Observation doesn’t mean we can’t improve patient care
Have you ever been in a clinic or on a ward round and found yourself thinking, “If I were that patient, I would have no idea what this doctor is talking about”? Or sometimes you might think: “If I have no idea what the doctor is talking about, how on earth is the patient expected to understand?” I have found myself in this situation several times, and it often crops up in conversation with other medical students.
In these circumstances, there is not a lot that I can do to help patients. Sometimes if the doctor leaves the room and I think I have understood the situation correctly, I will try to give them more information. But, more often than not, these types of consultation end unsatisfactorily, with patients politely accepting an explanation they are not happy with and leaving more confused than when they first arrived.
I remember being in a paediatric clinic where the parents of a patient were asking for clarification as to whether their daughter would need surgery. The registrar didn’t seem to know, but indicated the young girl might require an operation. While he went to get his consultant for confirmation, the parents turned to me and a fellow medical student to ask if we knew whether she needed the operation. Not wanting to provide them with false information we had to admit we didn’t know either, and thankfully when the consultant arrived he was much clearer on the matter. However, by this point the look on the parents’ faces and the angry tone of their voices suggested that they had lost confidence in the care their daughter was receiving.
So what ways can medical students help those patients or relatives who we can see are puzzled by what they are being told? Going against the authority of your consultant and telling them “I don’t think that was very well explained” is unlikely to be well received. In clinic it can be difficult to help a patient who looks confused, and each situation is highly dependent on the consultant teaching you. But if your consultant does ask if you have any questions it can be useful to summarise the outcome of the consultation and go over the key points you thought might have been confusing for the benefit of the patient.
Another opportunity as a medical student to be better advocates for patients is on ward round. These are often hectic occasions where the consultants are pushed for time, and patients can look rather bemused when a team of people breeze in and out of their bay. Afterwards I have often found myself going back to see patients who seemed unsure of their management plan, or who had retrospectively thought of a question they wanted to ask.
Time and resource constraints mean that doctors are always under pressure to see patients as quickly and efficiently as possible, and sometimes it feels as though this is the source of hurried or unclear explanations. When a doctor’s communication has been a bit lax it takes patients with conviction and determination to press them and ensure they get the answers that they want.
As medical students we are able to take a step back and listen to the consultation more from the patient’s perspective. It is important for us to recognise examples of good and bad communication so that we can emulate good communication when we are leading a consultation. When I become a doctor and a medical student is sitting in the corner, I’d like to think that I’d be able to put myself in their position. I want them to think that I’d done a good job. Even better, I would like them to think I’d involved them and even asked for feedback on the consultation as well as offering to teach them. How easy that will be to do when I am faced with a busy ward full of people remains to be seen.Hannah Tobiss, final year medical student
1University of Nottingham, UK
Correspondence to: firstname.lastname@example.org
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2014;22:g6746