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We sit down with Ellie Qian, a medical student, to discuss the profound experiences that shape the journey of becoming a compassionate health care professional. Ellie shares a transformative encounter from her first year in medical school, where she practiced medical interviewing with a standardized patient, Chris, who has stage 4 metastatic lung cancer, and his supportive partner, Jordan. This deeply human conversation about end-of-life care, love, and the power of silence offers invaluable insights into the essence of medicine.

Ellie Qian is a medical student.

She discusses the KevinMD article, “Honoring humanity: lessons from a medical encounter.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Ellie Qian. She’s a medical student, and today’s KevinMD article is “Honoring humanity: lessons from a medical encounter.” Ellie, welcome to the show.

Ellie Qian: Thank you so much, Dr. Pho. It’s a pleasure.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Ellie Qian: Of course. So my name is Ellie Qian, I’m a rising second-year medical student. I am a non-traditional student, so I studied public health for my undergrad and master’s, and then did a post-bacc, and finally ended up where I am today.

Kevin Pho: Perfect. And what’s the reason that you started writing? Tell me about that intersection between writing about stories and your medical journey.

Ellie Qian: Yeah, of course. So I wrote this article after a really impactful clinical skills encounter session. So as a medical student we have these clinical skills sessions where we would practice with a standardized patient on how to conduct an interview, ask questions, gathering the standardized HPI. So these sessions are really meant to build our interpersonal and communication skills.

So this encounter in particular, I had a patient with stage four lung cancer, and they were there to discuss a further treatment plan. And I remember as I entered the room I could feel the weight of the room. It was more on the heavy side. And I opened up the conversation I normally would, asking them what brought them here and what I could help with. And so the patient shared very intimately that chemotherapy has taken a big toll on his body, both physically and mentally, that he did not feel like himself anymore, and he felt like a burden to his partner, family.

I think what made that encounter especially impactful was the fact that I don’t think he came in with an already made decision. So I felt really privileged to share that moment with the patient, where they could have this space to think through, to recount everything they’ve been going through, to verbalize their thought process, the pros and cons of each option, and also discuss with their partner. Their partner was also there with them. So that’s what felt really raw, very sincere to me, that conversation. I can discuss more details later, but that’s why I decided to write the article and document this experience.

Kevin Pho: So before going into these standardized patient encounters, how much training or teaching did they give you before going in? What did you expect before going into this standardized patient encounter?

Ellie Qian: So we started slow. I remember the first few sessions, they would give us a list, it was a standard HPI list. It’s about a patient, how their symptoms are, how long they’ve been experiencing it, et cetera. So at the beginning it would be simple from a medical side, like more simple cases where you’re just gathering their HPI, their medical set of information.

But as we moved on, I think these scenarios are designed to delve a little bit deeper, to make you navigate, to help navigate patients’ emotions, to dig a little bit deeper into their life circumstances. And we learn techniques along the way, like how to stay composed, how to gather your thoughts, how to convey your own emotions and empathy.

So in terms of what I expected, I would say that these sessions have exceeded my expectations. I might have imagined them to be more like a roleplay, that, oh, you know, they’re standardized patients. But they were excellent actors and actresses, and in this case in particular I feel like I was really drawn into the scenario.

Kevin Pho: So as you know, there’s only so much teaching one can give. Sometimes you actually have to do the interview yourself, and there’s really no experience that can replicate that. So this sounds like a pretty complicated case that you’re describing. So as you met this patient and the patient’s partner for the first time, and the patient was telling you the story and you’re realizing this is beyond anything that I’ve heard or been taught in the past, tell me what was going through your mind as he was telling his story to you.

Ellie Qian: Yeah, I would say first of all I felt really emotionally connected to the patient. And at many moments I would remember, OK, what was I taught? For example, the NURSE statements, about naming the patient’s emotions and saying things like, oh, that must be difficult, that must be frustrating. But I couldn’t bring myself to say those words, because I couldn’t say them genuinely, and I felt like those words could not match the weight or energy of the conversation.

So instead I would convey that I cared, that my empathy, through more nonverbal communication, maybe taking pauses, just embracing some moments in silence and to digest emotions that way. So I think it’s been definitely a learning journey on how to develop my own interview skills, developing a curated style that really works best for me, that I can deliver genuinely.

Kevin Pho: So how long did this encounter last in total?

Ellie Qian: I think about 30 minutes, 30 to 40 minutes.

Kevin Pho: So tell us the path during the encounter. So you mentioned that you’re trying to build rapport, trying to acknowledge the patient’s emotional cues, perhaps using pauses and silence to build that rapport. Tell us what happened next as this encounter developed.

Ellie Qian: So yeah, as I mentioned, I was a little unsure where to go at first, and the weight of the conversation exceeded what I was used to. But as I just showed up as myself, forget about, OK, I was there as a physician or clinician, just from a human perspective, from just a human connection level, trying to put myself in their shoes as much as possible and think about how maybe I would like to be communicated with, and show just true curiosity, true compassion, and asking just genuinely how we can best support them, help them navigate to a decision that feels right to their heart.

