The upside to students and residents. Sometimes I have fun at their expense.
I miss my family doctor.
That sounds like a really weird thing to say, seeing as I just saw her on Thursday, but I miss her. Because I haven’t seen just her in months. My family doctor teaches medical students and family medicine residents, and since last July I’ve only seen just her a couple of times. I’ve seen at least seven students in the last year, but there are probably some more that I’m forgetting. And I’ve had four appointments in a row now with students. So I miss her.
I mean, I still see her, but it’s not the same. When there are students, the appointments take twice as long, but I have probably less than half the usual time with my actual doctor. I’m very used to students and residents in the hospital, but it’s different when I’m seeing my family doctor. She’s the one who already knows everything and so it’s supposed to be easy. Students make it more complicated.
Anyway, I’ve seen a lot of students lately. And I have a lot of thoughts about the whole thing. And if I could talk to medical students everywhere this is what I would say.
You all generally have one of two reactions when you start talking to me about why I’m in front of you.
Some of you are quite obviously not interested in having me as your patient. I’m sure there are lots of possible reasons for this. I can guess at a few…you’re not interested in family medicine; you’re tired and you just want an easy patient; you’re uneasy because I know more about my conditions than you do; you’re put off because before you walked in my doctor straight up told you that I know more than you do; you’re hungry; you’re overwhelmed because med school is stressful…and I’m sure there are a dozen other reasons that I can’t understand because I’m not a med student.
I don’t hold it against you that it’s pretty obvious you don’t want to deal with me. Just keep in mind that if you’re not interested in dealing with me then I have no interest in dealing with you. I’d rather just see my doctor, so let’s hurry this up so she can come in.
Most of you have a very different reaction.
You are super interested and intrigued by me. I have conditions you’ve never seen before, maybe you haven’t even heard of them before, and this is exciting to you. I get that because I, too, am fascinated by the human body, how it all works and how it all goes wrong. I like that you’re eager to learn everything you can to be the best doctor you can, but please realize that what is a “really cool diagnosis” to you is less cool for me. Learning about rare and difficult to diagnose conditions is one thing, living with them is another very challenging, isolating and all-consuming thing. Please remember that. If you ask me whether I’m working or going to school, I will tell you that my job is keeping myself alive. And I really mean it. Please respect that.
You ask a lot of questions, and not just about why I’m in front of you on this particular day. I understand why this is necessary, because I’m never there for something straightforward, but rather something related to something else going on. You need to ask a lot of questions to get the whole picture. And then some, because I’m there to talk about a medication and now you’re asking me about disability rates in BC. Oh but wait, I can’t eat? What’s that like? Isn’t it hard to watch other people eat? How does TPN at home work? And where exactly does my central line go?
Again, I appreciate your interest in learning more. I like that you’re asking questions that medical professionals don’t usually ask me. They all know I can’t eat, but none of them ever ask me what that’s actually like. That said, I know my appointment time is limited. I would love to talk to you about all these things, and I wish there was enough time to cover it all, but there’s not and I need to get what I came in for. Yes, I want you to learn from my case, but I’m here to be a patient, not a teacher. And I know that you’re a student, but I also need you to be my doctor. I’ll be both if you’ll be both.
Since I mentioned my central line, can we talk about that for a second? Yes, TPN is amazing and it’s very cool that science has figured out a way to keep me alive even though I can’t eat. Yes, it is awesome!
It’s also terrifying. My life is on the line so that I can live. Let that sink in for a second. I’m fairly certain your reaction would be a lot different if you learned someone’s central line was in place for chemo. You would immediately understand that they had been through a lot, but it’s important you understand that I’ve been through a lot, too. I didn’t just end up here. I’ve had a lot of tests, a lot of procedures, and I’ve spent a lot of time in the hospital. And I will never be on the other side of that, but rather it will always be part of my present.
I just need you to remember that I’m a person. I’m a page of a textbook come to life on the exam table in front of you – footnotes, glossary and pharmaceutical information included, but I’m still a person. I’m your patient. I came to see a doctor. Actually, I came to see my doctor. That’s who I really want to see today.
