When medical students rotate through our office, I am their preceptor, but our patients are the real teachers. I was reminded of this the other day when my medical student and I went in to see Mr. P, a patient in his late 60s visiting the office for the first time. He has diabetes, hypertension, and severe arthritis, all of which he has struggled to control in recent months.
Second- and third-year medical students come to our primary-care practice for their month-long family medicine clerkship. They learn to interact with patients, and sharpen their ambulatory medicine skills.
My usual routine, after asking the patient’s permission, is to have my student go in first, interview and examine the patient, and present their findings to me afterward. We have a brief discussion, and then go in to visit the patient together.
After my student had examined Mr. P, I thanked the patient for taking extra time to work with him.
“Are you kidding? It was great!” he exclaimed. “You’re teaching him well — he was so interested in my story.”
This has not always been his experience with physicians, Mr. P explained.
First there was the doctor who spent 30 minutes giving a wonderfully detailed explanation of an upcoming procedure he was proposing for Mr. P. Then the doctor left the room without asking if Mr. P understood any of his soliloquy. He did not.
Next was a story of an appointment that Mr. P was summoned to so that his doctor could tell him the results of a test performed to find out whether he had a serious health problem. Mr. P sat in a sweat as the doctor slowly explained how the test is performed, and why it was ordered, finally ending with the only words Mr. P needed to hear: “The test was normal.”
Mr. P didn’t remember anything else from that visit. His advice to my student and me: start with the result, and then give the details.
Last, Mr. P shared a fond memory of his beloved family doctor from years ago. The doctor would start out their visits with a simple request: “Tell me the story.” Then he would sit quietly and listen attentively as Mr. P explained his symptoms without interruption.
“He didn’t always have the answer,” Mr. P said, “but he always listened and led me in the right direction.”
Mr. P is such a good storyteller that we had to remind ourselves to ask him about his current health story.
He told us about his issues, and how he had been instructed to deal with them. We adjusted some of his medications, and arranged a follow-up appointment in three months.
“I hope your student is here next time I come in,” he said as we shook hands and said goodbye.
My student and I walked back to my office, sat down, and simultaneously said, “Wow.”
“If you remember anything from this rotation,” I told my student, “remember everything Mr. P just said. It’s sage advice.”
We can teach and demonstrate clinical diagnosis, interviewing and examination techniques, and even share powerful stories of meaningful doctor-patient relationships. But there is nothing like listening to a patient explain what it is like to feel truly heard by a physician. This was an invaluable lesson for my student, and a humble reminder for me. It’s the sort of wisdom you can never get too much of.
Jeffrey Millstein is a primary-care physician and medical director for patient experience-regional practices at Penn Medicine.