So I think once I let more of a structure down, or more like, I don’t know how to say this, but that persona that a health care provider should look like, the conversation flowed a lot more organically, and the connection I felt was a lot more genuine. So the conversation I think flowed really well.

Kevin Pho: So take us into the exam room. What were some of the things that this patient said that really made you feel that weight of some of the decisions that he was going through? You mentioned briefly about the case, about how a patient may want to forgo further treatment perhaps, and the decision of doing that and spending more time with loved ones, and end-of-life care issues. So take us into the exam room and tell us exactly the things that this standardized patient said to you that really made you feel the weight of him and his partner.

Ellie Qian: Sure. So I would mention that he shared something specifically, that chemotherapy was really hard on his body, and he did not realize that holding on to a cold toilet could give him comfort, because that’s where he was finally stable, just holding on to the toilet and finding some comfort in that. I just found that that part of chemotherapy, or that part of living, was something I had not experienced or heard before.

But he also had this touch of, still, sense of humor in life, that he’s still connecting very deeply with his partner, and seeing like, oh, at this point I just want to go home and enjoy a good old Manhattan with my partner, and that’s all I needed. And I could see, yeah, there were tears in both of their eyes, and could feel that they loved each other very deeply.

And it’s a very, very difficult conversation, whether to pursue more aggressive treatment or palliative care. It’s certainly a very challenging conversation to have with a loved one, and even with the patient themselves. Sometimes they don’t have the mental capacity to really process what they think might be best for them.

Kevin Pho: So did you interact with the partner in the room as well?

Ellie Qian: Yes, yes I did. I think I said to the partner that I could see that you love each other very much, and you’ve supported your partner to the best of your ability. And the partner, after the interview, told me that in that moment he felt very validated, and he felt like they are bigger than cancer, that their connection with each other was bigger than the disease.

Kevin Pho: So what normally happens next? Do you get graded on something like this? Do you go through debrief sessions, feedback sessions? What happens next?

Ellie Qian: So normally, well, while the interview is happening, sometimes our preceptors, usually a physician, would pause, time us out, and then debrief a little bit. We would collect feedback from our colleagues. We usually have four, five people in a small group, and they will share their comments. And then we would jump back in, finish, end up with another round of colleague feedback. And then we ask one or two questions to the standardized patient about how they felt the encounter went, and also ask a specific question, also gather some general feedback.

Kevin Pho: And what kind of feedback did you receive?

Ellie Qian: Yes, so I asked them how I handled, how I engaged the conversation, did I make them feel invited, were they able to open up to me comfortably. And they said yes. Especially when I, oh yeah, I also asked them, I felt like sometimes I didn’t know what to say or what to ask, and whether it felt awkward. But they said not at all, they needed that moment of silence sometimes to process their thoughts. And yeah, I mentioned the partner mentioned to me that me acknowledging the support and love of the partner was very validating.

Kevin Pho: So as you had time to reflect on this encounter, and it clearly affected you, you wrote about it on KevinMD, you’re talking about it now, what are some of the main lessons that you’ve learned from this encounter that you could take with you going forward?

Ellie Qian: Yes, definitely, I have a couple. I think first would be that just to show up as your genuine self, show curiosity, approach a conversation how you normally would. I think some of the best conversations I’ve had were when I did not have a list of questions that I told myself I needed to run through. Those were the most genuine and organic conversations.

And second of all, I think it’s, it’s similar to the first one, but focus on building connection with the patient rather than thinking about how I would, quote unquote, perform in an interview. Thinking about, oh, did I leave too many pauses, did I seem professional, did I seem to the patient that I knew what I was talking about. And I think when you let those, it’s good to have a structure, but when you let some of those things go, and the patient would be OK with maybe sometimes you taking a pause and telling them, I’m just gathering my thoughts and trying to think from your perspective, how to build connection.

And then lastly, I think this is more of a reinforcement, it’s the power of truly leaning into a conversation and listening to the patients, what they’re saying, their inner voice. I remember I hear a lot of times from actual patients, not standardized patients, that when they would come speak to us, almost always, if they were to give one piece of advice to medical students, that would be to listen to your patients. And I would think at first, isn’t that, in the exam room of course, isn’t that obvious, to listen to the patient? But there’s a difference between hearing the words and still going with your own judgment, and actually taking those words to heart, seriously, and considering what would be best for the patient. So I think I would take that lesson to heart and take that as far as possible in my future career.

Kevin Pho: We’re talking to Ellie Qian. She’s a medical student. Today’s KevinMD article is “Honoring humanity: lessons from a medical encounter.” Ellie, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Ellie Qian: Absolutely. I have two. One is for all the standardized patients who are participating, taking part in medical education. I’d like to thank them very much, and letting them know that you are truly making an impact bigger than you might think.

And second of all, a message to my fellow medical students or premed students is to just lean into your experiences as a student. The time feels long, but it really goes by very quickly, and there’s something to be learned from everything, everybody. And you can either treat it as something you need to do obligatorily, or something that you can potentially gain a really lifelong lesson from. So just cherish the time we have as students.

Kevin Pho: Ellie, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Ellie Qian: Thank you so much.