New York University School of Medicine, United States
“Harris! Malcolm Harris!” I shout, walking through the waiting area. The glass pavilion is full of people anxiously waiting to hear their names. I draw in a deep breath to shout once more when a man raises his hand as he gathers his belongings. He walks with measured step, a dark, camouflage-print knapsack slung over one shoulder. When he reaches me, I rattle off the same introduction I have repeated every day for the past two and a half weeks: “Hi, my name is Ana, and I’m one of the medical students. Just to confirm, what’s your date of birth?”
Having answered correctly I follow him to the exam room. He is clean and pressed, wearing a black, button-down shirt and sporting a large, rhinestone-studded watch that peeks out from under his sleeve. I notice his last name embroidered on the front of his knapsack as he places it in the chair next to him and sits down. The perfunctory history of present illness begins. I ask him what brings him in today. Smiling, he says, “I just switched health insurance, and I’m starting my care here. Also, my social worker wanted me to tell you that I need to see someone for talk therapy.”
One question in, and he has already given me a loaded chief complaint. Continuing on, I ask why he needs “talk therapy.” Beginning with a disclosure of post-traumatic stress disorder from 10 years of service in Iraq, he goes on to reveal the details of his failed marriage—the result of his wife’s infidelity—and a beloved cousin’s recent attempt at suicide with an illegal firearm. He speaks without any hesitation, a sign of the veteran historian telling the same old tale.
At this point, I recall the lectures from “Physician, patients, and society,” a class aimed at teaching useful interview skills and how to be culturally competent. My mind frantically grasps for the PEARLS: Partnership, Empathy, Apology, Respect, Legitimization, Support. I quickly choose apology.
The words spill from my mouth, “I’m sorry to hear that.”
He is sitting forward with his hands clasped between his knees, his head slightly bowing down. Briefly looking up, he nods in response to my apology.
I sense that I have fallen short of showing my empathy. How inadequate this simple apology must be to him! The weight of his story hangs thick in the air as I try to formulate the biopsychosocial factors that led to his post-traumatic stress and depression.
Relying on another acronym, SIGECAPS, I verify that he meets the criteria for major depression. Quickly moving on, I ask the usual questions regarding his past medical, surgical, family, and social histories. I focus my efforts on finding the positives in his life, his motivation for continuing—anything to avoid further discussion of his unpleasant past.
As I remember this encounter, I wonder if I did him an injustice. In my naiveté, I believed that focusing on the positive would be more beneficial to him, but perhaps I could have helped shoulder a part of his burden by embracing his hardships and exploring them together. Had I been a more seasoned physician, would that apology have come from a place of deeper understanding? Would it convey more substance? I was given only a brief glimpse into his life, and I sincerely hope Mr. Harris received talk therapy and the help he was looking for during that first visit. But right now, I find myself apologizing for my shortcomings. I hope Mr. Harris understands.
Names and identifying details of the patient have been changed to protect confidentiality.
ANA LIANG is currently a fourth-year medical student at New York University School of Medicine (class of 2012). Before medical school, Ana attended Cornell University and majored in human biology, health, and society. She has many interests outside of medical school, notably reading young adult fiction, attending Broadway musicals, and performing Chinese folk dance. She will be applying for a pediatric residency position this fall.