And I don’t intend that to be mean, but you being here has me pulled in two directions. On the one hand, I really support and believe in your education, and I understand my role in that. That’s why I will always be cooperative, patient, and answer all your questions. Besides, if you’re going to learn from someone I want you to learn from my doctor because she’s excellent.
But on the other hand, I’m sick and I’m tired. I’m here because something is wrong and telling my entire story to someone new for the sixth or seventh or eighth time is exhausting. I don’t want to explain everything to someone I’m never going to see again. I just want to see the person who already knows everything.
When all is said and done, though, I know you don’t have an easy job and I don’t resent you doing it. I know you’re doing your best to be both a student and a doctor at the same time, all while trying to learn everything about everything. That can’t be easy and I want you to know you’re doing a good job.
So you keep doing your job, and I’ll keep doing mine, and we’ll go from there.
Finding my Miracle 
Thank you very much for this insightful post. As a medical student, I appreciate the massive privilege we have of being able to spend time with lovely people such as yourself. Your selflessness and patience as a patient never goes unappreciated but again thank you for helping us, the future doctors, in our journey to become just as good than your family doctor. From my point of view, it sometimes feels like I’m getting in the way whenever I’m asked to speak to a patient. None of us want to cause any patient grief or pain by talking to them. However, as you’re aware, patient contact is a major pillar of our learning. As a 5th year student now, I have had my fair share of patients refusing to speak to me over the last several years. Perhaps because they, understandly, feel as you do. I have never taken refusals personally so I would get definitively urge you to say ‘no’ (if you so choose) next time your doctor asks you to speak to a student. I will continue to make it a personal mission to ensure patients that I speak to have given informed consent before I speak to them. Again, thank you and I wish you the best.
Hi there! Thank you so much for that thoughtful and sincere comment. I really appreciate getting to hear a bit more about what this situation is like from your perspective. I actually saw my family doctor a few weeks ago, for the first time in months, and she didn’t have a student with her that day so I got to chat more with her about it. She hardly ever takes new patients and took me on as a favour to someone else less than 2 years ago, so she assumed all her patients knew they could request not to see a student if they didn’t want to that day, and she felt badly that I didn’t know that was an option. Now that I feel permitted and empowered to do so, and now that I know I will be able to get a break from time to time if I ever feel like I need it, I think the entire situation will be a lot less stressful for me. And so I think, as you were saying, open communication and consent is key to making a more comfortable experience for patients AND students. And please know that I have so much respect for what you’re doing, and even more respect for your openness and willingness to learn from patients. All the best to you, too!
This makes me so happy to read. I’m glad you feel empowered now. Everything healthcare professionals do is geared towards the patient’s best interests. I had a patient today who didn’t want me to take her bloods (a skill I’m very competent in and capable of) and I smiled and made a joke: “I wouldn’t want a medical student taking my blood either!”. It was a nice bonding moment and neither of us felt uncomfortable 🙂
I love that – it was the perfect way to make your patient more comfortable, and assure them that it’s okay to say no. P.S. you can take my bloods any day haha
Haha I appreciate that Catherine!
Ah. Med students. I oddly enough, on a tiny level, know what you mean with this one. My GP teaches also. I can’t count the number of maternity appointments I’ve been to between my three kids where med students have lined up (literally) to practice measurements on me. All have to take my “history” ahead of time (uncomplicated as it is, still annoying). And let’s not forget the one who, while likely seeing a pregnant belly for the first time, exclaimed “What the heck are those??!” in reference to my stretch marks. The look on my doctor’s face was priceless. She was completely mortified and embarrassed and held her breath while waiting to see how emotional my pregnant reaction would be. I laughed out loud. All this said, I am run of the mill, and healthy as a horse. And yet, it can still be very aggravating, and must be so much more so when you are actually unwell and feeling poorly. Our clinic is usually pretty good about telling me when I book my appointment, that there are med students in that day, and is it ok by me? And you’re right, they need to learn. And they need to see things that are complicated in order to become effective. But you have travelled a long road. I don’t think anyone would blame you if you asked when you made the appointment if there are med. students in, and if so, could you please simply see your doctor on her own. It’s absolutely to ok to put your own needs first sometimes. And just because they don’t get first hand access to you, they won’t necessarily miss out. Your doctor can still use your case and diagnosis as a teaching opportunity. Maybe just in a different way.
