Look Beyond Your Patient’s Chart

  • by Sonal Kumar
  • Sep 24, 2018

Practicing medicine is a constant challenge to construe information rapidly and responsibly. I find that approaching dentistry through the lens of my background in writing and the humanities has made me a more compassionate practitioner. Medical care and literature overlap in one essential quality — they both benefit from understanding narratives.

As I confessed in my dental school admissions essay and interview, it was never a love of science that drew me to the medical profession. When I decided to become a doctor, it was not because I was enamored by cell-cell interactions. Even now, I don’t get fired up by pharmacology.

I knew coming in to dental school that it did not have a reputation for fostering creativity. With a strong emphasis on memorization, the majority of first- and second-year evaluations are multiple-choice tests and oral examinations. But while knowledge of the location of the lingual nerve is important, it does not necessarily translate into a student becoming an ethical and empathic provider. Our patients must be identified by more than just their chart number.

In addition to a foundation in science, a doctor needs to take into account the patient’s history, current health status and future to fully understand human illness and disease. Alongside patients, clinicians synthesize symptoms, charts, past clinical experience, textbook and lecture knowledge, and patient communication to make a diagnosis and propose a treatment. In this way, a clinician coauthors their patient’s story.

Your patient’s charts are like the jacket of a book. They provide a synopsis of the story of your patient’s health, summarizing information about their periodontal status, radiographic findings and overall progress. As I read charts, I take mental notes about my patient, the main character of the story. If you are to help write the unwritten sections of the book with your treatment plan, you must first formulate the questions you need answered. Building these critical thinking skills also benefits time management — knowing what qualitative data you will need in advance can save a hurried dental student time. However, it’s important to keep in mind that these questions are only a starting point, as summaries are by nature not conclusive or comprehensive.

Your patient’s chief complaint is like the first few pages of the introduction. Listen, absorb and interpret as your patient speaks, as you — and the diagnosis and treatment plan you suggest — will help plan the later chapters. Keep in mind that your patient is sharing with you a unique opportunity and privilege by trusting you with their personal stories.

Avoid the impulse to skip past the chapters patients have been independently writing about themselves and immediately jump into the technical work of the dental procedure. The art of medicine is in the deliberate effort to nurture the doctor-patient relationship. See to it that you do the work to make that collaboration as strong as you can.

I have also found that in addition to adopting a literary metaphor, actually practicing my writing and reading skills has helped deepen my capacity for empathy and made me a better practitioner. In college, I composed an audio story after interviewing a 100-year-old widowed woman, Doris, on her perspective on aging and dying. Over Earl Grey tea and scones, she shared with me her fears and regrets. Her candidness and vulnerability made me feel a very special bond with her. In a similar way, reading novels can introduce you to the deep inner feelings of other people. This is an opportunity that textbooks do not offer.

Further, writing and reading can give practitioners a chance for self-reflection. It is for this reason the writing and blogging that I do in my spare time are most meaningful to me. Writing allows me to process my own intense emotions and serves as a vehicle to chronicle my personal journey towards doctoring. It allows me to express myself in ways I can’t as a multiple-choice test taker and to practice an art form when I feel bogged down with the science of medicine during the school year.

I dream about a dental school that provides students with similar options for exercising their creativity and delving into medical humanities. I think book clubs or lecture series about humanistic medical care would benefit students greatly as they move from the lecture hall to the clinical setting. There is a severely underestimated need for narrators, readers and writers in the medical profession, and my hope for my classmates is to actually get to know their patients.