My first dressing-down by a consultant in front of an entire team wasn’t so bad. At the time it was mortifying, but I got over that and actually learned a valuable lesson. I have come to think of the outburst as more of an impassioned – if somewhat strongly-worded – plea.
Some background; I had just “assisted” (in the most tenuous way – standing at the periphery, forceps in hand, desperate and equally terrified that the instrument would be required) in an operation while rotating through one of the surgical specialties.
Along with the privilege of ‘’assisting’’, I was told expressly to ensure I followed up on the patient after the procedure, to go and have a chat with them the following day – an excellent learning opportunity.
Of course I knew better, reasoning that my chances of seeing the surgeon in question again were minimal so I went and did things I deemed more pertinent to my medical education. A fine plan, until a chance hallway meeting on the last day of the rotation.
“Ah! There you are – how is that patient?”
In spite of the lambasting, I have come to the realisation that the consultant was absolutely right. While there is every tendency to withdraw to the library under the pressure of looming exams, interacting with patients is one of the truly priceless privileges of hospital-based education. As a learning experience, a 15-minute chat can elucidate pages of the textbooks while providing a piercing reality check – patients often know more than you!
Although the books are important too and useful in their own regard, a memorable patient encounter can make the intricacies of an entire disease unforgettable – useful when your head feels fit to burst from the endless torrent of information to which we students subject ourselves.
As a medical student, you are bestowed the liberty to approach (almost) any patient in the hospital with a view to conversing with them, once you are considerate and appropriate. It would therefore appear that there is an abundance of potential learning experiences from whom the medical student may learn about every disease, test and treatment option. On the ground however, this isn’t necessarily the case.
It’s a feature of the successes of modern medicine that only those who truly need to be in hospital are there for any prolonged period of time. Or, at least that should be the case. It’s currently an unfortunate reality that a significant proportion of inpatients should not be there – the “bed blocker” phenomenon.
Reflecting another success of modern medicine, an increasingly long-lived population is presenting challenges that are failing to be met, with the knock-on effects seen on hospital wards. From a student’s perspective, the extensive medical histories and life stories of these residents (having ceased to be patients) make for rewarding conversation, although cognitive-decline and dementia are, unfortunately, highly prevalent. With regard to patients who need to be in hospital, we may exclude the sickest patients – while some are willing and able to talk, the learning objectives of medical students are simply not a priority where these patients are concerned. This leaves the “otherwise-healthy” hospital patient; the person who experiences a spot of bother for which a short spell in hospital is required.
This single patient group – largely young, coherent with relatively simple symptoms and a willingness to be poked and prodded- exercises magnetic attraction over the medical student. The novelty of being the centre of attention soon wears off, however, particularly if you’re unfortunate to be labelled as an “interesting case”, which is why we, the medical students, like to swarm around in groups while you’re still fresh.
Exemplary medical practice in the 21st century preaches a patient-centric approach, and medical education certainly benefits from patient interaction. Not only that, but in addition to any exam-orientated benefits there is a genuine social satisfaction to be had from engaging with patients. Hospitals can be a rather dehumanising environment and many medical students would like to think that their company and conversation was somehow worthwhile for the patient.
As the health system as a whole faces into challenging and turbulent times, let’s hope the medical student-patient relationship continues to prosper – if only to help us pass our exams.