uring my years as a journalist, I interviewed scores of people: politicians, musicians and the average guy next door. Talking to strangers about the intimate details of their lives has never unsettled me.
To get those details, I learned to establish a rapport with my interview subjects. People won’t talk to you unless they trust you. Most of my interview experiences were positive, full of lessons on life and human nature. From time to time I was screamed at, hung up on, and threatened with lawsuits. And that certainly thickened my skin.
When I started medical school, I figured my interview skills and experience would put me at an advantage as I learned how to take a patient’s medical history. Which is, after all, another kind of interview. In some ways, it did. It was easier for me to overcome the discomfort of asking patients about things like their sex lives or alcohol intake. I was used to bringing up sensitive topics with people I’d never met.
But in spite of my extensive experience, I’ve often felt stilted, awkward or off balance when talking to patients. My question order lacked flow. I knew I needed to gather certain pieces of information for my medical history to be technically correct and complete. I fretted until I’d mentally checked off each item. At times I was more focused on whether I’d asked all my questions than on the content of my patient’s answers, and how those responses should guide our interaction.
Last week, I finally recognized the problem: I had been so focused on that memorized, mental checklist of questions that I’d neglected to have a conversation with each patient. I’d ignored my journalistic instinct. I’d ignored my own strengths.
So I regrouped. I resolved to tap into that journalistic instinct, that ability to guide a conversation, and above all to listen to someone’s story. I applied all these points during recent patient visit.
This was a patient I knew well, so I felt comfortable. I wasn’t tasked with gathering any specific information from her, eliminating the pressure for correctness and completeness. My job was just to be there with her, to keep her company during her doctor’s appointment.
So we simply talked. As she shared a stressful situation in her life and how it was affecting her, I wondered whether she might be depressed. I thought back to the psychiatry unit we’d just finished, and some of the depression screening questions I’d heard. I asked about her sleep, her appetite, her mood.
Though I knew I needed certain information from her, the mental checklist was gone, replaced by a desire to openly explore the subject with my patient. To hear her story. As a medical student, it’s clearly not my role to diagnose someone with depression (or with anything else). But these were questions no one else was asking. If I discovered something amiss, I would report it to the patient’s physician. This was more than an exercise. My questions mattered, as did my ability to have a comfortable conversation with this patient.
That’s exciting, scary, and humbling, all at once.
Taking a patient’s medical history is hard —far harder than I thought it would be. I have a lot to learn and a long way to go. I often don’t know what to ask, or even when to ask it. And I sometimes still need that memorized list, though maybe I should tuck it at the back of my mind rather than keep it up front.
But after this recent experience, I think I know what it’s supposed to feel like — this conversation between doctor and patient. And it’s a good feeling.