He was a World War II veteran, a member of the Greatest Generation. Although he undoubtedly carried painful memories in his heart from those difficult days, he was always smiling; he had a winning smile that could light up a room. He could captivate that same room with entertaining jokes that would leave everyone begging for more. He rode minibikes, danced the “Twist” at family gatherings, and cooked mouth-watering Mediterranean dishes for me when I was in college. He could readily relate to both young and old, and many of my college friends would often ask me when he would be coming back for a visit as he would amiably strike up a conversation with anyone he met. He put everyone at ease and made friends with people he met at stores and at concerts and other festivities and with a legendary celebrity. He was my maternal Uncle Mel and was the grandfather I never knew, for both of my grandfathers passed away before I was born.
Uncle Mel also taught me my very first, hard lessons about taking a medical history. I was a young medical student, and Uncle Mel was visiting us. He mentioned in passing that he was having some pain, and I, concerned for his health and eager to make use of my newfound medical history-taking skills, quickly started rattling off a few questions: “Where does it hurt?” “Is it sharp or dull pain?” “When did it start?” “Have you taken anything for it?” I honestly thought I was helping when Uncle Mel said to me sharply, “Please don’t analyze this.”
I felt stung, for Uncle Mel had never scolded me. I highly regarded his opinion and looked up to him with all my heart and soul. I quickly stopped questioning him, and the rest of the evening passed uneventfully. Uncle Mel’s spirits improved, and thankfully, he did not seem angry with me.
However, something in my heart was nagging at me. I was disappointed in myself but could not seem to understand or articulate why. A few days later, Uncle Mel passed away suddenly. I was devastated. He was so special to me and all those around him. And I felt awful that I did not have the chance to apologize to him for being an overly ambitious medical student.
I have thought about that evening often since that time. I now understand that I should have asked Uncle Mel for his permission to query him about his symptoms and explained why I thought it was important to do so. It is essential to remember this idea both during a role-playing medical school interview and when you are a practicing physician someday. Patients are often overwhelmed and need their physician to tread lightly and ask questions at a comfortable pace. Many times they are not ready to tell their story in its entirety or even possibly at all. As providers, we need to honor and respect this. It’s also worth mentioning that it is prudent not to offer unsolicited, well-meaning assistance as family members in the medical profession unless, of course, in an emergency. Family members who are providers cannot be completely objective and could miss a diagnosis. Furthermore, a provider’s family members may not desire such assistance and feel uncomfortable. And the most important lesson that I learned from that evening is that as providers, just because we can do something doesn’t mean we should; this concept is a basic tenet of medical ethics. Just because I knew what questions to ask as a medical student did not mean that I should have asked them.
Why is it so important to remember to ask permission to take a medical history during a role-playing medical interview? The role-playing actor may be portraying a patient who is reluctant to speak because of a psychologically traumatic experience that has prompted the visit. All medical history questions potentially have emotional ramifications for the patient. The admissions committee wants to ensure that you do not heedlessly start overwhelming the patient with a litany of questions. As a prospective medical student, you must remember at all times how vulnerable patients are. In the interview, it is essential to take a deep breath, take a step back, and gently and empathetically ask the actor playing the patient for permission to ask questions to help ascertain what may be causing the medical problem. For every medical problem that the actor presents with in an interview, ask yourself what may be sensitive about this medical issue. How might you approach the medical history questions related to the medical problem with compassion and understanding?
It is paramount to create a rapport with the patient before starting to ask the history questions. You might begin by addressing the actor by name and stating that you need to ask some questions to try to determine what is causing their medical problem and that these questions could potentially be sensitive to them. Ask the actor if it would be permissible to proceed with these questions and mention that if, at any time, they feel uncomfortable and want to stop the history-taking session, that they should not hesitate to tell you. If the “patient” asks you to stop the history-taking session, please display patience and kindness and use understanding body language. This approach is crucial for your medical school interview and for your future career as a physician
If I could go back in time to apologize to Uncle Mel for my foolish zeal, I would do so in a heartbeat. I learned my painful lesson. During the remainder of my medical training and career, I always tried to remember the importance of requesting permission to ask what may be difficult medical questions to the patient. Patients are well aware that the answers to these questions may indicate serious illness, and they are understandably frightened. We must always proceed slowly, carefully, and respectfully. In the words of Alexander Pope, “Fools rush in where angels fear to tread.”
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