How To...Talk To Patients

The differences that I began to notice in myself from merely wearing the white coat were soon evident in my partner. Early in the morning we took a quick trip to Dunkin Doughnuts before rounds, and while in line a man came up to him and asked about a problem he was having with his colon. After listening to some of this man’s story, feeling both confused and a little lost, my partner replied, “Unfortunately I cannot help you, I am only a first year student”. With just this phrase, he acknowledged what we all knew, that even with the white coat, we really were not doctors. Yet, despite this realization, on the second day of HIP, we spent an hour talking to our first patient.

To say that prior to being put in a room with a patient I knew nothing about, beyond her case (a rare disease that even I could not pronounce or remember the acronym for), the fact that she was friendly, and that my student leader had been on her case when she first presented to the hospital 8 months prior, that I was nervous and anxious, is probably the understatement of the year. You would think that for a people person who has no trouble making friends or even talking to complete strangers in line at a grocery store, spending an hour talking would be a breeze. Yet, there is something about wearing that white coat in a hospital and in a patient’s room that just completely changes the conversation dynamic and makes you feel like you should have more skills to communicate properly, as if just talking to the patient like you do a friend or a parent is unacceptable. Even opening the door and beginning the “Hi, My name is” conversation made my heart beat a little bit faster.

To maintain a feeling of informality, both my partner and I sat down to talk with our patient. We had agreed prior to talking with her that we would steer clear of all things disease and illness unless she brought them up (ie. once she mentioned that she could not fly anymore because of the fear that she could bleed from her ears, I could then ask her what other things her illness had impacted in her life), and would mostly aim to learn about who she was and her personal history. We started out talking with the “Where are you from” question and lucky for us, our patient could answer this for most of the conversation. She was Jamaican, but had come to the U.S. at around age 35, already married with children. As she spoke she laid down in her hospital gown on the couch and sometimes shyly put her hand over her mouth. This gesture merely added to the difficulty we had in understanding her Jamaican accent and soft speech. My partner casually asked her a few times to please repeat or clarify what she had said, but, in constantly doing this, we felt like we were putting her down and not respecting her cultural background by being so lost by what she said (I mean, it WAS English). She, however, was willing to continue to speak to us and spent the majority of the talk explaining the importance of listening, and education. She said that her children all worked in some way with health care, but that she “was stupid” and could not do these jobs, or even our future job for that matter. This phrase came up more than we would have liked and despite telling her once that she was not stupid, we lacked the skills to properly respond when this became a self-deprecating phrase she used over and over.

About half way through our conversation, right when she started to explain the onset of her illness and her feelings that she was going to “die” as for no reason she was bleeding profusely (something we learned that despite removing her spleen, her doctors are still truly unsure of the cause), some of her family members came to visit. I felt like they thought we were talking to her as a true doctor-patient conversation and that maybe something was wrong with her (I mean, there were TWO doctors). However, the patient barely acknowledged their arrival and instead informed her family that she wanted to keep talking to us and that they could wait, even if we felt that we could easily leave her with her large support system and have gotten enough out of the exercise.

Despite her family’s obvious signs that they wanted time alone with her, as they got up frequently and left the room and reentered the room with food, she would not let us leave until she felt that we had asked all we wanted to ask. In fact, even with a few awkward pauses, and looks between my partner and I for who should come up with the next question, I felt we handled talking to her, our first patient, rather well. This “successful communication” could be the reason that she invited us back the next day, and even told us directions to her house to go and visit her. Unfortunately, as she was not a friend but a patient, this led us to another situation of feeling like we lacked the proper training in doctor-patient communication to respond to her invitations. We were both afraid to sound like jerks and say no, but we also did not want to promise something we knew was impossible. All in all, while I definitely have had experiences talking to my friends and even helping them through problems, this patient interview made me realize just how much I need to learn to be a true doctor. Having the skills to communicate as a white coat is a whole different ball game.