Building trust, one patient at a time

by Lorien E. Menhennett

Sneaky.

That’s what my patient called me yesterday.

He meant it as a compliment. I took it as one.

I’ll back up, and explain the context of this clinical encounter. Yesterday was our final OSCE of the semester. OSCE stands for Objective Structured Clinical Examination. That’s a long way of saying we get videotaped interacting with a standardized patient, an actor who’s trained to play a certain role and then provide us with feedback about how we did. It’s a required part of our medical school curriculum. It’s how they assess our developing clinical skills. We’ve had several OSCEs since starting medical school, but yesterday was the culmination of our three semesters thus far. Up until this point, we’d only done bits and pieces of the standard history and physical exam. This time, we had an hour for the whole thing, from the chief complaint (why are you here?) and history to a head-to-toe physical exam.

I was nervous. In part because being filmed intrinsically makes me nervous. But also because this was a lot to remember. It matters, and I wanted to do well, to take the exercise seriously. Because in a couple of months, I’ll be doing it for real.

But once I settled in with my patient, I was fine. While taking his social history, I learned he was from Chicago. So I delved into that a little more. We talked about the differences between New York and Chicago. We joked about particularities of the Upper East Side. And then I attempted to gracefully move on to the TED questions — tobacco, ethanol (alcohol), and drugs. Sexual history was next. These two groups of questions are some of the most touchy. My feeling is that if you have the time, it’s a good idea to get to know the patient a little before asking those questions. Not only that, I simply enjoy hearing other people’s stories. What is someone else’s life like? Where have they been? How do they approach the world? It’s the curious reporter in me.

And that, my patient told me, was sneaky. In a good way. We were talking about Chicago and then all of a sudden you were smoothly on to more history questions, he said. By talking about his life, he told me, I’d developed a rapport that made him feel comfortable answering those delicate questions.

Not everything went so smoothly. I have lots of room for improvement. I need to find the right balance between spending time on those life-questions and spending time on the rest of the physical exam (which I didn’t quite finish within the hour).

But I’ll get faster. I’ll become more efficient. Those are skills I can learn, and will learn as I make my way through clerkships in the hospital. That I know how to earn someone’s trust — I think that’s more important at this stage. At least for me. The rest will come.

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