I’m still, my hand hovering, ready to knock at the door. It feels like the scream floor from Monster’s Inc. That’s what my friend pointed out after our first one last year. So stressful, so contrived. There isn’t really a patient behind the door, just an actor to be interrogated for a thorough history, to be manipulated for a complete exam. Sounds so cold, so clinical when we think about it like that. But – “you have 5 minutes remaining” – no time for chit-chat, please stop talking so I can auscultate properly.
In the beginning, there was so much we didn’t know. It was easier to talk about the things we shared—our hobbies, our loved ones, the Yankees game last night—than to think of questions to ask about your confusing symptoms. Now, we’ve learned the language of medicine. We have schemas, differentials, and agendas chock full of a long list of questions. We don’t really care about what you do or who you really are until we’ve marched through a complete HPI, PMH, PSH, Meds, Allergies, FH…then please tell me about your sex life, and, don’t worry we ask everyone, substance use. Then, we assure you we are not concerned for a stroke because we find no evidence of focal neurologic deficits on exam. Or that your emesis and diaphoresis is likely a case of viral gastroenteritis, nothing that warrants additional workup. Why do we use fancy words with extra syllables for things that already have perfectly good, easy-to-understand names when we speak to you? Emesis, diaphoresis, lacrimation. Is it to elevate us above the people we serve? Or is it so we can sound confident and intelligent when we really aren’t so sure? Because the more we know, it seems the more we have to learn. And that’s humbling and, honestly, quite scary. So, we learn to fake it or to accept uncertainty or a little of both.
I’m ready to knock on the door once more. This time, I’m confident. I’ve thought through a long differential. I know what to ask and how to interpret your answers. No more awkward pauses while I stop to think. No more making small talk while I stall for time, racking my brain for questions to ask about your chest pain. This time, I’m crisp and efficient. Just like a doctor should be. Smart, knowledgeable, quick to solve the problem. It was the first time I felt truly competent, like I had the skills and knowledge to make an accurate diagnosis. And it felt so good. And yet, you told me I was rushed, that I wasn’t empathetic, that you were hoping for a bit more warmth. I was shocked and ashamed. I’ve never received that kind of feedback. But isn’t this what we’ve been warned about? That in becoming doctors we lose sight of the patient in front of us. That in learning to speak precisely, to exercise shrewd observational skills, and to run through a differential while you talk, we stop listening, and, far worse, we stop caring. How sad that in the day I felt most like a doctor, I felt the least like myself.
Weeks later, I’m perched at the bedside with my attending. The patient is sitting up in bed, tearfully explaining that she just got off the phone with a cousin concerned about the upkeep of her house and belongings. She doesn’t care about material things, she says. She just wants someone to ask about her. To care about her and how she is doing, how she is feeling. I glance at my attending, waiting for him to ask about her symptoms overnight, to redirect to assess her clinical condition. It’s 11 am, and we’ve barely seen a third of our list. But he doesn’t. He sits quietly, waiting for her to continue. She does, and he doesn’t interrupt. So, we listen, not interrogating or examining. Eventually, after offering our silence and a few words of comfort, we leave the room. “That’s medicine,” my attending says softly. Relief washes over me. I agree.