Learning to care

The penny dropped during a second year medical student tutorial on history taking.  The task was dealing with neurological symptoms, and improving empathic skills in consultations with patients.  A wow moment for me! Anna, role-playing the doctor, reflected ‘I was not caring enough in my interviewing’.

Is it not this caring that underpins the work of a truly practicing GP, or indeed a doctor in any branch of serving patients? And is it not true that many of our youngsters applying to study medicine give the wish to care as their motivation in the first place?

My husband, a fellow GP/Tutor and I often debate the merits of the structured interviewing skills that medical students are ‘taught’ from very early on in their course. Is it creative to streamline these fresh youngsters into such thought patterns so early on? While they learn to perform to ‘taught’ consultation, and communication styles, what actually happens to the caring process within each of them? And how motivated does our teaching leave them eventually?

In our student days both of us had enjoyed exploring and developing our own styles of conversing with the patient, listening to their histories, sympathising with their predicaments, empathising, even crying over their ordeals. We were both so different as young medical students. At the same med school where we now teach, there was much diversity in how we dealt with this amazing interaction between the ‘sick’ patient and the doctor that we call a consultation.  My husband to be came from downtown Birmingham with an accent I disliked and I was a Ugandan refugee. English was my fifth language. We listened and spoke to our patients in such different styles. And perhaps it was just this rich promise of variety of consultations that attracted us both to becoming General Practitioners.

Back to Anna: in her first run of interviewing, she spoke to George an 80-year-old patient presenting with dizziness.  Anna had actually covered the basic elements of history taking quite thoroughly. George, played by her fellow medic, was  just as much in the learning seat as he acted to unfold the history of a patient 4 times his own age.

 The other ten medics observed as Anna asked George all the structured questions she could remember relating to the presenting complaint. Anna also attempted to weave in good communication skills with her patient, such as signposting. Each observer in the tutorial commented on how Anna engaged these different communication skills. The group also looked at different causes of dizziness.

As the tutorial progressed, and the whole group tried to understand why George had presented now, the impact of  his dizziness began to dawn. His wife was so concerned that she was planning to ban George from his favorite hobbies in the garage and allotment if he fell.  

At last, this dawned on Anna. The dizzy spells risked making George almost housebound! In her initial attachment to sticking to the ‘protocol’ of consultation/communication skills, Anna had missed unraveling the main reason behind George's visit.  She risked not meeting the patient’s agenda, or indeed his wife’s, if she remained only focused on the neurology, or ‘disease’ aspect of the interview.

In her realization though, Anna’s learning point was achieved and she did care!