Updated: May 7, 2020
By Najma Aden
I want to help people.
The overused and almost tacky answer interviewers dread and medicine applicants seem to love. As vague as it is, I find it being the underlying reason for my ambitions as a medical student. Sure, you can help people doing, literally, anything. But I’ve always found the idea of being there for someone at their lowest, to be incredibly appealing.
Yeah, cringy, I know.
Despite this, I realise now that I never before understood the magnitude of what a healthcare worker’s listening ear alone can do for someone. Having never shadowed a doctor prior to my medical school induction, I never witnessed any such interaction between doctor and patient. My idea of practicing medicine was still somewhat childish and glamorised. I envisioned myself running around hospital floors, shouting all kinds of nonsense words such as ‘stat’, and dramatically announcing to the families of patients that we managed to revive their loved one.
I hope that I still get to do that, but the practice of medicine I experienced on my placements was so much different. Hospital wards were mostly very quiet, unlike the busy bustle of Seattle Grace that I had spent so many hours watching. I have yet to see anyone running, or shout code blue. Though I don’t doubt these things to be a reality, they are definitely but a small part of the practice of medicine.
My medical school has weekly communication skills sessions, in which we pretty much get taught how to conduct a patient consultation. I remember being very confused about this prior to starting this course, because surely, we had all managed to get through 18+ years of life knowing how to talk to people. These lessons had to be a waste of time, right?
Boy was I wrong.
There was so much to remember. Different pneumonics for how to structure the conversation, the right way to ask questions, how to begin/end the history taking, and more.
And I made so many mistakes. Looking back on it, I am grateful to have had these sessions prior to my first encounter with a patient. I definitely felt somewhat prepared, and more at ease, with asking questions that previously would’ve been very uncomfortable for me to ask.
Before I knew it, I had my first placement as a first-year medical student. My PBL group and I visited Salford Royal hospital for the day. After a quick introductory talk by the nurse, who would be supervising us for the day, we were split up into our clinical partners and taken to different wards. My clinical partner and I ended up on the dialysis ward.
It was quiet. A lot of patients were dozing off on their beds, some were sat with family, others passing time reading a book or scrolling through their phone. I remember feeling panicked. This was the first time I was to talk to a real patient, not a simulated patient as I did in the communication skills sessions. I did a frenzied run through of the history-taking structures and conversation starters with my clinical partner, outside the drawn curtain separating us and the patient. Taking a deep breath, I move the curtain back, and I introduce myself.
“Hello, my name is Najma Aden and I’m a first-year medical student at the University of Manchester. Is it okay if I take a seat?”
Everything my clinical partner and I spoke about before we introduced ourselves left my mind. I found not thinking as hard about what question to ask next, instead moving with the flow of the conversation. I paid less attention to the technicalities of things such as ICE, but by paying attention to the conversation I found myself asking those questions anyway. My history-taking technique was far from perfect, but I still left that conversation feeling accomplished.
I learnt so much about the patient in those twenty minutes; his name, his age, his job at his love for his pets, the impact of his kidney condition on his life and well-being, his situation at home, his relationship with his mother, and so much more. It was during this conversation, that I realised medicine was so much more than the glorified clinical version I had had in my head. I understood how essential these kinds of conversations were. Building a rapport and human interpersonal connections with the patient would affect their care in ways I hadn’t even thought of previously. And it made me so excited for my future (fingers crossed) medical career, hopefully having many more conversations such as this one.
I have since been on many more placements and have taken a lot of histories. My technique has definitely improved; I’m not as awkward as I used to be, I spend much less time saying ‘ummm’ and I’m yielding much more information from each conversation.
Please don’t feel discouraged if you feel your first patient encounter doesn’t go so great. Whether you had a particularly difficult patient to talk to, or you feel you didn’t ask many of the right questions, now is the time to make mistakes.
A few tips I’d like to give you are to make use of communication skills sessions, don’t shy away from having a go, remember, practice makes perfect. Don’t be so hard on yourself, in the grand scale of it all you are still a foetus in the world of medicine. You have so far to go, and improvement will come with time and experience. Most importantly, make sure to have fun along the way. Practice with friends and family and get comfortable asking those uncomfortable questions.
I wish you the best of luck with your medical career. You got this!