As a medical student with a limited knowledge base and limited exposure to taking care of a high volume of patients, my idea of being the physician I hoped to be involved in spending time at the bedside and really getting to know my patients as people and hearing their stories. As I was learning my way around how the medical world worked as clerkship student, this was perhaps the only thing I could offer to my patients.
As an intern, it suddenly dawned on me that it was no longer possible to spend the amount of time as a medical student with patients as now I could now. I was carrying more than double the patients, and a pager. Even as I spent time with patients, I became acutely aware of how many more tasks awaited me, or at least the pager going off would remind me. I found myself becoming less patient and redirecting patients if conversations veered away from the disease at hand.
This troubled me, and I was worried about whether my interactions with patients would suffer and whether they might resent me for having such curtailed encounters compared to what a medical student could offer. I was pleasantly surprised that this was not the case. Seeing and caring for so many patients made me more prepared and more proficient at understanding and appreciating the nuances of human emotions and behaviors. One learns through experience and practice how to discern the unshed tear, the inaudible sigh, and the desperation for control and agency. I got better at knowing how to respond to certain behaviors, words, and gestures, even if they initially appeared negative.
As my intern year went along and I knew more about medicine, I also became much more confident in answering patients’ questions, explaining their diagnoses, and our plan for them. After spending time in the ICU and CCU and on difficult services with truly sick and decompensating patients, I developed a much stronger sense of sick and not sick. There was power in knowledge, and for patients and families facing such uncertainty and disruption, an assurance that even though they may be in the hospital, their vital signs and their labs made me more assured about where they are. It is humbling when patients trust you and open up to you. It is equally humbling when patients trust you entirely to lead them through illness with your plan and when they relax and truly take your word for it when you tell them that it will be okay.
This was a different skill set than the one I imagined myself developing as a doctor, but ultimately a deeply meaningful and satisfactory one. I hope the two mindsets aren’t mutually exclusive between listening and inspiring confidence. I’ve realized that both require a high level of presence and mindfulness, focusing solely on the human being in front of me. I hope to continue to develop both as I continue my training and strive toward the ideal doctor-patient relationship.
Johnathan Yao is an internal medicine resident.
