Medical Student Reflection III: Small ways to show respect for patients

by Academy of Clinical Excellence on March 24, 2011

After watching one of the Academy members deliver bad news to his patient, I asked if he had a systematic way of approaching such situations. “It’s like asking a girl out,” he replied. “There’s no instruction book. You have to feel it out - it’ll be different for every patient.”

I have to admit, I was disappointed. Part of my reason for taking this elective -- shadowing most of the members of the Academy for Clinical Excellence -- was to learn the elusive secrets of medicine, the tricks to ensure that my future patients will hold me in high regard.While I haven’t discovered any secrets, I have noticed that all of the Academy members provide small, often subtle gestures of respect for their patients. None is earth-shattering, and no gesture on its own would change a patient’s opinion of a doctor. But when two or three are combined during the course of a patient visit, a sense of compassion and respect is clearly conveyed to the patient.

Below are a few of the gestures I’ve noticed:

Tell patients that you haven’t forgotten about them.
One afternoon a fellow was unexpectedly absent, so the attending doctor was running late for most of the clinic. In between seeing patients, she would stop into an exam room where a patient was waiting, and let the patient know that she hadn’t forgotten about them, she was sorry to be running late, and she would be in to see the patient as soon as possible.

Thank patients.
Several times during this elective, I’ve heard doctors thank their patients. It might be during the greeting (“thank you for coming”), at the end of the history (“thank you for providing all of those details - it’s very helpful”), after an admission that the patient hasn’t quit smoking (“thank you for being honest with me”), or at the end of the visit (again, “thank you for coming”).

Give patients a reliable way to contact you.
Often the Academy doctors will not only provide their card, but will write an additional email or phone number on the card, or will tell the patient which of the several ways of contacting them will be most likely to get through.

Introduce me (i.e., the med student)
Often the medical student and the patient feel the same hesitance about interrupting the attending doctor. If the attending begins the encounter without first introducing everyone in the room, the introductions will likely never be made. This ends up making both the med student and, more importantly, the patient feel a vague sense of discomfort throughout the visit.

(Briefly) evaluate medical concerns that are entirely outside of your speciality.
In a clinic for patients with renal transplants, a patient mentioned in passing that he recently slipped on some ice and fell on his shoulder. He had a negative x-ray, but still had some residual soreness. The doctor took a minute to examine his shoulder. I believe that small action reinforced the patient’s sense that his doctor cared for his whole person, not just for his kidney.

There's unfortunately no instruction book for becoming a great clinician. The doctors I’ve shadowed provide far more than small, subtle gestures for their patients. Yet by following a few of their more easily-copied practices, I hope to slowly progress on the path towards clinical excellence.

-Aaron Bobb, MSIV, JHSOM

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meg March 31, 2011 at 6:43 pm

Your ability to be fully present and awake to the moments you've described so vividly will serve you in good stead in your own clinical encounters with patients. You have a meaningful life ahead of you - enjoy!

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