Prior to starting the clinical portion of my training, I often wondered what it would be like to be the provider for a patient who is not able to manage their disease as advised. My goal was to have an approach to the patient that was not paternalistic, but I find this to be easier said than done. Mainly, the difficulty arises from the role placed automatically upon the physician, whose counsel is sought by patients because that physician is perceived to be an expert in his or her field. It’s a challenge to rise to this role, to speak confidently (as we are taught to do early on in third year), and yet to balance this with humility — the quality that patients actually need.
Recently, I was expected to discuss a patient’s case with a team, in front of the patient, in the patient’s hospital room. I was to have a plan and sound “confident and unwavering.” But, honestly, I struggled — because there is so much at this stage, and will be at every stage of my career, that I do not and cannot know. Even if I was already the world’s expert on a limited subset of disease in one specialty, I still would not know the details of this patient’s life, the detail that will cause this patient to not be able to adhere to a plan, unless I begin a conversation with them from the standpoint that only they can teach me about themselves. I can be truly confident of what I know if I humbly gather that information and tailor disease-related advice to the patient’s context.
Ms. Montenegro is a third-year Mayo Clinic School of Medicine student, writing as part of her family medicine clerkship.