Can We Really Understand Our Patients?

The following post originally appeared on Medscape’s The Differential on January 12, 2011.


Knowing I had recently completed a rotation in OB/GYN, a friend asked me how they (medical schools) make male medical students understand what their pregnant patients feel like. It was an interesting question. And it got me thinking about understanding what our patients go through – no matter their age, or sex, or condition.

As medical students, there is not much discussion about how our patients feel. Sure, there are classes about human suffering. But these classes deal with generalities. Each patient experiences their condition in their own unique way. To draw upon the obstetrical cases, telling a woman that she is pregnant can be met with a variety of responses that range from fear and dread to joy and elation.

I once heard Dr. Wil Alexander say, “The moment a symptom occurs, a story begins.” Those words seemed so profound at the time that I wrote the idea down and saved it. Each patient who walks through the hospital doors is more than a symptom. They are more than a diagnosis. They are more than a disease. They are human beings who have a story – a story that is just waiting to be told.

The question that my friend raised, regarding how male medical students are made to understand the experiences of their pregnant patients, made me realize that there is little done to help us understand our patients’ experiences. But I am okay with that. Because each experience is too individual to explain away with a blanket statement. It is impossible for anyone to know exactly how another feels.

The important thing, in my opinion, is for us to connect with our patients and convey that we acknowledge that they are going through a difficult or trying situation and to offer ourselves as they cope with it. It can be something as simple as giving them permission to be candid about their raw emotions – the frustrations and fears that build up – in a safe environment where no one will betray their trust or judge them or treat them any differently because of it.

It would probably be a good thing if we could understand exactly what our patients were experiencing. It would probably help many of us with our empathy. But without that ability to understand perfectly the experiences of our patients, we are left with the ability to accept perfectly the experiences of our patients. And I suspect that for most of them, this much is enough.

  • About a year ago I developed psoriasis.  First dermatologist treated me like I was an inconvenience, since I wasn’t a Botox patient.  Second one did.

    Even if I never have symptoms again, I will always know what it’s like being a psoriasis patient.  I don’t have a clue what it feels like to be a cancer, diabetes, pregnant, or HIV patient.  Being sick, regardless of the illness, is a unique experience and I don’t believe any physician can, or should claim to understand their patients unless they’ve actually been in that situation.  To say otherwise comes across as hubris or arrogance.

    But patients don’t care if you understand them.  I certainly don’t care whether my dermatologist has a clue what it’s like to have a skin disorder.  What patients (we) care about is whether we believe our physician genuinely wants us to get better.  There is no more desperate feeling in the world to have something wrong with your body and wind up being treated by a doctor that doesn’t really care whether we get better or not.

  • Excellent point!