24 February 2012

Poker face

One afternoon I donned my white coat and "shadowed" (observed) a physician in the community. This physician was particularly talented at bonding with her patients. Several patients made a point of telling me that I was fortunate to be learning from a doctor who listens so well.

We encountered a patient who was fidgeting and whose eyes appeared sunken. When the doctor asked what had brought her into clinic, she replied that it was anxiety.

The doctor asked her to describe what was making her anxious.

The patient had infidelity problems in her marriage. Their son had recently been diagnosed with a major illness. She had discovered that her husband had secretly spent their life savings pursuing an addiction. Her husband was refusing counseling.

Her tragic story tore at me (how could it not?). While she was telling it, I was unsure how I ought to outwardly react. Should my facial expression and my body language reveal or at least hint at my horror and my sadness? Should my brow be furrowed or not? Should I be nodding or shaking my head? Throughout the patient visit, my preceptor needed to convey to the patient that she understood her pain, that it was natural for the patient to feel the way she does, that the patient was no less of a person because of all of this, and that there was hope. I studied my preceptor intently throughout the patient encounter, and her expression was rather neutral and calm throughout. In all, I thought the preceptor did an excellent job, and the patient appeared to be feeling more relaxed by the end of the visit.

Our curriculum includes workshops on patient interaction, although I'm not sure to what extent these skills are innate and to what extent they can be learned. A doctor needs to be many things to be effective with patients: an astute observer, a motivated learner, a good communicator, and an engaged listener. Even if a clinician is the right person for the job, it is a tough balance to strike.