I hear a lot these days about restructuring medical school curriculum to help train medical students not only to be clinically competent and to have an excellent bedside manner but to also be culturally aware and emotionally appropriate. I agree that such training is crucial however I would add authenticity to the equation.
Rewind back to 2002 as a medical student, one lesson that I remember best for the nervousness that was forever instilled in me was the didactic on appropriate patient draping. I was so fearful that I would accidentally grossly expose a patient during a physical exam, and so I meticulously gave patients excessive time to undress and gown themselves. Sometimes I would offer to properly tie them into their gown myself because forbid their gown flew open inadvertently I could potentially be the cause of embarrassment and distress to my patient.
Fast forward to today after five years of internal medicine practice, half my patients start undressing for their physical when I’ve barely got one leg out the door ready to exit the room. Usually, if I offer to leave the exam room a good portion will look at me in astonishment saying, “What’s the point, you’re going to see everything soon anyway,” over which we’ll have a good laugh over the undressing situation particularly after I share with them my specific training experience on the matter.
Laughter has become an integral part of my practice. I never entertained the thought of joking or initiating a joke to my patients in medical school or residency. Now, after five years of practice I’m starting to feel more comfortable in my own skin and can freely joke with my patients. I’ve found that humor can serve as an initial ice-breaker for the new patient who is nervous about establishing care with an unknown doctor. Humor can temporarily relieve the anxiety of a stressed patient. Humor can sometimes soothe one who’s grieving when we can sit and laugh together about memories of their loved one. Humor keeps my pap smear exams bearable when my female patients notice with surprise that our stirrups are fitted with oven mitts, so their feet are more comfortable in the awkward child-bearing position.
Humor keeps me sane. When you’re seeing twenty patients a day many with chronic co-morbidities and ongoing lists of chief complaints that have to be discussed, diagnosed and treated within 15 minutes, you sometimes have to laugh with the patient just to get through. I don’t know when the internal switch occurred but as a physician starting out in my very first job in 2010 whose initial response sometimes after a long day was crying because I couldn’t solve every issue, to laughing with my patients, I’ll take the latter. When I first started working I felt somewhat incomplete, which was discordant with the fact that I was in a profession where one of my personal goals was to help my patients feel more complete at least medically and psychologically in a sense of general wellness. I also felt that I could not display the diversity of emotions towards my patients that they did to me which I believe hampered the formation of a true connection. Patients (including myself when I seek medical care) want to see and know that their physician is human and basically a regular everyday person like themselves.
The doctors I remember the most while growing up were the ones that were smart, funny and personable, and they were the ones I aspired to be. With some consciousness I am learning to shed my professional shelled exterior and am beginning to be in touch with the individual I used to be before medical training so that I can better connect with the individuals who entrust their care to me. Clinical and cultural competencies are vital, however, authenticity is something we need to actively work on maintaining not only for our sanity and sense of personal fulfillment but also for the benefits it provides in terms of facilitating and maintaining the creation of a lasting and meaningful connection with our patients.
Eki Abrams is an internal medicine physician.
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