COMMENTARY
Embracing humanism BY SAMUEL ROGERS I used to belittle any discussion about
integrating social sciences into medicine. I knew that doctors need to have some understanding of their patient’s feelings, and I also knew that having a good patient-physician relation- ship is an important factor in delivering good care. However, I underestimated how difficult this is to do. Midway through my first year as a medical student, per-
sonal blunders made during clinical experiences and observa- tions with my physician preceptor showed me firsthand why competency in social sciences is a req- uisite element of solid clinical skills. Furthermore, I recognize that even those who perceive themselves to be socially adept will probably have dif- ficulty at the bedside or clinic. My own difficulty at the clinic is
heard wheezing to notice the patient’s feelings. My preceptor, on the other hand, recognized and addressed his fears, taking advantage of an opportunity to build a relationship with the patient and establish trust. That trust surely would have an immediate and future impact on the patient, probably helping him to be more compliant and also more likely to bring future concerns and questions to the table in subsequent encounters. After this experience, I started to pay more attention to how
where I first discovered my inepti- tude. I was examining an adolescent patient complaining of a cough, and I did my best to conduct a history and physical exam. I reported to my preceptor and followed her back to the patient, eager to learn. After ex- amining the patient before and after a treatment with albuterol, my pre- ceptor explained to him that he had asthma. Then, she told the patient not to worry. She explained that there are professional athletes and Olympi- ans with asthma, and when properly managed it usually does not hold a person back. The patient’s facial ex- pression suddenly changed as his eyes softened and a smile crept unto his face. At that moment, I realized I had been focusing so much on the disease that I had ignored the patient. Only then did I see that in my initial interview with him, he showed signs of severe anxiety about his illness. I mistook that anxiety for shy- ness. I also remembered from lectures that the jovial attitude I carried during our interview was inappropriate with a patient in such distress. I was too preoccupied wondering if I really
At that moment, I realized I had been focusing
so much on the disease that I had ignored the patient.
my preceptor interacted with her patients. I soon realized that, without fail, she always took the time to probe into her patient’s social con- text. Sometimes, she did so by just asking a well-placed follow-up ques- tion, letting the patient know she wanted to understand what he or she was feeling, or simply allowing time for the patient to think. She put in effort to appreciate the patient as a person rather than a potential disease that needs fixing.
As a student, it might be fair to say that being overwhelmed by the bio- medical aspect of medicine is largely why I have not been great at relat- ing to patients. Surely, as students and doctors progress in their clinical reasoning and exam skills, the social aspect will develop concomitantly. However, I believe this thought is naïve. Indeed, it is well-documented that more often than not, well-trained physicians ignore or miss cues from
patients that would otherwise prompt investigation into their feelings or life circumstances.1
The quest to treat patients natu-
rally revolves around the biomedical aspect of disease, and doctors frequently ignore the social facet because the conse- quences are not always immediately obvious. Sometimes, doctors do not probe into social context be- cause they do not feel equipped to handle the patient’s emo- tions. I once completely brushed off a standardized patient’s concern about contracting Alzheimer’s disease because it
July 2012 TEXAS MEDICINE 7
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