The patient was sitting up at 45 degrees with his legs stretched in front of him. He was looking out the window and had a fan on his bedside table. He didn’t look pleased, so I was expecting to be told to come back later. To my surprise, he welcomed me with a smile and told me to grab a chair. I led the conversation by introducing myself and gaining consent, followed by asking the most typical question, “What’s brought you in today?” That was when he took a glance, a deep breath, and replied, “Do you know of a condition called multiple myeloma?” Of course, I knew what multiple myeloma was and the different nuts and bolts. I gave him the textbook definition of multiple myeloma, and that’s when he stopped me. At that moment, we swapped roles, he became the teacher/knowledge source, and I became the student. Typically, patients expect you to be the knowledge source and provide the information; this wasn’t the case here.
He taught me what multiple myeloma looked like first-hand, and the best part was he enjoyed teaching me about it. He would pull his medication bag to show me what he was taking and explain no cure for his condition. He said he has had and will continue to have multiple transfusions and that he woke up one day, and his partner had noticed he looked “grey.” Immediately, I knew what he was saying: hemochromatosis, which tied in with the regular transfusions he had been prescribed. I asked if he knew about hemochromatosis, and he knew all about it. I was amazed at how much information about his condition he knew! He said, “The only way for me to get treated is by having continuous blood transfusions. I can’t stop them. And I know there is no way for the body to get rid of iron.” He even knew the name of the type of proteins found in his urinalysis (Bence Jones Protein). I was shocked by how effortlessly and efficiently he explained everything to me. He was very informed and proud of it.
I am so thankful that the patient felt very comfortable talking to me for this long. I reflected on what could’ve prompted him to speak to me and teach me besides being bored at the hospital. I wanted to make sure I could create a safe and calming environment again for the next patient.
Learning can happen anywhere in the hospital. It would be best if you were ready and motivated. There are so many opportunities to learn, and patients want to teach you. When a patient tells you about their condition – believe them! Especially if it is a patient who has lived with a condition for many years. Indeed, they become professionals about their health and what they require.
Physicians are taught and encouraged to use a patient-centered approach during interviews with patients. Importantly, we are taught to maintain a balanced power dynamic. In the clinic, patients appreciate you and think highly of you. If balanced, patients will help the physician correctly diagnose and create a better doctor out of you. It’s well documented in the research that there are psychosocial factors that could affect the doctor-patient relationship. Being aware of the factors and making sure the power dynamics are balanced can help both the patient and the doctor. There is already tremendous pressure placed on patients when they visit the doctor, which is a difficult journey for many. Be a human first and a doctor second.
Sarah Murad is a medical student.
Image credit: Shutterstock.com
