October 2014 | ISSUE 14
The Art of Medicine: Year 1s learn the art of medicine not just the science
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By Nicole Lim
Assistant Director, Communications & External Relations

Wrong prescriptions, chaotic waiting rooms, treacherous spills everywhere and many anxious and confused patients were all part of the picture painted by a group of Year 1 students as they imagined a polyclinic staffed solely by doctors.

This was one of the skits that brought to life the Year 1s’ lessons learnt during Polyclinic Week. Apart from the roles of different healthcare professionals, teams also presented what they learnt about why patients come to the clinic and their journey as medical students.

For all teams, however, the starting points for their field work were the patients in the waiting rooms of Bukit Batok Polyclinic.

“At first, you’re apprehensive in approaching patients as they are real patients, but after a while you realise that they are not so intimidating,” said Daryl Peh, a first year student.

His classmate Ho Ying Na agrees. “All of us felt nervous about communicating with patients. We learnt patient communication skills during ICPs [Integrated Clinical Practicals], such as non-verbal communication skills, and during Polyclinic Week we got to put these skills into practice.”

After the first few conversations, they soon realised that while a good medical education is taken as a given by the patients, those doctors who leave a lasting impression are the ones who listen and make the patients feel comfortable.

Year 1 Berwyn Tan said, “What struck me when speaking to one patient was that the first thing she told me was that her doctor was a very good doctor because he listens to her. I think what’s very important for doctors nowadays is not just the hard skills, but the soft ones too. So we have to practise communicating with patients, listening to their concerns and adapting our consultation to suit their needs.” 

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At the end of Polyclinic Week, the students shared their experiences and findings from their field work with the class

Assistant Dean for Family Medicine Associate Professor Wong Teck Yee said, “Polyclinic Week is about giving students an understanding that each patient encounter is unique – patients have different reasons to seek help and their reasons may differ at each encounter. To ensure maximum benefit from each encounter, one needs to adapt one’s interaction. That is a skill that takes time to refine, which is why we want to expose our students to this early on.” Polyclinic and Hospital Week are timetabled during the first two months of the MBBS programme at LKCMedicine.

Seeing the complex team of healthcare workers coming together to care for patients brought home the reality of modern medicine. Gong Cheng Sean said, “I think the most important takeaway is the importance of an interdisciplinary team. We have to work together with other healthcare professionals and we have to be humble and learn to defer to the judgement of others.”

This takeaway was also very evident in the wrap-up presentations of Hospital Week.

 

Hospital Week

The Year 1 students also got the chance to spend a week shadowing healthcare teams in a hospital setting. While they followed different tertiary care and rehabilitation teams over one week, they all spent one shift with the nursing staff.

Year 1 Cecilia Chen said, “Nurses know the patients and their private lives better as they spend more time with them than the doctor, so patients might feel more comfortable sharing with the nurses.”

Fellow Year 1 student Wee Lin shadowed a nurse on a particularly busy day on the ward. “With every patient, she was very patient. One patient had vomited and stained the bed, but she didn’t lose her temper, she was really understanding and soothed the patient. It was very inspiring,” said Wee Lin.

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With the nurse's guidance, a student checks a patient's blood glucose level (left); a nurse explaining how the defibrillator works (right)

But it is not just the nurses who play an important role in the patient’s recovery.

Sunil Ravinder Gill, who spent the week with the rehabilitation team, said, “Hospital Week allowed me to see how different healthcare professionals come together to allow a patient to recover. Usually, we think the doctor does most of the work. But especially in rehabilitation, the different healthcare professionals play very significant roles in enabling stroke patients to regain a level of function needed for daily living.”

Classmate Carol Tay agrees. “What I learnt from Hospital Week is that the patient is really at the centre of it all. Everyone works as a team to integrate the patient back into society.”

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Students put up skits about the lessons learnt during Hospital Week during the closing session

Assistant Dean for Phase 2 & 3 Associate Professor Tham Kum Ying is pleased with the success that Hospital Week has become and the impact it has on students’ understanding of medicine. “The main objective for Hospital Week is for students to understand a patient’s journey through the hospital, the different reasons why they are admitted, how different healthcare professionals support and care for the patient,” she said. “This year the students have again surprised us with their understanding of the subtler lessons that Hospital Week has to offer.”

 

Treat the individual not the symptoms

For all the students, the biggest lesson learnt was the need to keep the patient at the centre of their care and treat each patient as an individual rather than a collection of symptoms.

“I remember being told that it’s more important to know what patient the disease has than what disease the patient has,” said Aliza Wong, who held this motto close during her time at the hospital and polyclinic.

This means finding innovative ways to get the necessary information from patients while maintaining a comfortable and relaxed conversation that encourages the patient to open up.

One instance that left Berwyn inspired was a consultation he saw in the care manager clinic at the polyclinic. “The care manager had a very short time, so in order to build rapport but still get the information she needed, she made it sound like a normal daily conversation about the patient’s day and habits.”

It is not just what is said. Tan Yu Zhi said, “Most arguments are caused by tone of voice and not just what you say. So I think as a good doctor, you need to know how to talk to a patient, use a calm and caring tone to reassure the patient.”

Kimberly Chan agrees. While having a conversation with every patient may not always be possible due to the many dialects and languages spoken in Singapore, bonds can still be forged even without words. “One physiotherapist I met just smiles at her patients, nods and is very encouraging. And the patients can sense that she’s caring for them,” said Kimberly.

How will these lessons affect their own intentions and aspirations as they train to become doctors? Ying Na says, “As aspiring doctors, we have to remember to build emotional resilience and treat each consultation separately, and not carry emotions over from one consultation to the next.”