One more week over. We finished up learning Cardiology, but we also had an experience that most students don't get to experience. On Thursday afternoon, we delivered "bad news" to three of our standardized patients. These SP's are very good actors who pretend to be patients as we play our role of the medical student. We got a little "prep" on Wednesday in order to prepare for this. We were told of 4 things to look into in order to be prepared for Thursday's event. 1. Elderly abuse. 2. Potassium overdose. 3. ALS. 4. Dementia. So on Thursday at 1:30p.m., I was at the school in my professional dress and white coat to talk one-on-one with 3 "patients".
The first patient I had was the elderly abuse case. His wrists had makeup on them to resemble bruises. Talking with him, I realized that even in delicate situations, the most important thing is the patient. While my nerves had been a little shaky prior to beginning, I realized that as I sat in the "office" talking with a man about his living situation with his son, my nerves dissipated. Engaging in conversation with real people can easily make you become comfortable. Even if you are nervous, you must remain calm for the comfort of the patient. We talked about abuse, I presented options, and afterwards, we talked casually as ourselves to give feedback about the encounter.
My next "patient" was an older woman who I had to diagnose with ALS (Lou Gehrig's disease). This encounter felt mostly real to me. I have an interest in neurology, and with this SP, I discussed the prognosis of the disease, treatment options, and realistic expectations regarding her care. I felt oddly connected to the SP as we talked about her wish to travel. During our feedback session, I told her how it was the most comfortable I had felt. Even though delivering bad news is not easy, connecting with the patient is critical in maintaining the doctor-patient relationship and showing empathy and compassion.
The last encounter was THE hardest encounter of all. We had to tell a mother that the ER made an error with her little girl, ending with administering too much potassium via IV and killing her daughter. Starting off with the news that her daughter passed away, the mother expressed shock, then sadness, and finally anger. It was extremely difficult for me in this situation because I had no answers for her. I could not tell her why it had happened or how it had happened. I could only try to comfort her, which in this scenario was most trying, being as I had told her it was the fault of the hospital. I mostly sat in silence while she cried. During the feedback session, I told her how hard it was to be in that circumstance. Luckily, she said that I dealt with it well, taking advantage of the silences and explaining the situation so that she could understand.
Overall, I was told very positive things about my encounters. I was informed that I had great eye contact, showed great sympathy, and explained all situations with great care. After the hour and a half of delivering this set of bad news, I was emotionally exhausted. Even though this encounter was played out by actors and actresses, I am extremely glad for the privilege of "practicing". Many medical students don't get a chance to try it before being thrown into the fire during their clinical years with real patients. Getting the chance now will hopefully make the real encounters more manageable. While delivering bad news will NEVER be easy, I hope that I can show how much I sincerely care and that I will be able to comfort my patients in the future. Whether delivering a bad diagnosis to a patient, telling a family that a loved one died, or helping a patient through a delicate situation, each and every patient deserves attention and compassion from their physician. These two attributes can easily distinguish a great physician from a good one.
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