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Journal of Postgraduate Medicine, Vol. 55, No. 1, January-March, 2009, pp. 72 Students Corner The Student-patient relationship: A student's perspective on the grey areas Kulkarni GauravV Seth G. S. Medical College and K E M Hospital, Mumbai Code Number: jp09017 The clinical rotation which commences in the second year of the undergraduate course in India is a defining moment for most students. Aspirations in glittering careers in clinical medicine sprout from these humble beginnings. Seeds of transition from a medical student to a doctor are sown here. The initial phase of observational contact with patients in emergency situations or sufferers of chronic ailments is vital in molding the theoretical mind in a more practical direction and leaves an indelible mark. This neo exposure to the suffering populace gives rise to the student-patient relationship which is quite distinct from the doctor-patient relationship. [1] To begin with, it is not as well-defined an entity like the latter. Adding to this is the absence of correct technical briefings of the unwary students as regards their boundaries, scope and limitations. This leaves the magnitude of this adaptation open to personal interpretation and the young minds are faced with dilemmas. [2] There is a thick red line between being an inquisitive undergraduate and parading as an incorrigible ′know-it-all′. Half knowledge is dangerous. But sharing this half knowledge with patients may be even more catastrophic. Oncology cases deserve a special mention here as the presentations range from incidental findings to disseminated disease. Students seldom delve into the intricate details regarding staging of tumor pathology. However, this lacuna in their knowledge does not deter some from offering surprising estimates of prognosis to patients at first glance, which even a vastly experienced surgeon might refrain from committing to without further evaluation. An overconfident approach on the beginner′s part may fuel unreasonable expectations from patients. At the same time a timid, over-guarded or overtly emotional approach may scare a patient with curable diseases into believing he is nearing the white light. This culprit approach may remain uncorrected as that batch of students may move on to a new rotation of postings before it is realized by the faculty. Mere mention of the word ′tumor′ during elementary level differential diagnosis for the sake of academic discussion amongst students may be enough to set off the alarm bells ringing in the psyche of an alert patient. Here I am reminded of an incident where a patient with renal cell carcinoma presenting as ′lump in abdomen′, pointed out to the discussing group of students that his chances of survival were not ′slim′ as they thought, since he had already been informed by the treating doctor that the disease was in its initial stages and very well amenable to surgery. He then later refused to be examined by students. Many a times, students also seem to show scant respect to patients′ feelings and their need for privacy and rest. It is not uncommon to see a number of students auscultating a single patient simultaneously. Although patients are generally positive regarding students′ participation, such behavior could make them change their attitude. [3] Can such events be prevented from repeating in the future? I would like to think so. By making effective utilization of the observe-imbibe-emulate method of learning in the wards, students can alleviate their anxiety and this has been documented to result in better communication. [4],[5] A short series of lectures on bedside etiquettes and expected conduct in the wards in the week preceding the first round of postings, briefly enumerating the scope and limitations could become the pillars on which foundations of clinical medicine can later be built. In spite of the significant patient load in teaching hospitals, it has been my personal experience that most clinicians try to inculcate into bright open minds, all that they deem essential. However, it is imperative to cover up the lacunae in this aspect of medical learning since it is this very student-patient relationship which has to blend smoothly into the doctor-patient relationship in later life. Acknowledgments I would like to thank Dr. Avinash Supe for his continuing encouragement and inputs in the manuscript.References
Copyright 2009 - Journal of Postgraduate Medicine |
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