I sat opposite her, the cracked leather on my rolling stool crinkling as I leaned forward. My eyes locked on the upside-down words scribbled on the paper that was torn from my preceptor’s notebook a few moments prior. Dear God, my patient wrote, I am grateful for this life.
When I arrived at preceptorship that Tuesday afternoon, the physician I was assigned to told me I would be completing a patient history on my own. As a first-year medical student with minimal unsupervised patient experience, I felt my comfort zone being stretched. Had my preceptor instead told me to swim with sharks, I probably would have been equally as nervous.
At that point in my medical education, I felt closer to being an actor than a doctor. In our first-year clinical skills classes, we experimented with standardized patients in simulation labs. We would masquerade as ‘doctors,’ blurting out the first thing that came to mind. So, when my knuckles grazed the door, anticipating my knock, knock on exam room 2, I took a deep breath and pretended I was, in fact, an actor.
My patient and I made the smallest of small talk before I dove into what brought her to the clinic. She had been experiencing shortness of breath and heart palpitations. She spoke to me about her young daughter, her recent move and her lack of social support. Her rambling sentences reminded me of myself. As I felt my own heart pounding in my chest, I listened to hers with my stethoscope. We were both tachycardic.
Soon after I had exhausted my list of questions — repeating myself several times under the guise of thoroughness — I returned to my preceptor. We debriefed my findings and discussed differential diagnoses. Panic attacks were at the top of our list.
The clinic where we were working treats the uninsured and underserved in the community. Referral to psychiatry was not a simple click in our patient’s chart. Financial, social and personal barriers complicated this; a psychiatry consultation was not an option. We needed to find an alternative solution.
Upon re-entering the exam room, my preceptor asked a few directed questions to gauge our patient’s comfort level. Our goal was to find a stress-relieving strategy that was easily accessible and endorsed by the patient. The mention of yoga, meditation and tai chi were met without a response. But then, What about journaling? This struck a chord.
We spent the next few minutes discussing the benefits of journaling and writing statements of gratitude. My preceptor urged our patient to write to whomever or whatever she believed in, whether that be God, nature or even herself. She tore out a page from her notebook and handed it to our patient who immediately started scribbling away.
As a physician, I hope to meet my patients where they are. In times where productivity is quantified and can be held against us, it can be difficult to justify going against the grain. However, personalized patient care does not have to come at the expense of productivity. By involving our patient in her care plan and seeking her input, we found something she would actually follow through with and benefit from. The extra few minutes it took to reach this consensus was time saved down the road.
Maintaining an open mind is something I hope to cultivate throughout my career. All patients come to us with unique backgrounds and circumstances. Prioritizing listening and observation can help us pick up on subtle cues and can allow us to shift how we proceed with their care. Always advocating for our patients’ best interests is our duty and can make all the difference. As medical professionals, we have the responsibility to continuously learn and do right by our patients. For that opportunity, I am grateful.
Image courtesy of the author Christine Zickler.
Contributing Writer
Florida International University Herbert Wertheim College of Medicine
Christine Zickler is a medical student at Florida International University Herbert Wertheim College of Medicine in Miami, FL, Class of 2026. In 2020, she graduated from the University of North Carolina at Chapel Hill with a bachelor of arts in english with a concentration in creative writing. She enjoys long walks by the water in her free time. After graduating medical school, Christine would like to pursue a career in surgery with a focus on the pediatric population.