I’ve interviewed a lot of patients by this point in my education. I’ve established a good rapport with many of them. However, it is a rare event for me to really connect with a patient, and that happened to me the other day at my outpatient pediatrics site.
The patient was a girl that my preceptor said was “a character.” He said he often struggled to get a good history and physical for her, and he hoped that I might be more successful. Her problem list included a few mild psychiatric diagnoses. He introduced me to the girl, and left me to get started. We chatted about all the typical things – school, diet, home life, and recurrent complaints. As we talked, it was apparent that she was extremely talkative and opinionated. She showed herself to be very bright, talking about her high grades, her reading habits, and her eclectic hobbies.
My preceptor popped back in the room briefly and said I should start the physical by listening to her heart and lungs and then he would be right back. Once he stepped out of the room, however, he was sucked away into several other rooms. He didn’t return for a long time. So I sat in the room, trying to make conversation.
Between conversations, when there was a lull, I would hop up and do a portion of the physical exam. Because I had so much time and the atmosphere was so relaxed, it was the most complete history and physical I’ve done in ages, and it was actually a lot of fun.
The neat thing was how much of a connection we had. She was someone I think I would have been friends with if we were in high school together. She reminds me of myself as a child, and reminds me of my boyfriend and some of my friends. I worry though, that she has been saddled with some heavy medications to manage her conditions. I had a hard time deciding if she really had any psychiatric problems or if she was just a normal, if a bit anxious and socially awkward, teenager. I hope that people appreciate her for her skills and talents and quirks and charms and don’t stifle her with medications unnecessarily.
The downside of third year is the lack of continuity. It is unlikely that I will ever see this patient again, and I wonder what will happen to her. There are many questions I have that will go unanswered. At least we were able to have a good talk, and hopefully my preceptor will be able to sustain a good connection with her in the future.
