Seize The Power

I love biology. I want to get into a big vat of it and roll around, or maybe print out hundreds of problem sets, shred them, bag them, and use them as a duvet so that I can inhale the inky ribosomal goodness all night. For a dork like myself, it would be easy to get sucked into the purely academic world of medical school, which, while not always fun, is almost always interesting.

LPP, however, brings me back out of my self-absorbed focus. My experiences with patients have a distinctly different feel from the practice trials my classmates and I run through together. With my fellow students the work is reciprocal; I am helping them achieve their goals, they are helping me achieve mine. But with patients I always feel vaguely guilty for wasting their time and energy. They have invariably gone through the story several times when I walk in, and I will clearly not be adding to the diagnosis. Even though my preceptor never qualifies my title of Medical Student with (Barely), I can feel it hanging in the air during introductions.

My preceptor, a pediatric hospitalist, used to start our sessions by saying “Let’s find you some nice parents.” And it always made me wonder how many of the parents were not nice? Were nice parents and patients the exception, rather than the rule? Or did she just know that my presence as a useless lump of ignorance would simply be so irritating that it would push any normal person over the edge in the stressful environment of a hospital?

So I begin every interview by thanking them for their patience, and warning them that many of my questions may be redundant. My preceptor must do a good job of picking “nice parents”, because the people never seem to mind telling me everything all over again, even when they’ve obviously been sleeping (or not) in the hospital, and the exhaustion and worry are written all over their faces. They never say “Please, for the love of god, go get someone who doesn’t answer every question with ‘I can see why that would concern you, and I’ll make sure Dr. X addresses it when she comes back with me in a few minutes.’”

Instead they usually perk up, some even evidently relishing their role as educator – they know the questions because they’ve been asked them all before, and sometimes I can feel them steering me, however unconsciously, along the seven cardinals path. Because I don’t necessarily know myself where I want to go, my questions are probably more rambling than anyone they’ve encountered before. My review of systems encompasses every detail from conception to now – “Here for a cough? Tell me about that indigestion he had as a newborn!”

Over time I began to realize that perhaps these interactions were not as one-sided as I thought. There is one thing that I have to offer, even in my uneducated state – time. My circuitous questions may be a waste of time diagnostically speaking, but I think the patients enjoy the interview anyway because I am interested in all they have to offer - I need them more than they need me. I don’t know if they actually realize the balance of power is tipped in their favor; after all, it seems much of our early training is geared towards disguising that fact – but I do think they sense it on some level, and they like it.

In observing my preceptor and her colleagues, all of whom are phenomenal communicators, I can see that one of the arts of medicine is preserving for the patient that sense of their power and value. Even as my time becomes more valuable from a medical perspective, I want my patients to still feel as though I need them more than they need me. Because, ultimately? I do.