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Teaching and Learning Moments

Experiencing the Patient Experience

Zverev, Samuel

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doi: 10.1097/ACM.0000000000003919
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She squirmed, sobbing hysterically, grabbing onto the railing of the inpatient hospital bed with IVs still bound to her arm. A grown woman was shouting and crying, not because of physical pain or injury, but out of fear. The sea of medical professionals surrounding her bed only seemed to exacerbate her dismay. She refused to acknowledge any of them, consciously omitting the small army of physicians and nurses crowding her room. She would only speak with one person … me.

As part of my premedical education, I was given the unique opportunity to work alongside clinicians and patient advocates as a patient experience intern in the largest and most diverse hospital system in New York City. An undergraduate student with no formal medical training and clinical experience limited to volunteering in hospitals, shadowing physicians, and attending my own medical appointments, I had never before found myself in a position where someone wearing a white coat and stethoscope would require my assistance, let alone my expertise.

As I overheard the patient’s panicked yells to her husband—loaded with Russian swear words—through a barely functioning flip phone, I decided to strike up a conversation with her in her native tongue. “How are you feeling?” I asked, using a respectful greeting in Russian culture.

“Terrible!” she cried out, grimacing and timing her reply in between fits of tears. After some time, the tension faded, and we concluded our impassioned conversation. The resident and nurse standing closest to the patient exchanged blank glances while trying to decipher the foreign dialog that had unfolded before them.

I learned that the patient, a 54-year-old Russian mother of 2 from Queens, had picked up a second job to support her family because her husband was recently laid off. To her, every day spent in the hospital meant her household went without a paycheck and a home-cooked meal—she clarified that her husband’s cooking did not qualify. The catalyst for her emotional display was when the radiology resident came to take her to “nuclear medicine.” She told me she had never heard of such a thing and asked why it sounded so sinister. Shocked at the terminology of choice, I assured her that he just wanted to take her for a postoperative CT scan.

Serving as a patient advocate while I was also a premedical student placed me at a unique crossroad and allowed me to witness and understand how medical professionals may err in establishing relationships with their patients.

After the atmosphere in the hospital room settled to a tenuous calm, I asked the patient, “Why did you only agree to speak to me? Was it because I spoke Russian?” She replied that as much as she preferred a native speaker to the robotic dictation of the electronic translator, the reason she gave me her attention was because I was the only person who asked how she was feeling and offered her any sort of explanation. She recounted how over the course of her stay, the nurses and physicians had simply wheeled her bed out of the room and taken her to various tests without offering her any information on where she was going or why.

I understood that this patient encounter was teaching me something I would never learn in a classroom or see on an exam. The core competencies required for providing quality medical care did not lie only in medicine itself, but in the interpersonal interactions and relationships built between provider and patient.

I realized that I wished to be the kind of physician who is passionate about helping patients understand their conditions and lets no questions go unanswered; not just one who is eager to provide medical intervention while reciting iatric jargon. I promised myself that the day I put on the coveted white coat and stethoscope, I would continue to treat patients as though I had never put them on at all.

The resident thanked me for my help. It seemed almost paradoxical, being shown gratitude by a physician. I interpreted the exchange as an unwritten rite of passage into the medical world. For the first time, I was not only learning from it but contributing to it as well. I continued to visit the Russian woman during my patient experience rounds and interspersed genuine exchanges among the questions on my checklist. The rigid inventory, designed by hospital administrators, included bureaucratic items such as: “Have you had any issues with clinical staff?” and “Rate your stay on a scale of 1 to 5.”

I learned to speak with patients instead of to them, transforming corporate interrogation into personable conversation along the way. With each patient I rounded on, I was able to learn how to bridge and connect with patients and appreciate their contributions to medicine. While physicians and scientists taught me physiological pathways and chemical mechanisms, my patients taught me communication and amiability. For a student of medicine, anything can be a teaching moment, and anyone can be a teacher.

I did not plan for one of my first and most meaningful interactions with a patient to involve tears and panicked screams, but it was this experience that shaped my understanding of the patient experience and of the many facets of delivering care. The field of medicine, so saturated with the physical and medical sciences, is incomplete without the core values of humanitarianism, personability, and the ability to foster conversation.

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