Practice Editorial Board and Terrence J. Joyce, student representative to the editorial board. Submit essays for publication in AFP to Amy Crawford-Faucher, M.D., Fairfax Family Practice Center, 3650 Joseph Siewick Dr., Suite 400, Fairfax, VA 22033.
Copyright © 1998 by the American Academy of Family Physicians.
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