Site, Onset, Character, Radiation, Associations, Timing, Exacerbations, Severity.
I found the theme of what is unseen by doctors fascinating in this week’s session. The patient artwork* with the tree flowering below ground, the rich tapestry covered by the curtain of depression, the speck of blue amongst the tumult of colours…
You feel as if your being taught to see more in lectures, to make new connections and think of the many possibilities to reach the diagnosis but perhaps this is not the case, perhaps I see less now. Again one of the patient artworks brought this home to me – when they drew what they wanted from a doctor, they drew a hand. When I see a patient and I look at their hands I’m looking for clubbing, I’m checking for capillary refill time, nicotine stains and any other clinical clues – I’m not looking for personality and reassurance and comfort like patients are when they have a doctor examine them or even shake their hand. This reminded me of a song I used to love which sees the story of a person’s life written in their hands. Maybe we as doctors should see more like this, I’m so taken up with lists of questions to ask and signs to look for that when I see a patient I doubt I see with the kind of penetrating eyes that the patients drew for doctors, that could see what was left unsaid, the flowers in the tree roots so to speak. A new mnemonic:

Sight, Openness, Care, Rapport, Attention, Time, Empathy, Silence…

*To see further patient examples of the artworks which inspired the above reflection visit Messages to our Future Doctors  in the  ‘Patient-Perspectives’ category of this website.