A Lesson in How to Show Compassion

During our pre-clinical years at the University of Alabama at Birmingham (UAB), we are divided into small groups of six students each for our clinical introduction course that runs alongside our classes in the basic biomedical sciences. In these small groups, we are each assigned to a physician who will serve as our faculty preceptor and mentor. Depending on the week, we might watch our preceptor do a full history/physical examination on a patient, practice components of the exams ourselves, or simply discuss the ethical and emotional demands of the job.

As I reflect upon my first two years of medical school, one particular moment from my clinical course stands out. We had just practiced conducting a basic history and physical examination on “standardized patients,” who are healthy adult volunteers who help model common scenarios that we may see with patients in the hospital. These encounters are video recorded, and we are typically assigned to watch them by ourselves or sometimes with our small groups so that we can learn from each other’s successes and mistakes.

In one of our first recorded encounters, the “patient” to whom I was assigned arrived to clinic with what was supposed to be a run-of-the-mill cough. In the end, it was fairly clear that he likely had the flu. Yet I listened to this patient as if there was nothing else happening in the world; I was totally focused on him and everything he said. I took each word he spoke seriously, trying to analyze and understand every important detail about the discomfort he felt from this cough that just wouldn’t go away. I vividly remember that as my group and I watched my video recording together, we found ourselves nearly cracking up at my facial expression of grave concern. This fake patient most likely just had the fake flu… and there I was, looking at him almost as if he were literally dying. To this day, I still chuckle a bit when I think about the look on my face in what was my first “real” patient scenario.

However, what I remember most was a specific comment I received from my mentors in this situation. After our encounters with any standardized patient, we must return to the room to receive feedback. In my follow-up with this patient, he thanked me and said, “You know, you are the only student today who heard me say how much this cough has affected my life and took the time to empathize about how hard it was for me rather than to immediately just ask about the color of my sputum.” He stopped himself, looked me in the eyes, and said, “I hope you never lose that.” Later, after watching my videotape, a mentor pulled me aside and said nearly the exact same thing: “I know it seemed funny for us all to watch, but the look on your face – that was compassion in action. I really hope you never lose that.”

I began to understand that yes, I had looked foolish to my peers and even to myself as we watched my video. But in that moment, I could confidently say that this fake patient truly was my world. He was concerned about his cough, and he trusted me to be able to help him. So I took him seriously, and I was fortunate that he in return took the time to convey just how much that meant to him. It was then that I realized: there is no run-of-the-mill cough. There is no circumstance that is unworthy of my full time and attention, even if it seems out of place given the “minor” nature of the complaint.

I’m sure that, as a physician, I will see hundreds of patients with a cough. I will see hundreds of runny noses or headaches or cases of back pain. But I, too, hope I never lose the ability to understand that the mere fact that I have seen chest pain before does not make my current patient’s chest pain any less terrifying to him or her; the fact that the chest pain is likely to be acid reflux rather than a heart attack does not mean I should dismiss my patient’s story or tell them that it is “no big deal.” For that patient, it could be the world. And that makes it my world.

As an early medical student, I have not yet learned all of the biochemistry, the pharmacology, or the microbiology of the most complex diseases I will someday see in the hospital or clinic. I may know very little about the nuances of treatment or how to be the best physician possible. Yet I have learned, in my first two years of medical school, that there is no such thing as “just” a cough. A cough could be something serious, like tuberculosis, or more likely a seasonal cold. And even though I may look silly taking the cough so seriously and giving it every ounce of my undivided attention… I, too, hope I never lose the ability to do so. Because to my patient, it matters.