I walked up the stairs in my heels, white coat and stethoscope, which I had no idea how to use, on the first day of my first clinical day two weeks into medical school. The question of whether I belonged in a position of authority felt more prominent than ever as patients in the lobby passively asked me about their treatments and I waited for the staff to return from their lunch break. I told them we were in this together as we waited in the lobby, equally anxious to learn how to address their health concerns. The notion of the door to the back office serving as a gate to information reminded me of what it feels like to be on the wrong side of the monopoly of medical knowledge. I wondered what it would be like to join the inner circle and remove that gate after becoming a physician. That is a problem for a later day, I determined. Today, my goal was to shadow a patient.
After the staff returned, I met with the practice manager, five medical assistants (MAs), three residents and my preceptor. The practice manager quickly set up my electronic medical record (EMR) login. The other staff members rushed in to ask her about prior authorizations and the synchronization of blood pressure cuffs to their system. The MAs gave me a breakdown of the typical insurance in the office, and the residents shared the challenges of their medical education. My preceptor soon became busy onboarding a new physician assistant and reviewing charts as part of his role as a practice co-owner. As I got acquainted with the practice, I prepared for my first assignment: learn from a patient. I returned to the lobby once again to find my patient teacher.
A man sitting alone in the corner made eye contact immediately, his eyes on the door. He scanned my white coat nervously as I approached. The man I call “John” told me I was welcome to learn from him and dove into his story. John told me about his time in Afghanistan and how he always checks the exits and entrances immediately upon entering a building. He recounted saving pigs while his commander shot them in front of him, watching friends die in combat and enduring moments filled with thoughts of nothing but blood. He said these memories amplify his depression, anxiety and post-traumatic stress disorder. He mentioned that he saw a different physician each time he went to Veterans Affairs and that social services referred him to my preceptor after a pulmonary embolism and mismanaged psychiatric care.
He continued to talk to me, making intense eye contact as MAs called his name from the lobby and took his history in an exam room, discussing sensitive topics while focusing on the computer. Sexual history, medical history and the question of John’s occupation came and went in ten seconds. The medical assistant left, and I talked to John for another hour as we waited in the exam room for my preceptor. I asked John about his other experiences with medicine. He told me about his two daughters. He struggled to find pediatricians for them due to his anti-vaccination beliefs. He explained how no pediatrician was willing to take them on, despite one of his daughters crying herself to sleep every night without apparent physical abnormalities. He said medicine had failed their family, and he hoped this experience would be different.
My preceptor came in to introduce himself and discuss the next steps in onboarding John as a patient, including routine blood work and an appointment for a comprehensive physical exam the following week. My preceptor came and went in a swift five-minute visit. I felt frantic; my preceptor did not know how distrustful John was of the system, how fragile this interaction was and how this man could leave and never come back. My preceptor technically did nothing wrong, but I felt disillusioned with a system that tried to put this man’s complex worldview and barriers to healthcare into a 50-word blurb. Before John left, he turned to me and said he would have left ten minutes into waiting if I had not been there. Despite having extremely limited anatomical, biological or medical knowledge, I recognized the power of listening. The experience was incredibly impactful in demonstrating how many patient experiences are not immediately obvious. John’s comment about leaving if he had been alone taught me the need for volunteers, social workers or staff to keep patients company during visits in outpatient settings. I am unsure how physicians navigate such limited time with people who carry so many obstacles to healthcare in their past and current personal beliefs towards medicine.
After shadowing John, I switched to shadowing my preceptor until 5 p.m. During this time, I watched him remove a toenail, counsel a family about moving their father into hospice following a stage 4 cancer diagnosis, advise someone to go to the emergency department and inform a patient that their ear pain was due to a pimple. He swiftly entered rooms, talked to patients and addressed their concerns. His simultaneous crisp and comforting dialogue left me in awe. Despite my preceptor’s ability to efficiently see and comfort patients, John will stay with me throughout my time as a medical student as a reminder that patients are more than a five-minute visit, regardless of smooth work flows. John’s patience in detailing his past experiences greatly helped me understand him. John taught me not to assume a patient’s path to seeking medical help is straightforward and to listen to patients’ stories when time allows.
Image Credit: “Doctor chest with stethoscope in pocket” (CC BY 2.0) by AuthorityDental.org
Contributing Writer
Texas Christian University Burnett School of Medicine
Martha-Grace McLean is a medical student at TCU Burnett School of Medicine in Fort Worth, TX class of 2028. She graduated from University of Florida with a Bachelor of Science in psychology in 2023. She enjoys reading, running and painting in her free time. After graduating medical school Martha-Grace would like to pursue a career in pediatrics.