Congratulations to our Martha Hughes (2019, Medicine), who has won the Society for Academic Primary Care’s Medical Student Prize for 2023!
The Prize is awarded each year to the highest scoring essay of up to 1000 words on the topic of a consultation that changed one’s approach to practice, and is open to students and foundation year 1 doctors from across the UK. Martha’s essay reflects on how an experience from the early weeks of her first clinical placement demonstrated to her the importance of holistic care and warmth, and the role medical students can play in enhancing patients’ experience of healthcare.
You can find her winning essay published below. Well done Martha!
Martha Hughes (2019, Medicine)
A Consultation in Primary Care that Changed My Practice
“Are you two ready to go down and see Mrs F now?” Our GP supervisor asked us.
I didn’t know about my colleague, but I was not.
We were only 1 week into our third ever week of being in GP surgeries/wards – as fourth year medical students this year was to be our first exposure to patients, procedures, and placements. I’d been convinced over my preclinical years that I was champing at the bit to finally get to interact with the population I would be devoting my future career to. However, despite now having been furnished with the most basic skills of examining and history-taking, it was a more intimidating prospect than I’d imagined.
In a consultation room at the bottom of the stairs waited a (we were assured) sweet, gentle lady in her 90s struggling with her osteoporosis. My mind helpfully rid itself of any useful questions that would help me learn more about how this patient was coping. My stethoscope weighed a little heavier around my neck.
Out of the door we walked.
We called her name in the waiting room, imposters in our GP-appropriate formal attire. I made sure my badge denoting me a student was as visible and as bright orange as ever: “DON’T ASK ME TO DO IMPORTANT THINGS” was the message I relied on it to convey.
“So, tell us what brought you in today.”
“That sounds very difficult for you, can you tell us a little more?”
“What medications do you take?”
“Can we have a feel, and a listen please?”
We recited our questions by the book, as good little medical students should. The answers she gave were thorough, and helpful. Her presenting complaint was an unfortunate fall, but we tried to take the advice of our supervisors and focus less on the clinical side, and more on the impact of her health on her life.
At her age, the subdued way that she talked, with a tinge of fatalism, without much hope for improvement in her constant pains, aches and significantly decreased mobility, it made sense to me. She had lost her husband several years ago and had no other family in the country. She relayed her responses with everything we needed to know, but nothing more. The fatigue of it all was tangible.
Back upstairs, I had noted the longstanding sertraline prescription.
My eyes flitted to the clock; when had our GP said she would come down and take over? Our unpractised script wasn’t developed enough to continue for much longer and the idea of sitting in the uncomfortable silence of our powerlessness was rather unappealing. Her answers became shorter as meaningful enquiry ran dry. Which is when my colleague changed the game.
“Mrs F”, he asked “are you French?”
For another aspect we had noted beforehand was her distinctly foreign surname, a theory bolstered by the unmissable strong accent that had remained after all these years.
“Oui!” She replied, in her own native tongue.
“May we practice some French with you?” He asked, reflecting the language change back to her, and was met with obvious and instant delight.
As if shattering an invisible wall between us, our patient became anew. From the content of her words to the emotive intonation, we were now talking to a different person. Gaining a quick assessment of our ability, she spoke slowly and carefully, and we moved out of the faded yellow four walls of the surgery, lit only dimly by the grey light coming through clouds and blind slits, and into the golden fields of southern France. We all smelt the simple but aromatic meals cooked lovingly by her mother when she was a girl, and knelt with her in her multicoloured flowerbeds as her vocabulary came to life. We shared laughter about our mistaking of apple (pomme) with potato (pomme de terre).
Before our eyes, she sat straighter. The fluidity of her words was mirrored in a slight additionally fluid body language, as if a fraction of her pain had been left behind with her English. The same consultation that was my first experience of a patient was also my first experience of the person around the patient-status they hold within that building. Inexperienced as I am, it is hard to know where lie the biases that I will have to challenge, but this was a fantastic example of how equating old age with inevitable depression is one of them.
For me, this experience also shone a harsh light on the effect of loneliness and isolation that is so widespread among our elderly in the UK, the good work that charities such as The Silver Line, Mind, and the Red Cross do, and how beneficial funding and expanding social services for this demographic could be.
How did it change my practice? In the way that matters for the next few years, I learnt that my role as a medical student has importance. Not in the same way as a prescribing doctor, or a wound-dressing nurse, but in offering a chance to connect with someone outside of the ten minutes of clinical exchange that are afforded in consultations. By taking this position seriously, my peers and I can genuinely impact people’s experiences, as I saw happen in front of me.
The levity in that room between the four of us (at the end, GP included) exchanging questionable French and the joy of that novelty, this is medicine too. By being able to connect on that personal level, we could feel the trust building and the patient-doctor bond developing.
Though my representation of those I interact with will be skewed towards pain, fear and illness, this is but a sliver of who people are. I will not always be able to speak the native language of my patients, but each will have a language to which we healthcare providers must always try to hear, and respond.