I heard a gist of the story. Since I know the medical student and his family I asked him to relate the events in writing. This was what he wrote in Thai.
Our group (year 5 medical student, a year before becoming an extern) chose a 35 years old female patient who has systemic lupus erythematosis as a study subject. She consented. We presented her to our tutor and discussed her case.
After that, just prior to attending a lecture, I went to thank her for allowing us to learn about her and her disease. I found her crying. So I decided to listen to her problems and missed the lecture.
She was told she had a complicated illness and had the impression that the only hope was to be treated in a medical-school-hospital. After many attemps, she thank the angels that she finally was admitted. A lot of tests was done. Many doctors came and examined her. Once she was short of breath and eventually a cardio-logist was consulted who told her that she had ‘fluid around her heart’ (pericardial effusion) but the amount was not large, the space was not easily accessible and it may resolve by itself, so no specific treatment was necessary (that was what she was told).
Then, because of the skin involvement, she was seen at a skin conference, where many doctors dis-cussed with one another. None talked to her nor even had a cursory look. She returned to the ward none the wiser.
Finally she said that she must have a rare Western disease, because the many doctors used that strange label (presumably SLE). So far, some explanation of her disease had been given by the resident MD but he had to wait other’s decision. She wish she knew the severity of her disease so that she can be prepared for the eventuality.
End of story by this medical student.
I then wrote him asking him to clarify certain points. Aside from these questions, there was no prompting in any portion of his story.
1. Penalty from missing lecture?
This was not noticed by the lecturer.
2. Did you relate this events to your friend. What were their responses?
They noticed my absence. What I related did not seem to interest them.
3. What was your posture while listening to the patient?
She was lying down and I stood next to the bed to be able to observe her facial expression.
4. Did she just pour her feeling out and why you? How long did it take?
The conversation lasted an hour. Yes, I did occasionally prompt her with questions.
She probably found me sympathetic as I often asked her whether I could be of help and at times will relate ‘her request’ to my senior (i.e. resident MD in charge of the patient).
5. What else did you do to help the dilemma and how did she respond?
I apologise for all of us and told her that most of her apprehensions resulted from mis-communication. She eventually smiled, and said she will wait till the treatment works before returning to her home which is nearly 2000 km from the present medical school hospital.
6. If you were in this situation again, how would you improve the encounter.
I must try and prevent this occurrence. I must try and recognize early signs from the patient’s body language. A lack of a welcoming sign when visited may need careful attention.
- How often does one see and experience this scenerio at one’s OPD or wards as one rushes about? If not often, why?
- What options are opened to this chap if he does not want to miss his lecture?
- If there was a roll call and he was penalized?
To the reader:
- Should medical students have a role in patients’ care?
Finally, happened to read an article of a similar vein in November Lancet 2004. A medical student related his experience with an old illegal with chronic renal failure, who could only speak Chinese and no one to look after. He labelled this patient as being in ‘a prison of mind and body’. He then discussed his role as a medical student in that he can only offer “my time, my ear and my voice”. An editorial added: professionalism should not be a veil for protecting a doctor’s paternalism and power.
Keyword : Ethical problem, Bed side teaching, Doctor-patient relationship