Fresh out of residency, feeling up-to-date & on top of things- I know my guidelines & my red flags, I can be efficient and compassionate, I can investigate & differentiate, I have all the right tools and reflexes to cruise along.
The first patient arrives. My classic opening line: “how can I help you?” is met with a blank stare. I never fully understood the complaint by the end.
Then comes the second patient. I improvise a new greeting: “how was your weekend?” Without adding a word, I learn about weekend plans, then medical worries, then impressively detailed tales of woe. Being one hour behind has never felt so productive.
I’m shadowing during another patient encounter. “Been fishing lately?” is the opening line (this is an experienced md, I see). The patient recalls how he felt half his face go numb while fishing, and he couldn’t move his leg. He just managed to drive home. The sound of red flags rising resonates in my head. The casual conversation continues however despite alarm bells urging me to rule-out and diagnose. The encounter ends with some gentle teaching, follow-up planned in one week.
I’m a bit puzzled. I learned to modify my approach to get information, but am overwhelmed by the problems encountered and the slow management. My questions are answered the following week however.
I went to a Native Reserve with another physician where we visited patients in their home. Each encounter lasted at least 60 minutes, only 5 of which were medically-oriented. An active member of the community comments on this doctor’s approach: “never has a health-care worker integrated our community so quickly”.
She explained that the community doesn’t appreciate the “book approach”, as illustrated by an elder’s outrage when interrupted by a health-care professional looking to obtain a complete history. She explains that, as a sign of respect, elders are never to be interrupted. The physician working with the community summarizes: “There’s no rush, we have to build trust and relationships before we can treat. We need to calm our eager reflexes learned in medical school and sometimes lower our red flags”.