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Crossing the Tarp
Posted 04:04 PM, October 20, 2008, by nmahmudMy standardized patient encounter went well this week. She was a middle-aged woman with a persistent pain in her right ear. Her mother had gone deaf shortly after having similar symptoms, and she feared that her newfound irritation was no coincidence. After a few minutes of interrogation, I still didn't have much clinical sense of what was going on. But I imagined that a licensed MD would. All I knew was that she looked scared, and all I could think about were horses.
Only a few days earlier we were charged with the task of getting a horse to cross a piece of tarp that was laid out over the ground. Simply enough, right? Not quite. To the horses, this innocuous tarp was altogether unfamiliar. It was shiny, reflective, crinkly, and flapped slightly in the wind- nothing like the ground they were used to walking on. My horse was terrified. He stopped a foot before the tarp and refused to budge. I tried to show him that it wasn't dangerous by stepping on it with my own feet, but he wasn't convinced. Out of impatience, I gave him a tug and he stubbornly reared back.
Only after several more tries did the horse cross the tarp. He required guidance, ample time, and lots of encouragement. It isn't so different with patients. The one in front of me, with a hand over her ear to sooth the pain, was afraid and looked to me for direction. And it was easy for me to divorce myself from her perspective. Even though I didn't know the clinical obstacles that lay ahead of her, I wasn't in her situation, and that was enough to make it difficult to understand. A doctor needs to be sensitive to the fact that the patient's perspective may involve strong uncertainty and fear. Because of the horses, I was that much more aware, and I carried on my interview with nothing but the patient's perspective in mind, as best as I could.
Comments
Comment by: Natalie at October 22, 2008 09:57 PM
I experienced similar sentiments when interacting with patients-- my tenacity and desire to reach a goal kick into overdrive. I've gone through several training sessions on how to externally quell these feelings;yet, I wonder if it comes out unbeknownest to me. Obviously, it did in the case of the horse and the first few rounds she refused to cross the tarp. As I stood back and observed the horses reactions in response to each of our actions-- it was then I came up with the idea of "Act, then wait...." Wait for what? I really have no idea. I guess it was for the "patient" to adjust and make an evaluation within her own time. To me, this idea of waiting was moreso a modification in my own mental perspective. It was accepting that change did not have to occur immediately. My actions in turn assisted the patient in making a decision and added to the calming, trusting aire that my collegues and I had been attempting to create.
Comment by: Joslyn at October 29, 2008 12:01 AM
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I have to agree that the exercise of "crossing the tarp" was quite eye opening. I would have to agree that the day made me more aware and conscious of the way I interact with patients and with people in general. It not only made more sensitive to the others' needs and fears, but it also provided insight as to our growing role as future doctors. I am starting to see how we need to be determined advocates for our patients and to use a type of gentle assertiveness (rather than just eye contact and a "nice" demeanor) in order to gain respect from our patients and to establish a partership that could lead to positive outcomes.