Friday, March 23, 2012

The trouble with the medical encounter...

I thought I'd start with a big topic. It's one that plagues every autistic medical student I know, and it's quite a contradiction when you consider how pivotal and central it is to everything we aspire to be.  But humor me anyway, if you will.

You are sat in a waiting room, surrounded by sick people. Your name is called out by a man walking towards the crowd, and you respond by standing and approaching him. He greets you, asks how you're doing and if your journey was a pleasant one.  You both then walk to the man's office.  It's obvious which seat is yours, and so you don't hesitate to sit. Over the next seven minutes, you discuss your current ailment with this man and you both work towards identifying what might be wrong and formulating a management plan. You walk away happily while he remains seated.

This is the scenario that plays out thousands of times a day around the world.  It sounds routine enough, almost monotonous, even.  As a student, you are expected to emulate this to a degree, not by the doctors or your peers, but by the patients who have been invited especially to talk to you about their health condition.  That involves, first and foremost, being polite and expressing your gratitude to this person who is giving up their time to benefit your learning.

For me, stressors appear before I have even started the consultation; the first hurdle I often experience is getting the patient into the room!  As I walk down the corridors and get my patient, I am wondering how and where I should stand as I call their name, what I should be doing as they walk towards me, whether I should shake their hand and say "Good morning", what conversation I should make as we walk back towards the office - if any, whether I should walk alongside the patient or in front...  The list is endless, and most of it is so trivial that it is ridiculous that I should even be thinking about these things.

So we are all in the room and we are all seated. I need to introduce myself formally, and also my medical student partner who will be observing and making notes.  While I do this, I need to make sure I am sat appropriately - what sort of posture conveys interest to the patient? Not slouched, obviously. But not too straight and stern, otherwise I might sprain something.  Eye contact! Facial expressions! But the lights are too bright and, when I try to focus on making eye contact with this patient, I feel dizzy and everything else loses focus. I feel like I'm slurring my speech - but I still need to keep talking! Ask questions - relevant questions. He has come in about the heart attack he had six months ago. Why am I asking if he has epilepsy? The two aren't related.


Not the good kind of silence.  The patient has stopped talking.  Is he thinking?  Or has he finished?  Is this my opportunity to ask another question?  But how do I ask it without it sounding stilted?  He was just talking about his daughter's band.  How do I go from that to, "So what meds are you on? Do you have any allergies?"

I ask the question.  It feels awkward.  I am still trying to coordinate my eye contact and body language.  I am also trying to read his body language.  He just crossed his legs.  What does that mean?  My legs aren't crossed.  The other medical student's legs aren't crossed.  But she is writing, so that's good.  The patient is saying stuff that is useful.  I think.  I am not paying attention.

Interview over.  "Can we examine you?"

This should be fine.  It's a strict routine - a list of things I have to tick off.  Let's start by looking at his hands.  Oh no, he's talking again - "Do they tell you a lot?" But I'm busy!  It is rude of me to continue, so I'll stop and let you speak.  I'm not really sure what I'm going to say back, but thankfully my colleague is there to fill in the gaps.  Now I can continue working.  Except now I need to listen to his heart and he is still talking.  Do I wait until he has finished or do I ask him to stop talking for a minute?  How do I ask that politely?  There is no polite way... It is probably better if I wait.

"Your heart is fine; nothing to worry about."

"Thank you for coming in to see us today. It has been lovely meeting you and I hope all goes well."

Phrases I rattle off at the end of every consultation.  Don't forget to smile and shake their hand.

It's over.  I can relax.  But wait.  I have another patient to see in a few minutes, but I'm so tired after that!  So much thinking.  So much effort.  Headache.


  1. This is recognizable, even though I've not been a med student. Any type of client/you situation would be almost exactly like that...

    Good luck.
    Thx for sharing.

  2. I think we are the same person.