Oh Catherine, I could hug you for those words. You explain it so beautifully and I can relate to your position.
I can picture the scenario now where you are answering the question about your job status as literally “keeping myself alive” in all seriousness and the student is smiling and chuckling assuming it’s a joke and nodding in praise of your humour. Do I see quiet steam rising from your indignation about their dismissive, insensitive reaction?
All those questions – do you have a business card with your blog details on it? Maybe they should start right there with your blog and it might save you some energy. (Friends of mine made up business cards listing their child’s multiple food allergies so that when they eat out, they can give them to the chef in advance to avoid miscommunications. It was a convenient and easy reference for everyone.)
Patients in South Australia have the right to refuse consultation with a student but I have only exercised it once when I was utterly exhausted. I usually agree because I feel it is in my own interests (and the interest of other people with similar conditions) to raise awareness and understanding. Also, these students are there with an open mind and willingness to learn most of the time so they are very receptive to our sharing. I would rather they get their information from expert patients than some academic professor whose theoretical book knowledge or attitudes may be out of date and out of touch.
Even so, patients shouldn’t feel obliged to be someone’s ‘teachable moment’. Participating every time (or even one time) can be so exhausting physically or emotionally to our own detriment. We have the right to say ‘no’, to protect our wellbeing and to get the service from our GPs and fully qualified specialists when necessary.
P.S. I hope they don’t charge you extra for extra time taken due to being their teacher – surely they should pay you for your teaching time or maybe get a discount? 😉
Very good points! And I’m in Canada so I don’t pay at all for doctor’s appts 😉
I’m just re-reading this Jodie, and I’m liking your idea about business cards with my blog on it. I think I might do that, and if the student is really interested in knowing more I’ll just direct them here. Thanks!
I think it is exhausting & taxing on me to have a student see me. I understand that they have to learn, but I hate going through my medical history all over again. I only have so much energy & patience. I hope that you get to see your actual doctor soon.
I’m so sorry I haven’t emailed lately. Things have been rough & trying for me this past year or so & am now doing HPN 20 hours on & 4 hours off. It has literally saved my life.
So Catherine, you Do NOT have to consent to have students see you!! U can opt out!
I would do that if I were you. I have done this once myself, when as an RN, I just could not handle having an exam by a resident! I said No, I was here to see the specialist that I was referred to.
They will respect that.
Elaine.
Thanks Elaine – I will keep that in mind!
Dear Catherine
I just forwarded this post to a BPK student that will start Med school in the Fall.
I know he will appreciate this article and many of your others.
Love always,
Darleen
Dear Darleen – happy birthday!!And also thanks 🙂
Ah Catherine, I’m always so moved by what you write. I don’t often find words to tell you. You have such a gift of insight, self-awareness and wisdom, mixed with wonderful, loving, wry humour. Please will you consider weaving all your blogs into a book one day? I think every medical student should have it on their compulsory reading list but it would be a wonderful gift for everyone with long-term health issues. Actually the last 4/5 words after ‘everyone’ are superfluous. Wishing you a GP appointment all to yourselves – as I don’t doubt for a moment that she misses you too! Thank you xx
Thank you so much, Angela! Your words are perfect. And hehe my doctor called me back in to go over some recent test results and I strategically made an appt for a day that I don’t think there will be a student 😉
Oh brill! Hope the appt and those results give you both some hopeful clues. (If a student were to turn up they need sending for a rare cup of tea xx)
A rare cup of tea haha I will keep that in mind!
Perhaps you could have a quiet word with your GP or maybe post this blog entry to her (saves retelling it). It may give your GP an opportunity to brief students before they see you so that they are more sensitive to patient issues. Who knows, she might actually give them a copy (with your permission of course) to consider well in advance. Job done!
Another thought provoking excellent piece of writing.
Thank you Catherine! Excellent as always- You have a gift dear girl.
All residents should have to read this.
👏👏👏👏