Beyond the H&P

“Beyond the H&P”

A Guest post by Jessica Morgan

Beyond the H&P

It’s 4:00 pm on a Thursday: time to present at teaching attending rounds. I have prepared my presentation and know about the patient’s pathology, but I can never help myself from being incredibly anxious for these moments. I gather my papers and begin…

“This is a 54-year-old undomiciled male with a past medical history significant for alcoholism, insulin-dependent diabetes mellitus, and chronic pancreatitis who presents with hematemesis.”

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I take a breath. “That wasn’t so bad”, I think to myself. Now for the rest of the presentation. I delve into the details of how the patient presented to the hospital and how he is not currently vomiting or having any other signs of overt gastrointestinal bleeding. I quickly address the important points of the physical exam—namely the 5 cm hepatomegaly upon admission to the medicine team—and finish out with my brief plan:

“Based on our ultrasound and MRI findings, the presumed etiology of his hematemesis is hemorrhagic cholecystitis and we are consulting with GI and general surgery about future management of this condition.”

I take another breath. “It’s over!” proud of myself for delivering a decent presentation. Now it is time for us to see the patient as a group. I am very excited at this point because I have been following this patient, Mr. Z, for about a week now.

I first met him the morning after he was admitted, and spent much of his first day with him. It was a Saturday and I decided to accompany him downstairs for his ultrasound, spending the entire exam right next to him. We did not talk very much, but at the time I didn’t think it mattered.

Throughout the rest of the week I checked in on Mr. Z a few times a day. I always saw him first thing in the morning and asked the same questions I have asked so many people before: “How was your night? Did you sleep well? How are you eating? Are you having any nausea, vomiting, or diarrhea? How about fevers or chills? Headaches? Any questions for the team?” Of course we did not stick to this exact script every single day, but more or less, that was the majority of our interaction with one another. As far as I could tell, I had gained all of the information about him from the ‘History and Physical’, and there was nothing more to add. Mr. Z is a very nice man and always seemed happy to see me when I came to talk with him, but we weren’t becoming incredibly close.

As we walked into the room—my attending, three other medical students and myself—I saw the same Mr. Z as I saw every morning. “Cachectic male appearing older than stated age lying comfortably in hospital bed in no acute distress”. I assumed this visit would be just like all of our one-on-one meetings throughout the week. Then my attending began speaking.

At the beginning of the month I realized my attending was a very special physician. He truly connects with his patients, and I could see when he began to speak to Mr. Z, something very different was happening. This was not “going through the motions”. He asked Mr. Z about his life; where he was from, if he was married, if he had children. These were things I had never asked Mr. Z; these were things not included in the H&P.

Hearing the answers made me feel like I had missed the entire point of this week, possibly even the entire point of medical school; “Yes I was married once, and I have three kids back in the DR”. How could I have spent time with this man every day, claiming to take care of him, without even asking who he was? I was truly disappointed in myself, but nothing compared to what came next. My attending asked the deepest question I have heard in the hospital: “What is the one thing you would like us to know about you?”

Mr. Z clearly was confused by this question, and rightly so, as I doubt he has ever been asked that in general, let alone as a patient in a hospital. “What do you mean,” he asked. “What is special about you?”, my attending clarified. “Special?….About me?” Mr. Z asked, even more confused. At this point, I almost began crying. I was touched by how deeply my attending desired to know our patient. My heart broke knowing that Mr. Z had probably never been asked what he thinks is special about himself, and he probably thought nothing was special about him at all. This man who I presented as “undomiciled with past history of alcohol abuse” does have something special about him, as we all do. The narrative of his life was not defined by his diagnosis.

Working with this attending during my inpatient month opened my eyes to what is truly important about taking care of patients, and it is taking care of patients. I cannot expect to connect with someone if I never even try to. I may know all about their disease, how to treat it, and even the prognosis. But what is the purpose of all of that if I don’t even know who I am saving? I think daily about how special the moment was when Mr. Z looked up at my attending with awe just because he had asked a real question about himself. It should not be something so shocking for us, though. My attending was not doing anything out of the ordinary by asking Mr. Z about himself; he was just taking care of another human being and establishing a connection.

I know I have many years to go in my medical career, and this encounter truly shaped the way I see patient care. I want to be the kind of physician—and the kind of person—who cares for people, both body and soul.

Jessica is Medical Student at the NY University School of Medicine. She can be reached via her twitter account at @MorganDonor_24.

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