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The Journey Down the Medical Rabbit Hole

Pursuing a career in health care has created opportunities I could have never imagined possible, welcomed or not. The bond a physician has with his patient is not something that can be recreated in any other field. Prior to medical school, I knew I would be exposed to situations and learn the intricate privacies that most people do not have the blessing to learn. But of course I could have never predicted how deep the rabbit hole would go in terms of connecting with my patients.

My first rotation during third year was pediatrics. I felt very fortunate that I connected well with my patients and their parents. I have a personality where everyone is my friend; I have felt that if I display trust towards my patients, they will reciprocate and trust me back. In pediatrics this mentality works very well, but I also run a big risk of getting into trouble. Rather than rewarding myself with a reflection on why most encounters in pediatrics have luckily come with ease for me, I would like to reflect on my most difficult patient in peds. One who did not inherently trust me.

I walked into the waiting and called for Mr. John Smith. To my surprise Mr. Smith was a 50-year-old full-grown man, not a boy or young teen. The office I worked in specializes in ADHD and every so often continues to treat adults who were initially diagnosed in my pediatrician’s office. My usual smile and bubbly personality that would normally make a nervous child feel at ease backfired immediately with Mr. Smith. The exam began with him measuring his own height and weight, and then arguing that I took his blood pressure incorrectly. When interviewing him, he would respond with one-word answers, roll his eyes and make comments like “now you’re catching on.” About five minutes into the interview, I discovered that Mr. Smith had been noncompliant with his medication for the past two months because he was incarcerated. I questioned why he was in jail, to which he responded bluntly, “For assault.” I clearly was not prepared for this answer and I began to think more about myself, my security, and how I got in the situation of being in a closed room with a criminal between me and the door. In an attempt to conceal my loss of words, I began to take ‘notes’ on what he just said. Big Mistake. Mr. Smith then became very defensive, questioning why I was writing down that he was in jail. In my most calm manner, I tried to explain that everything I write down gets shredded, and it is ultimately the doctor’s decision on what goes into his chart. I tried to further rationalize the situation by explaining his criminal record is important to know for prescribing ADHD medications, but in his mind the interview was already over. And what disappointed me the most was not his behavior, but mine – I felt relieved to end the interview prematurely and postpone the physical.

When I left the room, I was bombarded by female staff telling me, “I can’t believe you decided take him,” “He’s known to hit on the female staff,” and “As a physician, I refuse to see him – he makes me feel uncomfortable.” I realized I was not the first person to have trouble with Mr. Smith. Rather than feeling safety in numbers, I immediately felt disappointed in myself. The patient had been cast out by multiple staff members over the years, as well by his family and the police. No wonder he was so defensive with me. When I returned to the room with the physician, I made it my priority to listen to the patient’s story, sympathize with his situation and be objective. He and I then talked for 30 minutes. I learned all about the jail system, his beliefs on life, the meaning behind his most recent tattoo, the friendships he had made in jail, the friendships he lost outside of jail, that he was a victim of domestic violence, that he is now the perpetrator of domestic violence, that he has a restraining order from his wife, and that he is having trouble re-acclimating to life. At the end of the interview I didn’t necessarily feel more comfortable with my patient, but I knew he felt more comfortable with me. He thanked me for letting him open up and wished me good luck in the future. And I wished him the same.

With just one short month under my belt in my third year, my eyes and mind have been opened to a much deeper level. I always knew that with the white coat comes the responsibility of knowledge, guidance and confidentiality with your patients’ health. But ‘health’ has taken on a new meaning for me. And I’ve come to learn that the provider’s role has many creative shapes and forms, depending on the patient’s needs at that time. The patient I examined has experienced many battles in his life, and I learned it was wrong of me to judge his past and present. In that moment, I was his caretaker: it was my duty to listen to his story and to ensure that he was getting the best care for his mind and his health. Finding the fine balance between connecting with my patients and separating my emotions and opinions from my patients will be something I will have to work on every day in my future career. It’s going to be a journey, but I’m excited to be on the right path.