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Academic Medicine:
Teaching and Learning Moments

Teaching and Learning Moments: PPQRST

Vaishnava, Prashant

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Mr. Vaishnava is a third-year medical student, Michigan State University College of Human Medicine, East Lansing, Michigan. He is planning to apply for residencies in pediatrics.

“PPQRST—Palliative, Provocative, Quality, Radiation, Severity, and Timing”—I remember repeating this mnemonic over and over, as I prepared for the first of eight meetings a classmate and I would have with a patient volunteer over the course of 15 months. We had been paired with this patient as part of the Longitudinal Patient-Centered Experience (LPCE) for preclinical students at the Michigan State University College of Human Medicine.

For the first encounter, I was completely prepared. I was ready to find out all about the patient’s symptoms. A brief phone conversation had revealed she had been diagnosed with multiple sclerosis (MS) over a decade ago. I had it all planned out. We would walk in, shake hands, establish the objective of the interview, initiate the interview with open-ended questions, and proceed with closed-ended questions. I was even ready to respond to emotions.

Things didn’t turn out quite as planned—they went better. We walked in and shook hands, but departed from my planned script. We found out about her. She is a loving wife and mother of a ten-year-old daughter and eight-year-old son. She home schools her children, helping them make Christmas decorations to adorn the kitchen windows. Her children, when given a break from their home schooling, like to wrestle with their father and entangle him into what they call a “pretzel.” (On one occasion, they even tried to “pretzel” me.) We walked around the house as she attached names to the friendly faces in the pictures on the walls. We heard about how involved her family was in church and how our patient and her husband are nationally recognized for leading a movement of natural family planning. We came to appreciate what was important to her.

We discussed her symptoms with her, too. She revealed how debilitated she was when the symptoms first came on, trials with a variety of drugs over the past decade, and how things have improved since she has been seeing a personal trainer. Our patient’s unique story unfolded over the course of eight visitations. Each visitation unearthed new information, broadening and enriching our understanding of what sort of patient has this particular disease (and less so what disease this patient has). For our patient, MS changed her life. It challenged her to accommodate to MS and motivated her to seek out ways to restore some degree of independence, for example, through the personal trainer she has been visiting for more than a year.

The first encounter in the LPCE challenged the structure I expected (and prepared for). It ultimately helped me realize just how important it is to find out about the actual patient, not just their disease. Looking ahead, I plan to add another P into my fail-proof PPQRST mnemonic to remind myself to get to know the Person.

Prashant Vaishnava

Mr. Vaishnava is a third-year medical student, Michigan State University College of Human Medicine, East Lansing, Michigan. He is planning to apply for residencies in pediatrics.

© 2003 Association of American Medical Colleges

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