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Katie Groom is studying medicine at a London university. She is currently coming to the end of her first clinical year, based in a London hospital. Here she describes the tension she feels between respecting patients as people to be cared for and seeing them as 'subjects' to learn from as part of her clinical training.
This is one in a series of stories that the Point of Care programme is presenting on the issues that staff face in trying to ensure a positive patient experience. The views given in this article are those of the author and do not necessarily represent the views of The King's Fund
It was just another normal bedside teaching session with one of the notoriously scary professors on the acute admissions unit – or so it seemed. It turned out to be an experience that neither the patient nor I would ever forget.
The patient was in her 30s and worked in a clinical position in a London hospital. Her husband, a 'non-medic', was accompanying her. The patient did not have a firm diagnosis as yet; more tests were being done. We started by asking the patient what brought her into hospital?
As she was telling us her symptoms I became acutely aware, as did the other students, that she had what looked like a classic presentation of the first signs of multiple sclerosis. I felt my temperature rise as I realised the patient, a practising clinician, was thinking exactly the same as us. The session became an awkward game of dodging what we all knew.
The consultant stepped in, asking another student to give him the diagnosis. At last multiple sclerosis was mentioned. I vividly remember the blood draining from the patient's face. My heart raced. I didn't think that such events really happened. I was receiving the information that was in my head as if I were the patient.
It was at this point, in my first clinical year, that I began to question our role in relation to the patients. Up until now we had learnt about physiology and pathology. Now we actually became part of real people's lives.
Bearing in mind that this patient was in acute admissions and hadn't had time to prepare for her diagnosis, I felt uncomfortable being part of what was simultaneously a consultation and a teaching session. The primary focus of the session was our learning, not her well being. Of course medical students need to 'play doctor' and experience giving diagnoses first hand as part of the training. But it seemed to me to go a bit too far at the expense of this patient.
Now that I have just started my surgical rotation, I am even more aware of these problems. Our learning is our top priority, not the patient.
Surely the patient's well being should be at the top of a doctor's priorities, with the teaching of their students taking second place? That is doubtless what patients would prefer. In our introduction to the module, I asked the doctor whether we should ask patients whether they'd be happy for us to take part in their operations. The doctor replied: 'they are asleep', as if their opinions and consent did not matter.
Our days as medical students have become focused around which patient has the best clinical signs, who has the most severe pathology, and what’s the most exciting surgery we can scrub in on (exciting being the most life-threatening for the patient). Our time is consumed with meeting deadlines, completing an endless number of assessments and preparing for exams; we rarely sit back and reflect on patients as individuals.
Should we be thinking more about whether a patient who has been recently diagnosed with cancer would really want an army of medical students asking endless questions? I know I certainly wouldn't want to talk to a whole host of people after receiving a life-changing diagnosis myself. What stops us from putting ourselves in our patients' position? Surely that's what empathy is, something we all defined in our entrance interviews for medical school. How is it that we have become so consumed with our own learning that we forget those initial reasons why we went into medicine?
When I defined empathy at my interview I wasn't just ticking a box, it was something I genuinely felt; medicine was a career where I would be able to practise it every day. How have I forgotten this? Looking back at the personal statement I wrote during my A-levels, I remember my enthusiasm and the experiences I had already had with patients. Back then, I worked as a carer in a residential home, where I focused completely on the residents and their needs. I took part in GP visits, when all I did was talk to patients and listen.
This all seems so far away from where I am now. As exam season is well under way, putting our patients first really does take a back seat. We are furiously trying to examine patients with diseases we haven’t seen before – anything that's going to help get us a better mark in our exams. Taking time to think about patient care first surely just wastes time?
All these questions have been buzzing around my head, alongside all the other information I'm desperately trying to cling onto. Maybe it is time to realise that in less than a couple of years we actually will be doctors. These patients we overlooked and pestered while abusing their time will now be our main priority. Of course we need to put our own academic work first – after all, good patient-centred care relies on competent doctors. But it also depends on doctors who put their patient first.
Perhaps, as medical students, we need to strike a balance. We need to take the time to remember our experiences, reflect on our patients and how we make the next patient feel that bit more comfortable. Maybe we should even go back to those experiences we had before medical school, those that prompted us to take the path that led us to where we are today. Taking a step back from our checklists and deadlines would enable us to listen to our patients and get to know them. Maybe it would make the whole process much more efficient and enjoyable for patients and clinicians alike.
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