Medical Student and a Medical Patient: When Two Worlds Collide

Dr H.B.

A 20 year old male, of Indian descent, presented to West Middlesex Accident & Emergency Department, with severe abdominal pain. The pain was a sharp, constant, 10/10 pain, located in the epigastric region, radiating through to the back, and had been present since waking that morning. It was associated with profuse vomiting, approximately 6 episodes in the last hour; no haematemesis. There had been no change in bowel habit, no history of unfamiliar food, or travel abroad. He was a student; did not smoke; and drank a moderate amount of alcohol, roughly 15 units a week. He was otherwise healthy, although did mention that he’d had similar episodes like this when he was younger, but it had been dismissed as a ‘stomach bug’ by his GP.

On examination he was clearly in some discomfort, and looked pale. He was tachycardic and tachypnoeic. However he was normotensive, and apyrexial. There was tenderness on palpation in the epigastric region; however he did not show signs of peritonitis. Based on the history and examination, a differential of pancreatitis was considered1; confirmed by a highly raised amylase2.

Was I involved in the patient’s care? No. I was the patient. That diagnosis of pancreatitis, three and a half years ago, would change my life. For worse, and for better. Unfortunately, it didn’t stop there; further investigation revealed it was a chronic picture.

Being a medical patient is hard, as is being a medical student; when those two worlds collide, it becomes difficult to visualise the light at the end of the tunnel. That tunnel is a dual carriageway with two roads: the medical student with the physical illness; and the patient with medical background.

Talk to most medical school students and doctors, and they will tell you medicine is a demanding profession; the exams are at least. I can vouch for that; and it got a whole lot harder following that day. Studies on prevalence of chronic illness in physicians are limited, and so the effects on training are not well understood3. I missed vast quantities of the training schedule. Each admission would cost me a minimum of a week, and clinical education is an aspect of medicine that is difficult to ‘catch up’ on. The most uncomfortable aspect, however, was not knowing, or ever finding out, the cause. Idiopathic chronic pancreatitis. Without the cause, you don’t know how to prevent a flare up. Worse still, you don’t know when to expect the next flare up. Preparing for my final exams was difficult, naturally. The night before, as it must have been for most students, was filled with anxiety, worry and little sleep. That, unfortunately, was compounded by the residual fear that I would wake up the next morning, with that abdominal pain that gives me nightmares; unable to take my exam which I had worked so hard for.

Does being a patient with medical insight make things easier or better? In one simple word: no. Every time I think about my condition I see prognosis; complications; numbers; type 1 diabetes mellitus; necrotising pancreatitis; cancer; death4. Not only that, but you are treated differently by health professionals. To their credit, they thought they were doing right by me as a medical student, by treating me as such, but at the time, I just wanted to be a patient. I didn’t want to be questioned on the causes of pancreatitis, during my first admission, by the A&E consultant (to which I replied with the text book answer, which we all know so well, including the sting of a Trinidad scorpion)5.

The famous proverb goes: every cloud has its silver lining. Out of everything that has happened, I have to come believe that it has made me a better doctor. This only came to my realisation a short while ago, when my consultant expressed that I was a very conscientious doctor. I began to wonder why this may be, and it is possibly because I have been able to develop a true sense of empathy. Something we are ‘taught’ at medical school, but empathy cannot be taught. To know what an individual is going through; what they need, you must have been in their shoes. Having been a medical in-patient, on numerous occasions, I know first-hand how depressing hospitals can be; how alone you can feel; how it changes your state of mind. I can relate to my patients’ ideas, concerns and expectations6. I am prepared to go that extra mile; stay an hour late, if they are getting the care they deserve. Often, as medical professionals, we see our patients as that clinical vignette from text books, which we must diagnose correctly and initiate appropriate management for. Patients are far more than this. Sometimes we need to take a step back, and look at the bigger picture, and realise everyone has their own individual story. This was mine.

 

 

References

  1. Carroll, J. K., Herrick, B., Gipson, T. & Lee, S. P. (2007) Acute pancreatitis: diagnosis, prognosis, and treatment.American Family Physician. 75 (10), 1513-1520.
  2. Winslet, M., Hall, C., London, N. J. & Neoptolemos, J. P. (1992) Relation of diagnostic serum amylase levels to aetiology and severity of acute pancreatitis. 33 (7), 982-986.
  1. Gautam, M., & MacDonald, R. (2001). Helping physicians cope with their own chronic illnesses.Western Journal of Medicine175(5), 336–338.
  1. Kudo Y, Kamisawa T, Anjiki H, et al; Incidence of and risk factors for developing pancreatic cancer in patients with chronic pancreatitis. Hepatogastroenterology. 2011 Mar-Apr;58(106):609-11.
  2. Quinlan, J. D. (2014) Acute pancreatitis.American Family Physician. 90 (9), 632-639.

Leave a Comment