Everyone Has a Story
As part of Quillen’s efforts to create well-rounded physicians, students are involved in Doctoring courses, which include classes such as Physical Exam Skills and Professionalism and Ethics. In addition, for the first time as a class, students are partaking in Interprofessional Education and Communications, with the goal to prepare students for a career that involves collaboration with other professions, such as Nursing and Pharmacy, and improving communication between patient and healthcare provider. The IPE course was previously offered as an optional course but due to the success of the course, it was implemented as a mandatory component of the medical school curriculum.
Set up throughout the semester, IPE sessions focus on current issues in patient care and exposes students to clinical settings where interprofessional relationships are critical to successfully coordinating treatment options for patients. Working alongside students from other programs such as Pharmacy and Nursing, we are made familiar with this approach to patient care through standardized patient simulations. Working in teams, we are given a patient scenario and must coordinate with team members on topics to discuss during a “patient encounter”. On some occasions, the scenario runs smoothly and we effectively meet the goals of the patient during their encounter. On others, we stumble a bit to achieve the same goal.
But how do we even learn what questions to ask a patient, or find out what is important to the patient at the time of their encounter? The Communications course aims to answer those questions, and works alongside the IPE sessions throughout the first semester of the M1 year.
From my experience so far, I felt that the Communications course was the most impactful of the Doctoring I courses. While diagnosing and treating patients is an integral component of a physician’s job, the steps to reaching that end are just as critical. The patient’s “story,” as many in Quillen call it, is something that informs physician’s about a patient’s life—their habits, their work-life, their struggles—and influences their health decisions. Learning their story and addressing their concerns is half the battle, and were at the core of this course.
Seated across the table on Thursday afternoons every couple of weeks were Pharmacy and Nursing students that quickly became friends, and beside me another friend and M1 classmate, Ryan. At the head sat our facilitator who directed the class sessions, emphasizing different interview skills each week and providing constructive feedback after “consultations.” After introductions to the session’s focus, we took turns speaking to standardized patients and provided feedback afterwards, discussing strengths and points of improvement that could be applied to the rest of the group.
From simple check-ups and inquiries about the benefits of vitamin E, to difficult topics such as cancer, domestic violence and depression, each presentation was an opportunity to learn effective ways to respond to a patient’s concerns. Conveniently, we avoided discussion that required extended medical knowledge, such as the details of a diagnosis (it was our first semester as medical students, after all). Instead, we focused more on active listening, responding to emotion, and maintaining neutrality about charged topics, such as smoking and illicit drug use—while gently informing about the benefits of cessation.
While I enjoyed many of the patient scenarios, I found a few difficult to finish.
In one case, an older woman sat across from me, a head wrap meant to symbolize a current experience with cancer. Her case read that she had a previous diagnosis of Stage 4 cancer, and recently finished a round of chemo. She had a family, a husband, and two younger sons.
What was difficult about the case was not the poor prognosis, suggesting that the last round of chemo did not work and that her time was finite. It was the exhaustion in her voice, the resignation to her fate, and how much she reminded me of my grandmother.
Misdiagnosed early on with a variety of diseases until a final diagnosis of a metastatic cancer, my grandmother followed several treatments before deciding to live her last few months without treatment, if only to spend time with family without the exhaustion that haunted her from the medications. The standardized patient before me had communicated the same wishes to me, with a strong desire to live her the rest of her life pain-free. Our conversation then moved from life-extending to palliative care options.
At the end of the interview, I encouraged the patient and promised to do everything in my power to make her last moments with her family memorable ones, and I told her I was only a phone call away if she needed me. I gave her words I would have wanted my grandmother’s doctor to give her—to make her feel cared for and know addressing her concerns were my priority. Because at the end of the day, I think that is what a patient truly wants—to feel validated.