"It's time," I said quietly, ready to meet my first patient for a new volunteer position.
Startled big brown eyes pierced my body as I walked into the waiting room to meet my patient. A young girl, no older than 14, sat quietly in the room next to an older man, possibly her father. An expressionless face accompanied by matted hair and a cool detached look peered above the young girl’s mask. When I got a better look at the girl, I noticed fading bruises on her forearms.
It was as if a thick brick wall enclosed the young girl; all of my attempts to gauge what had happened to her were met with what appeared to be concocted stories.
I began by asking her simple questions about her day, and when I inquired about the bruises on her forearms, the girl would respond passively, "I got hurt at school, that's all."
"How?" I ask.
"I fell down the stairs," the girl would say. I knew the girl was not being completely honest and I needed to
find a way to get her to tell the truth so I could help her. I thought hard about how to breakthrough with the girl and remembered my first experience learning about patient care at the Columbia VP&S GHO Medicine & Research Summer Program.
Summer Before Starting College
Last summer before starting college, I was overjoyed to have been accepted into this program. As the days passed, I learnt about medicine, public health, and research from a variety of speakers, including physicians, researchers, and medical students. At the start of the program's second month, I was given the opportunity to practice a simulated patient interview. Despite prompting from the director that “it is just a conversation,” my heart skipped a beat at the prospect of interviewing a patient. After the interview, disappointment and frustration flooded my mind when my program mentor walked through the evaluation form with me about how I performed and what I did wrong in approaching my patient. My nerves caused me to rush the interview; I had prematurely fixated on a diagnosis with closed-ended questions without providing my patient with a space to tell her full story nor inquiring about my patient’s social history.
"It’s important to care for and understand your patient, not just be concerned with determining the diagnosis," my mentor observed.
My mentor took the time to educate me on patient-centered care and supported my growth. I began learning about the value of listening, empathy, and reacting to my patients' concerns. To put these skills into practice, when it was time for my final simulated patient interview, I asked my patient open-ended questions designed to learn more about them and their environment, while remaining empathetic and nonjudgmental towards them. By doing so, I was able to successfully determine the standardized patient's diagnosis and the most beneficial treatment required to treat them.
Back to the Present
I looked at the young girl, who seemed distant despite her proximity. I asked the child’s father to step out for a moment to make the girl more comfortable. Focusing all my attention on the girl, I explained the confidential nature of the encounter and asked her about her home life. The girl shifted and opened up, the only hint that I was on to something.
Looking down, the child replied, “I miss my mom.”
“What happened to your mom?” I asked.
“She passed away,” her voice breaking with emotion.
"I am so sorry you had to go through this," I said, reaching out my hand and placing it on her hand. "I am here for you."
The imaginary wall that had previously shielded the young girl crumbled, and she looked up through glassy eyes and hugged me. The child talked about her loneliness and how she tried to be more useful around the house. She took on more responsibilities but was injured while cleaning. She was afraid to tell her father because he already worked hard and would no longer want her to help around the house. I suddenly realized what my patient truly needed after listening–and it was not a diagnosis.