Baptism by H.P.I.

7:28 PM

Author | Raymond Strobel

(Patients' names and identifying details have been altered to protect their privacy. The events discussed within are true.)

Delonis Clinic Medical Student Checklist

Starched and dry-cleaned white coat?

Check.

Fountain pen and padfolio for taking patient's history?

Check.

Stethoscope that I have used a total of two times previously?

Check.

Copies of the New England Journal of Medicine for reading in between patient visits?

Check. (Now is an appropriate time to roll your eyes)

An understanding of the challenges I would face and the growth I would experience over the next three hours?

I had no idea.

The Delonis Clinic

The Delonis Clinic

My first patient at Delonis Clinic, a student-staffed free clinic for adults in the Ann Arbor community, was the first patient I had ever obtained a history from.  My experience with the "medical interview" consisted of a handful of mock sessions with fellow M1s, taking turns playing the patient and the physician.

I arrived at the clinic full of heady confidence. I knew the laundry list of questions with which to buttress a differential diagnosis – all I needed to do was mine the data (with a smile) from my patient. How hard could it be?

When I saw my first patient enter the clinic my pride evaporated. It took less than a fleeting glance to tell he was in immense pain, limping towards the exam room with tears in his eyes. My confidence shaken by his suffering, I began to have second thoughts as I introduced myself.

"Hi, my name is Raymond Strobel – I'll be taking your vitals and history today. You must be…" My voice trailed off as I distractedly leafed through a pile of papers in my padfolio for his file.

"Mani, it's Mani... argh, the PAIN!" Mani forced his words through gritted teeth; much like water erupting through cracks in a dam, their intensity bore witness to the sea of agony tenuously contained behind his contorted face.

Forget the script – this man needed help. "Ok Mani, let's get you to the exam room", I said as I offered my arm as a brace (he seemed to be guarding his left knee).  "Then we'll figure out what to do about the pain."

Was it just to visit my inexperience upon Mani?

Would I hurt him?

I fumbled with the blood pressure cuff, racing against the clock. I was taking too long; at any moment, I expected Mani to demand to see the attending physician – his suffering too great to bear the ineptitude of an inexperienced medical student. His labored, irregular breathing made taking a respiratory rate nearly impossible.

"Ok Mani, we've got your vitals. I can tell you're in a great deal of pain – when did that start?" I had made it to the solid ground of the H.P.I. (history of present illness). Now I could begin to work towards a solution to Mani's suffering.

As I mentioned earlier, my prior experience with taking a history was limited to practice with my M1 colleagues. In these sessions, the student playing the patient reads off of a condensed three paragraph script containing the relevant information. Unless the "patient" decides to ad-lib a personality and backstory (often for the sake of comedy, rather than enhanced realism), the mock visit is swift and effortless.

The Delonis Clinic

Mani's story was neither humorous nor brief; its length and complexity better approximated by the LOTR trilogy than the three paragraphs I was accustomed to. I struggled to keep the narrative on track.  The problem wasn't that Mani wouldn't stop talking, but rather that he had such a complicated history. I had to use both hands to count how many surgeries he had undergone.

40 minutes later (twice my allotted time), and with an extremely sincere "thank you for your patience", I made it back to the staff room to present to my attending. Together, we returned to the exam room and with a little additional work came up with a plan for Mani. My adrenaline-fueled focus began to give way to relief.

As we said our goodbyes and Mani began to hobble towards the door, he said something that struck me. Speaking almost to himself he asked,

"I guess you see why most doctors hate to have me as their patient?"

Mani's question caught me completely off guard. As I turned to him with a look of bewilderment, I realized his sincerity.

Mani had withheld judgment as I admitted my unfamiliarity with the battery of medication he was taking. Even as he was wracked with pain ("9/10" in intensity), he answered my excessively thorough line of questioning. Truthfully, I couldn't have asked for a more understanding and accommodating patient.

"Not at all, Mani", I replied, placing my hand on his shoulder. "Thank you for putting up with my inexperience – I'm pretty new to this." Just how new, I was afraid to admit.

"No, you listened to me. Most doctors don't want to hear it – thank you."

This Christmas eve, I am grateful that my first patient left me with such a positive memory to return to. Under different circumstances, I could have left my visit with Mani resolving to be more aggressive in curtailing future patient dialogues. Clearly, I need to work on my efficiency in taking an H.P.I. However, Mani had reminded me of an important lesson: that the simple act of listening can do much to win the trust and assuage the worries of your patient. It's one I won't soon forget.

Thank you, Mani.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

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