Thinking back on my observerships in first year, one that sticks out as different than I expected was when I went to follow a pediatrician over the winter holidays. We had met him in the hospital after the birth of our daughter and he was friendly older gentleman from Latin America. We had both attended our daughter’s appointments and he knew I was studying medicine, thus when I asked about shadowing him he was happy to oblige.
His practice was on the main floor of an older home, the entrance opened onto a public park. I arrived ready to learn more about developmental milestones, common complaints and more. As we started the day he handed me an extra stethoscope and the secretary sent in the first patient. Through the morning we saw a number of cases, issues potty training a child, a child with a mild fever was fit in, a cold sore. I hadn’t had much clinical exposure at this point, and what I had was in surgery. This was very different, very slow, and lots of talking. As lunch approached I wondered if we would see any interesting cases during the day.
Finishing up the paperwork on the final patient of the morning he had me wait in his office opposite the second exam room. While I waited I surveyed his bookshelf, picking up a small book on rashes. After looking at a half-dozen pages and a number of painful looking pictures he entered and we had a talk. I brought up the book and began to ask how one differentiates all the rashes. He waved his hand as if to clear the question from the room and said, “That is not what you need to learn right now. You need to learn how to talk with patients, how to counsel them. Figuring out which rash it is comes later”. This was different than what I expected as a response, but for the rest of our break it was on my mind. When the afternoon started I made an effort to focus on this aspect of medicine, the art rather than the science.
I saw the patient’s relief at his explanations and his concern for their situations. How they wanted to share when he asked the right questions. Also, the bonds he was forming with both the patients and their caretakers. Nowhere was this more apparent when he took over an hour with a single appointment, a teen having trouble at school. After a long conversation with the boy and his father, he talked alone with the boy and thoroughly explored the issues occurring at school and in his home and social life. This was followed by a counseling session with the family, exploring their relationships and living situation. This all ended with a plan all agreed on, some thanks and an appreciative handshake. It was this he was trying to share, the care, the connections and the counseling in medicine, what you can’t learn from a book.