My Second First Patient

I know I called Emelia my first patient, but I had another first patient today. And this one wasn't my patient in the traditional sense either. (Meaning that, yes, there will be a third first patient!)

Today was my first interaction with a standardized patient (which was recorded!). I interviewed Mr. Welkins (I'm only using his name because it's a made up name anyway) who was presenting with a chief complaint of frequent headaches. We were supposed to do a HOPI interview using the BATHE technique. HOPI stands for "History of present illness" and is basically just gathering details about what brought the patient to see you and what the chief complaint is, how long it has lasted, etc. At this point, we are not doing any physical exam. The BATHE technique is one strategy or approach to patient interviewing and is certainly not the only way to interview.

BATHE stands for:

• Background (When did the symptoms start? How long do they last?)
• Affect (How is it affecting the patient's daily activities? How is the patient feeling about it?)
• Troubling (What troubles the patient most about what's going on? What makes the symptoms worse?)
• Handling (What is the patient doing about it? What makes it better?)
• Empathy (Displaying empathy towards what the patient is going through.)

BATHE is not meant to be sequential (don't have to get the background, then do affect, then troubling, etc), but just helps keep track of different aspects of the interview that should be covered. Typically, the patient tends to take the lead in where the conversation goes.

We've been taught to do patient-centered interviewing as opposed to physician-centered interviewing. This basically means that we should let the patient guide the interview. This involves using mostly open-ended questions and letting the patient tell the story without the physician immediately asking only about what he/she deems relevant. Some yes/no questions are necessary when needing certain symptoms/issues clarified, but should only come after the patient has had time to express what they feel they need to.

At this point in our training, we don't have a clue about diagnoses or treatment. Mostly we're just starting to practice interacting with patients and asking questions that will elicit information. This standardized patient interview isn't going to be graded but is just for practice/critique. Our CAPS instructors will review our videos and give us feedback on how we did and how we can improve.

I wasn't nervous at all for this interview. I'm sure part of that was that I knew it wouldn't be graded, but mostly I was just excited to actually interview a patient - even if it wasn't real. While I do see the importance of all of this anatomy we're learning, actually interacting with patients reminds me why I'm memorizing all of these seemingly trivial details. Despite the fact that it wasn't a real patient and I could offer no help with diagnoses or treatment, it felt very much like a real encounter. Standardized patients are (typically) really good actors and could easily be mistaken as real patients. We dress professionally (complete with white coat and ID badge) and do exactly what we would do if it a real patient in an office.

The feeling of interviewing patients and trying to help them with what is going on reminds me of what prompted me to sign up for these four years of constant studying and paying massive amounts of money. It won't be long before I am responsible for actual patients and their well-being. For my future patients, I am learning every muscle I can, paying attention during lectures (most of the time!), and trying to see the bigger picture - because if all of this is not for them, it is not at all worth it.