Learning to interview.
(As aired on All Things Considered, April 17, 2003)

 

My medical school assigns students to interview patients almost as soon as we start, well before we know the slightest thing about the diseases the patients may have. The point is not to make the diagnosis, but to learn how to get the story with an open mind, how to connect with people about things that matter, to listen to the patient.

There were a lot of things I worried about when I contemplated medical school's challenges, but interviewing patients was one thing I thought would come easily. In my work life before medical school I'd interviewed strangers ranging from inmates of a youth prison system to emergency room patients. I asked people about crimes they'd committed, wrongs they regretted, the diseases they feared and the people they loved. I'd gone up to men on street corners and asked them about the details of their sex lives, and right there on the street heard all about it. Even if I couldn't keep my G protein-coupled receptors straight, I liked to believe that I was, at the very least, Mr. Empathy.

And I wasn't bad at medical interviewing, or at least not right away. I wasn't good at it, either, but that was OK. I was just having a hard time making sense of my patients' stories. Medical interviewing is a kind of detective work, except that instead of investigating deaths and injuries, you're trying to prevent them. There's generally only one person who can really tell you the whole history of a medical problem, and that's the person with the problem. A doctor has to connect the story a patient tells to the science of how the story came about and make that all into a new story. To say something as simple as `This is why you've got that pain,' a doctor needs to know when the pain came, how it felt and what else was happening at the same time.

But patients told stories that rocketed back and forth in time without warning. They told me symptoms out of order. They might tell me about two things as if they were connected, and then I'd find out they weren't, or I'd think there was no connection and then there would be.

They would drop hints of other vast territories of their lives that I'd then forget to follow up because I was so busy trying to make sense of the details they'd already told me. But I wanted the whole story, so I started writing more details down. I started learning how to put together the patient's story in a logical order in my head, even as I heard it in a totally different order. I started redirecting patients who were wandering too far afield.

A couple of months into this training we videotaped ourselves interviewing the patients. The man on the videotape was me, but he was not Mr. Empathy. And I watched myself writing notes furiously, only rarely looking up at the patient. And I looked up to ask short, almost curt questions, then went back to the notebook as the patient answered. I was a note-taking machine.

The worst thing: I loved this patient. Even weeks later, her complicated medical history stayed with me, but so did her resilience and passion for life, and the warmth with which she talked about her family and friends. But on the videotape I looked like a sloppy-haired version of the physician I hoped not to become. I exuded a brusque sort of competence, but not kindness. In only a couple of months it seemed to me that I had gone from Mr. Empathy to Dr. Jerk.

Watching myself making notes, I thought of all the private facts of my life that I would never tell a doctor like the one I saw on the screen. If I was going to get the patients' stories and help them make sense of them and try to help give the stories happy endings, I would have to start looking up from my notebook.

 

copyright 2003 joe wright

broadcast and transcript copyright 2003 national public radio