Lessons From a Medical Student: “I See You”
A young woman came into clinic presenting with difficulty sleeping. I began my encounter in the standard fashion I had learned to approach each patient — greeting, asking for how she would like to be addressed, and inquiring about what brought her in. Now a few weeks into the clerkship as a third-year medical student, I had become comfortable and confident in being able to systematically document the patient’s history of present illness, review of systems, and past history. I asked questions to rule in and rule out my working differential diagnosis for insomnia, fatigue, and headaches, while ensuring that I made eye contact and summarized her statements as I typed notes. But early in our conversation, I had a sense that something was not quite right in the hesitant way in which she spoke. I stopped and asked if she was alright. She stated that she was. I nodded and continued with an open-ended question about the nature of her symptoms. But when I glanced at her again, it seemed like there was something being held back.
I stopped typing, turned my body toward her and simply asked, “What’s on your mind?” It was then that she began to cry. She shared the thoughts that she had been having– the disappointment she felt about the place she was in, the events that occurred recently in her life, and the pervasive dejection she had been grappling with for months. She spoke freely, unscripted, undocumented. In that moment there was a shift where I listened and sat with her in her experience as another human being dealing with life rather than an encounter with a patient presenting a chief complaint. At some point she stated, “I’m sorry for this. I interrupted the questions that you’re supposed to ask.” That struck me. I stated to her that we are here to provide care for her, not to just fill out a questions script and finally a prescription script.
I thought about this conversation all week. It pained me to realized how much components of the system we have created to better care for patients — technology, templates, systems of diagnoses, scheduled time — can inadvertently create barriers in the human-to-human connection necessary to provide such care. It made me realize that as physicians, it truly is our responsibility to advocate for our patients by minimizing these barriers. It is not the patient’s responsibility to somehow surmount the complexities of a system they have been made subject to. It is our responsibility to consistently, intentionally invite patients to share with us who they are and the care that they need. It is our responsibility to take our eyes away from the screen and hands away from the keyboard, and instead lay them on the patient — to say I see you and I hear you as a person and not just a case I have to document.
