Tajwar Taher

Preceptorship W18
3/12/18
Term 2 Field Note 2

Reflect on what the doctor‐patient relationship means to you? Using specific examples, write
about a time you saw your version of the doctor‐patient relationship exemplified by your
preceptor. Or, write about a time it was not exemplified. (I blended a few of the prompts
together in my field note, but this seemed the most relevant.)

Relationship Status
Stepping out into the waiting room, I gazed at the pockets of people seated throughout.
Most had their heads down, busy with phones or forms. I wondered which one connected to the
sticker containing a name, DOB, and MRN that I clutched in my hand.
“Danielle?” I called out.
The woman to my right looked up. She gathered her belongings and made her way to me.
I smiled and introduced myself. “Hi, I’m Taj. I’m a first-year medical student and I’ll be
rooming you today. Thanks for your patience, I know we’re running a little behind.”
We glanced at the TV displaying how well each provider was adhering to their schedule.
Danielle’s provider was highlighted in fire extinguisher red.
“Well, maybe more than a little,” I admitted. Danielle chuckled as I led her into the clinic
and to her room. Once she’d settled in and as I pulled up her chart, I said “One of the MA’s
explained to me that your doctor is typically behind because she likes to be very thorough with
each patient. I know waiting for so long isn’t fun, but I think it’ll be worth it.”
“That’s reassuring,” Danielle replied. “I’m re-establishing care here after moving back. I
need to go over all these medications they say I’m on that I’ve never heard of. And I need to talk
about my pain. I have Lupus you see.”
“We’ll get all that sorted out,” I said, taking my eyes away from the computer and giving
her a reassuring smile. “I do have to take your blood pressure first.”
Danielle groaned.
After I set the cuff up and began pumping, she watched the pressure gauge with a sick
fascination. As the pressure cuff exhaled with a whooooooosh, Danielle inhaled sharply and held
her breath waiting to hear the results.
“170 over 100.” Her shoulders slumped and she nodded knowingly. “Does that sound
about right? Have you been checking regularly?” I asked.
“No, I’ve been avoiding it. I don’t want the constant reminder I’m dying.”
She said it with a smile, so I returned a teasing, exaggerated look of disapproval and say
“Well the doctor will see you soon. We’re going to take good care of you.”
When I’d finished charting her vitals and prepared to leave the room, I thanked her for
her time. “Thank you,” she said, and added “I look forward to seeing you as a doctor one day.”
“It’s not going to be a for a little while,” I said with a sigh.
“Maybe more than a little?” she asked with a sly smile, and we laughed.
“Eventually, I’d love to see you here again.”
“Oh, I probably won’t come back here once my doctor moves to a new practice,”
Danielle explained. “She’s so wonderful to me, I’ll follow her wherever she goes.”
 “Fair enough, I won’t take it personally.” We said our final goodbyes, but just as I was
about to leave, there was a knock on the door and the MA popped her head in.
“Are you done Taj?” I nodded. “Okay, the doctor should be ready in about 30 minutes.”
“Another 30?” Danielle asked disbelievingly. “Can I go to the cafeteria then?”
“No,” the MA replied with an apologetic frown, “once you’re checked-in, you do have to
stay here.”
“Do you want me to grab you a magazine or something?” I asked.
She thought about it for a moment, then smiled wanly. “No, it’s okay, I’ll just meditate.”
The MA and I stepped out of the room, but I caught one final glimpse of Danielle’s melancholic
expression before the door to the claustrophobic clinic cell closed.
We returned to the clinic pod, and I made my report to Danielle’s doctor, finishing with
“She wants to re-establish consistent care now that she’s moved back.”
The doctor, eyes glued to her monitor and fingers flying on the keyboard, snorted. “She
does huh? Well that’s something isn’t it?” The question seemed rhetorical so I remained silent,
but I glanced over at the resident working with her. The resident smirked knowingly. The doctor
finally pulled herself away from charting and nodded to the resident. “Okay, let’s get this over
with. God, today’s been such a long day. The schedule is so full.”
I watched them walk past without another word. I watched as Danielle’s door closed
once more and wondered what would happen within that clinical cell. The juxtaposition of
Danielle’s impression of her doctor and that same doctor’s behavior in the pod had left me
baffled.
From my conversations with primary care physicians, it seemed like the greatest draw to
the field has been the deep relationships formed with patients. While Danielle’s doctor seemed to
know Danielle very well, their relationship only seemed positive from Danielle’s side. Those
physicians I’d spoken to in the past claimed these longitudinal relationships were wonderful, but
there was a weariness in Danielle’s doctor’s voice that seemed to suggest otherwise. Perhaps
those physicians had really meant that the length of the relationship was the alluring aspect of
primary care, in that one could potentially witness an entire life from birth to death; I thought
they had meant the intimacy one develops with a patient by understanding them physically (and
even mentally) better than anyone else in their lives.
Both I’m sure are true, and probably contributed to Danielle’s doctor’s cynicism.
Relationships can be draining, especially if they feel one sided. Despite Danielle’s easy-going
nature, I wouldn’t be surprised if she didn’t adhere to her treatment plan. I could imagine how
frustrating it would be to invest so much time in a patient’s care and not have them follow
through on one’s recommendations.
The healthcare system has almost completely embraced a customer service philosophy in
which we attempt to keep the patient as happy as possible, but this experience made me wonder
whether that’s truly applicable to human relationships. Should providers hand out their time and
emotions like commodities to patients without seeking anything in return? Is it fair for Danielle’s
doctor to have to put on a mask every time she sees her patients, only able to be her true self
during half of her life? I was quick to make some mental judgements about Danielle’s doctor, but
the more I thought about it, the more I realized that they both required advocates and empathy,
that the “us vs. them” mentality that the customer service model can perpetuate was not
conducive to the health we’ve committed to bringing to this world.
As Danielle and her doctor exited the exam room, both appearing pleased with their
encounter, I couldn’t help but shake my head and think “Relationship status: it’s complicated.”