History Lessons: What Doctors Learn When Doing Patient Histories by Natasha Massoudi

   NATASHA MASSOUDI is a second-year medical student at American University of the Caribbean School of Medicine. She is a member of the Editorial Board at Intima: A Journal of Narrative Medicine.

NATASHA MASSOUDI is a second-year medical student at American University of the Caribbean School of Medicine. She is a member of the Editorial Board at Intima: A Journal of Narrative Medicine.

We learn in medical school to take full social, family and physical histories with a new patient. We use checkboxes to run down the list of points in each history. We are taught to be thorough and document each answer. Often though, between the checkboxes and lists, the patient’s story is forgotten. Why are they coming to see the doctor? What is their perspective on their own illness? In Paul Rousseau’s Field Note “The Color Purple,” he realizes that “diagnoses are really nothing more than the stories of life colored by the pain of disease.” It is in fact that often the beauty of making a diagnosis is exactly in the patient’s own words. They are often actually feeding practitioners the main problem.

What is striking is that being there for a patient’s story can come in many different forms. It is listening and echoing our interpretation back to the patient. It is finding the cause of the concern and relating with a personal story of our own. It is sheer silence that can connect patient and provider. Rousseau’s experience suggests that his listening gave respect to the patient and allowed her to open up and share her story. He makes a connection with her that breaks the tension in the room. Similarly, in the Field Note “Entry Points,” A. Scott Pearson writes about the need for an entry point to start a conversation that the patient feels comfortable sharing their story. He reflects on time spent with a family in the emergency room who had been in a car accident. Even though the family did not speak English and no interpreter was available, Pearson connected with their smiles and camaraderie that he felt in the room. They were working as a team together to determine the family’s physical injuries. There was a silent connection as he could sense their traumatic story.

Medical school has taught me the power of listening between the checkboxes and lists. Being thorough does not mean asking each and every question. The patient’s story ebbs and flows through feelings in the conversation. The beauty comes in the patient sharing when they are comfortable, when they feel that connection with their provider. There is often beauty in the silence between questions. For me, this is the true “art of medicine.” It is the act of listening to the patient and exploring their story with them that is the very essence of quality care.

NATASHA MASSOUDI is a second-year medical student at American University of the Caribbean School of Medicine. She received an MPH from the Public Health and Professional Degree Program at Tufts University School of Medicine and a B.S. In Biology and Sociology from Emmanuel College. She worked on monitoring and evaluation of health programs for five years at a public health and health consulting company headquartered in Boston. She was formerly an editor at the Journal of Humanitarian Assistance at the Feinstein International Center at Tufts University. Natasha is passionate about narrative medicine, women’s health, and integrative medicine. Massoudi is a member of the Editorial Board at Intima.


© 2017 Intima: A Journal of Narrative Medicine© 2017 Intima: A Journal of Narrative Medicine

Source: www.theintima.org