What do you picture when I mention a patient with diabetes? Heart failure? HIV?
I’m sure certain stereotypes pop into one’s mind when you hear someone has a condition. It can often be forgotten that we are interacting with people and trying to improve their lives, not simply treating a disease. This was reinforced when I spent an afternoon in an infections disease clinic interacting with HIV positive individuals. These are people, with their quirks and preferences, not some stereotype that might come to mind; they could have been your relative or friend. Having never knowingly interacted with person with HIV previously it was an interesting experience. You could see the stress in some patients before they were told their titers were undetectable or unchanged, their relief was palpable. My time in the clinic was a great reinforcement of the humanity of our patients.
Although an approach of understanding the whole patient is taught as part of our curriculum, real interactions are different. We are taught about “FIFE” as part of a strategy to understanding how a disease impacts a patient’s life (Feelings, Ideas, Function, Expectation). Asking about patient feelings, ideas about the illness, impact on function and expectations of the physician encounter. This is a nice list to remember, however, it doesn’t address our own preconceptions. In certain courses within our training this disconnect is addressed much better than others. Early in certain blocks one or more patients are invited to discuss their experiences with the class. These are some of the most valuable moments of my training thus far. They go beyond the theory, beyond the endless bullet points and algorithms and address the humanity of those we deal with and their concerns and feelings through a major disease or operation. Even with this included more is needed. I didn’t think I had many reservations, but I still wasn’t sure what to expect that first day in the infectious disease clinic.
They are people.
(As an aside, the doctor started his practice just as HIV was identified as the virus behind AIDS and was happy to share from this unique perspective the initial reaction of the medical community and progress that has been made in the last 30 years.)