“I just don’t feel well. I have no energy or mental focus. I’ve been to so many doctors and no one can figure out what’s wrong with me. Every test that comes back normal makes me feel less likely that I’ll ever find an answer.” As a third-year medical student, this was one of the scariest things a patient could say to me. If all of those other doctors with many years of experience could not figure it out, how could I? Was I just going to be another name on the long list of people who could not help this patient?
I was doing my rotation at an endocrinology outpatient clinic when I came across Mr. B. He had gone to every doctor he could think of and ended up at our clinic with a family history of a sibling with hyperparathyroidism, but after all of the bloodwork and scans came back normal, we had to come up with something else. Being a medical student, I usually go in first to gather a history and present it to my preceptor before we go in together, but this time was different. I was with another patient while my preceptor went in to talk to Mr. B, but when I came out to present my patient, my preceptor asked me if I would be interested in talking to him. “No one has been able to give him an answer as to what’s wrong with him so far, and he was curious if you had any ideas. Just go talk to him, no pressure, and see if you can come up with anything,” my preceptor said as she gave me a pat on the back and left to see the other patient waiting. “Me? Why would the patient want to talk to me — if my preceptor couldn’t give him an answer, what could I possibly contribute?” I thought as I walked towards the room.
Up until that moment, I had been really struggling and only a few people in my life were aware of what I was going through. My third year had not been going as planned and on most days I was questioning my purpose in life, which I had once been so sure of. “Am I smart enough? Am I capable enough? Am I strong enough to keep going and finally get through this rough patch to reach my goal?” These were only some of the questions that were constantly running through my mind almost every waking moment except for when I was with patients. Despite all of my struggles, shortcomings and self-doubt, my patients and preceptor saw something in me that I failed to see in myself. Over the year, many of the patients I had seen felt compelled to tell my preceptor how good of a job I had done. They had worked with other med students before and I was one of the best. Some even asked her how long I would be with her and if they would be able to see me again. Best of all, my preceptor would not skip a beat to agree with them. Though I just could not understand what it was they saw in me, I wish I could tell them how much those kind words meant to me and how on the days I felt the most worthless, their words were what got me out of bed, knowing that I had done something right and made the slightest difference in this world.
I took a deep breath and walked in. I introduced myself to Mr. B as I took a seat. “So, my preceptor gave me a quick summary, but I want to hear it from you, so start at the beginning and tell me what’s going on,” I said. He was my last patient of the day and my preceptor felt that I had seen enough thyroid and diabetes cases so she told us to take our time, and so we did. He told me about all of the different doctors he had gone to, all the tests they’d done so far, everything they thought it was but ended up not being and how after three to four years of going through this all, he felt like he may never find an answer. He told me that he was a retired pharmacist and had been doing his own research, trying to find anything he thought might help to mention to a doctor. So, of course, I asked, “Do you have any ideas?” and he did. It took us two tries to reach a very plausible cause. He had brought it up to his PCP before, but there were more plausible causes, so it was further down on the differential list at the time. I was doing research as we were speaking, trying to figure out a diagnosis, only to find the perfect fit, symptomatology, timeline, cause, etc. “I am but a med student Mr. B, so I can’t formally diagnose you, but I will talk to my preceptor and print out some information to take to your PCP to see if she agrees with what we came up with. Don’t lose hope just yet,” I said with a smile as I left the room to talk to my preceptor. When I came back to the room with my preceptor, I could see that Mr. B looked the slightest bit more relieved and relaxed. We did not give him a final answer, but we gave him hope for one, validation that what he felt was real and reassurance that we were not going to give up on him just yet.
There is often so much to learn in medicine in so little time that some things may not seem as important, but interactions like these are what remind us of them. We may be the experts on medicine, but patients are the experts on their own bodies. If we fail to include them and value their opinions and reasons for seeking care just as much as our own, we may end up doing more harm than good. Patients are in an extremely vulnerable position when seeking our help; it may not be life-threatening or even be anything at all to us, but if a patient made their way to you, it is because they felt it was important enough to seek help. Sometimes a simple validation or reassurance can make a world of a difference to them. Just because someone who has more experience than you cannot figure out the answer to a question, that does not mean you will not be able to either. Quality health care requires teamwork because each member, including the patient, provides a different perspective that helps us reach the final answer. Lastly, people who believe in you do so for a reason. You may not know it in the moment or ever, but trust that you must be doing something right.
My struggles are far from over, and some days it will still be hard to get myself out of bed. Mr.B reminded me of my purpose that day, and I am forever grateful to him for having given me a chance to make a difference in his life.