Thursday, May 24, 2007

Short White Coat: I'm concerned about you

Short White Coat is a blog written by first-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

In Patient Doctor I -- the art of taking a medical history -- several classmates and I intrude weekly into the lives of Beth Israel Deaconess Medical Center patients to practice our interviewing skills and bedside manner.

Last week, these skills were captured in all their glory on videotape as we interviewed "patients," portrayed by actors, about stomach pain and bisexual curiosity. I bumbled my way through the interview, armed with a year’s worth of reading about how far to sit from a patient, what tone to adopt, how to listen attentively, and when to stay silent -- more the stuff of a Miss Manners column than a class textbook.

Though we often joke about such inorganic means of teaching and implementing kindness -- "That must be tough for you" is one empathic statement that we deliberately overuse to the point of absurdity -—I’ve found that learning the vocabulary of human connection can be just as critical as the language of human anatomy and disease.

Take "concern" -- I’m concerned about how your six-pack a day might be affecting your health; do you have any concerns about controlling your asthma?; it sounds like you’re concerned that this might be cancer. Equipped with this word alone, we can convey caring, encourage positive life changes, uncover diagnoses and treatment strategies, and elicit patients’ fears or the real reasons behind their visit.

When I was first robed in a white coat and thrust in front of a patient last fall, I felt uneasy adopting such vocabulary because it implied that I had some clinical expertise to offer. Over dozens of interviews and scores of awkward moments, I’ve come to realize that talking the talk without walking the walk, so to speak, can be valuable in its own right -- as long as you use the right words.

Thinking back on my first year, I wonder whether this language has been the most lasting lesson in some ways, a piece of medical school that has readily seeped into my relationships with friends and family in ways that endear rather than alienate. As our Patient-Doctor preceptors reminded us yesterday in our closing session, even a seasoned doctor’s most critical skill is making conversation. It’s not a bad skill for life, either.

Posted by Ishani Ganguli at 03:49 PM

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