Meeting our patients eye-to-eye

Dr Neasa Conneally recounts a patient interaction from medical school that still sticks with her

One of the great benefits of the GP training scheme is that the weekly teaching time is very protected in a way that teaching in other schemes often is not. As well as clinical cases and research, at least half of the time is devoted to reflecting on patient interactions and experiences, or as I once heard it snidely put by a non-GP colleague, “sitting in a circle and talking about your feelings.”

One thing that came up recently was the concept of HALT, namely how your clinical judgement and behaviour can be significantly impaired when you’re hungry, angry, late or tired. It’s something we’ve all experienced and should be aware of, particularly when on call. Of course that’s very difficult when you haven’t eaten or drank or sat down in hours and the referrals in your shelf in the emergency department are piling up and you’re being bleeped for an urgent cannula up on the wards and no, apparently none of the nurses have done the required training course. It’s very easy in those instances to get worn down and to lose the idealism in the job that you dreamt of having since you were small.

Thinking about this brought me back to my very first days as a medical student, when things were still bright and shiny and incredibly exciting. The scene was a large Dublin teaching hospital (which shall remain nameless) and we had just started the first weeks of our surgical rotation. We were all fresh-faced and eager in our new white coats and as yet un-dog- eared Oxford Handbooks, generally just holding up the walls and getting in the way. The ward round proceeded by us being swept around the hospital at a fast clip by the surgical consultant in his pinstripe suit, who barked orders to his team as we all followed behind like little ducklings. It sounds like a scene from Doctor In The House starring Lancelot Spratt but, rather incredibly, happened within the last five years.

The consultant was quite sure that there was no acute surgical issue and off he swept, happy with his plan

During the round, we arrived to one well-to-do lady in a smart dressing gown sitting primly up in her bed, who started asking the consultant about her ECG and whether her CRP had started trending down. This immediately struck me as out of the ordinary, as she clearly had some level of medical knowledge, but this was either not picked up or ignored by the team, who told her everything was just fine and not to worry. The consultant was quite sure that there was no acute surgical issue and off he swept, happy with his plan. The SpR, who was doing her very best to impress, was happy, the SHOs were happy, the intern who dutifully wrote the notes was happy, and we were all very happy because precisely nobody had paid any attention to us. As we were leaving, I tried to convey some sort of sense of mortification to her about how the entire interaction had gone.

To my great fright, she then beckoned me over to her and asked: “Will you come and talk to me later?” I felt uneasy about this because I couldn’t think what she could possibly want from a green student like me. I figured she must be lonely and I had no greater plans than drinking tea all morning in the student res so I could at least take her history, a currency greater than gold to the average medical student.

When I got back up to the surgical ward, she sat me down beside her bed and said: “Did you know that earlier, you were the only one who looked me in the eye?” She went on to tell me that she had been one of the few women to graduate from her medical class in the 1940s and that she had spent years travelling the world as a ship’s doctor, until she had to stop working when she had children. She gave me all sorts of advice on how to survive in medicine as a woman and I immediately felt chastened at myself for also assuming that she was just another lonely little old lady sitting up in a bed.

It is by far the patient interaction that has stuck with me the most, and one that I frequently remind myself of to this day when I’m hungry, angry, late or tired. It is very easy to forget, when the bleep is incessantly bleeping and you’re being snowed under by referrals, that each patient is a real person with their own story and life outside of what’s brought them into the hospital that day.

No matter how badly our day is going, we should always take pause, look our patients in the eye and remember that.