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Crisis Ministries offers chance to visit real patients

Editor’s Note: Chelsey Baldwin of Little River is a first- year medical student. This column follows the journey of her class in becoming doctors.

By some lucky chance I made it to class early the morning the Crisis Ministries sign-up sheet was posted in Baruch Auditorium. I have been commonly disappointed to find that I had been beaten to the chase by my classmates every time prior to this. My discovery did not go unnoticed by others for long. A swarm quickly accumulated, and I luckily was able to acquire a spot the same evening as a few of my friends from class. As I have mentioned in previous articles, we are all too eager to see real patients. I say “real” for the fact that we are extremely familiar with the standardized patient. Standardized patients are trained to play the role of a patient and then, often to my dismay, report back detailed feedback about our examination and interviewing skills.

Real patients, though, I was sure would be excited to talk to me and never notice the subtle mistakes in technique that I would make or so I had built up the encounter in my mind before arriving at Crisis Ministries. In some ways my idealization of the interactions with patients was correct, and yet in other ways I couldn’t have come close to predicting the impact the encounters with the patients at Crisis Ministries would have on me. I was right in thinking that these patients wouldn’t be particular about noting the mistakes I would make, however the attending physician was sure to note them. Making mistakes is a great way to learn, and so for that reason I was thankful for the constructive criticism. As for the enthusiasm of the patients to talk with us, it was surprisingly low. I got the impression that this was a situation of going to see the “doctor” or else.

Mrs. X, my first patient, informed me that she hates to come to see the doctor. She went on to explain the horrible circumstances that landed her at Crisis Ministries. While we were able to treat her for the problem she presented with, I was saddened that we couldn’t do more for her. Next I went on to see a patient in whom we were unable to reproduce the symptoms of which he complained. Therefore we were unable to do anything for him. His apparent disappointment translated into my own.

Slightly downtrodden, I went to see the final patient of the night, Mr. Y. This interview went surprisingly well, and I was sure that I had picked up on a possible underlying presence of diabetes. However, this was not the cause of the patient’s presentation to the clinic and therefore was not presented to the attending physician. Instead, the patient’s immediate condition was treated.

At first, I was satisfied with this approach for the fact that the patient seemed opposed to any further examinations, especially those associated with the word “diabetes,” the reason for which I would later discover. I also feared the possibility of being wrong and therefore wasting the attending physician’s time.

Mr. Y was examined by the physician, and then my second-year mentor and I returned to explain the treatment plan to the patient. Mr. Y went on to inquire about the meaning of high glucose levels noted in his urine in the past. My stomach sank. I had incorrectly ignored my instincts. Mr. Y explained that he avoided ever following up the test out of fear that it could mean a diagnosis of diabetes. Mr. Y elaborated that he had a family history of the condition and was afraid of having it too. Being the final patient of the evening, and with the attending physician having taken his leave after solving Mr. Y’s problems to the best of this knowledge, we were left in a helpless state. I couldn’t help but feel like we failed Mr. Y. I had let my own fears of criticism and being made to look foolish keep me from speaking up. I made him promise to bring up these questions next week when he returned for his follow-up, and yet I feared that he would not.

Afterward, I rode home with my friends Tracy Tholanikunnel and Steven Hill, fellow first-year students and dear friends. I opted out of our plans to grab a beer afterward to reward ourselves for a long day of hard work. Instead I went home to agonize over my time at Crisis Ministries. It took me several days to see the good in the experience that I had that night, and yet there was much to be appreciated. We successfully treated two out of three patients. I had written my first assessment forms of notes and prescription. Plus I was exposed to ethical issues pertaining to patient autonomy. We cannot force our patients to take treatment for which they do not wish to receive, and I must be prepared for that. However, this doesn’t detract from the saddening fact that those who need our help the most seem to be the least willing to take it.

Finally, I learned that the support of my peers is endless, and I will always be thankful for the sympathies and advice of my peers that accompanied me to Crisis Ministries that evening.

Friday, Feb. 25, 2011

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