Medical Student Reflection I: Easing into a new patient, avoiding a pitfall

by Academy of Clinical Excellence on March 3, 2011

Fourth year Johns Hopkins medical student, Aaron Bobb, just completed a 2 week elective offered by the Miller-Coulson Academy of Clinical Excellence. During his time, he shadowed many of the member physicians in their clinical settings. Through a series of blog posts, Aaron documents some of what he learned and witnessed during his elective.

The doctor and I entered the room knowing nothing about Ms. P. except that she wanted to transfer her care to Bayview. We found a well-appearing talkative woman in her late fifties, armed with a stack of medical records and several concerns. She recently had a “heart scan” and wanted the doctor’s opinion about it. She had chronic neck pain and dry eyes, and a genetic test for HLA-B27 came back positive, “confirming” a diagnosis of Reiter’s syndrome. She had stomach upset which she thought might be related to taking Lipitor. She wanted to know what her cholesterol level was.

As we stepped out of the room while Ms. P. changed into a gown for the physical exam, the doctor told me about his way of approaching new patients. “I try to be mostly receptive, almost passive. When you think about it, we’ve just met each other. She might not appreciate me pronouncing all of her ailments and how to fix them.”

Later during the visit, Ms. P. mentioned an encounter with a previous physician she’d seen for her stomach upset. “After being in the room with me for two minutes, he diagnosed H. pylori [gastritis] and gave me all these pills to take. I don’t like taking pills, and I didn’t like him.”

The doctor ended the visit by ensuring Ms. P. that he would read over her heart scan and find out when her last cholesterol level was tested. He prescribed no new medicines and agreed to hold off on the Lipitor for the time being. He deferred any blood work until he had time to look through her records.

I believe Ms. P. left the office feeling that her new doctor was thoughtful, conscientious and respectful. The doctor could have been more “efficient” by attempting to do more during the visit, but Ms. P. may have been less satisfied and confident in her doctor, and would likely be less adherent to any future treatments prescribed (and perhaps would search out yet another doctor).

That previous doctor, who prescribed the antibiotics for H. pylori, was likely correct in his diagnosis and treatment choice, but moved too fast for his patient. As medicine continues to increase in technicality and sophistication, doctors may need to slow down and do less to make sure their patients remain in the loop.

-Aaron Bobb, MSIV, JHSOM
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electronic medical records March 15, 2011 at 7:32 pm

Very useful information! this can be a guide for the student to avoid pitfall. Thanks for sharing this observation. I enjoyed reading it.-pia-

meg March 4, 2011 at 2:35 pm

Great observation! Less is definitely more in many cases. Here, doing little more than taking time to listen to the patient yields immediate benefits to the patient and the patient-doctor relationship, which will continue to multiply in the future. Can't wait to see what else caught your eye in this elective.

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