By Siri Tummala, MS-II
This article was originally published in the May/June 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
“Cranial nerves two through twelve intact. Sensation is absent to light touch in right C5 and C6. Strength five out of five in bilateral upper and lower extremities. Bilateral hyperreflexia noted in patellar reflexes. No gait abnormalities,” I recite to my neurology preceptor. I quickly tap my right foot in nervous anticipation of disseminating the physical examination findings and their implications to the patient.
Context is everything. One year ago, abnormal neurological findings on an Objective Structured Clinical Examination (OSCE) would excite me. It was a free space to explore various pathologies in depth without fear of harming the patient. But this is not an OSCE. Gone are the days when hired actors pretended to be patients with medical cases. This is the real world with patients experiencing debilitating symptoms presenting to clinics. Now, abnormalities are not just an opportunity to see topics I learned in class or in a textbook last year come to life. Rather, abnormal physical exam findings in the real world can have devastating effects on individuals’ lives and on their overall wellbeing.
Informing patients about abnormal findings that warrant further imaging is not an easy task. I take a deep breath and knock on the door. I calmly deliver the news that his neck pain, hyperreflexia, as well as his numbness and pain in the middle and pinky fingers necessitates an MRI of the cervical spine for evaluation of possible cervical degenerative disc disease.
“So, I won’t know if I have that disease until I get the MRI?” asks the patient.
“Yes, that’s correct. Imaging is a tool we can use to confirm our clinical findings,” I reply.
The patient’s body starts to reflect the stress he feels from this information. Sweat beads form on his forehead. His brows furrow. His lips quiver.
“But it won’t be until a couple of weeks that I can get the MRI and have the results back,” he worriedly says.
I sense his uncertainty, and I spend twenty extra minutes with him. I calmly explain that it is normal to feel anxious about the unknown. I further explain that imaging is a helpful tool we can use to confirm our clinical findings. I reassure him that physical exam findings and imaging results together will allow us to formulate an efficacious treatment plan to fulfill his goal of improving his symptoms.
Our job as healthcare professionals transcends purely applying medical knowledge to real-life settings. The quality of the medical information we give patients is valuable only if it is delivered in an understandable manner that takes into consideration how that information affects their daily lives. If the pathology is prioritized over the patient, medical care will not suffer, but the patient will. Given that our primary duty is to ensure the wellbeing of patients, patient encounters are more fruitful when extra time is spent explaining the importance and relevance of the information. It takes years to fully master medical topics for medical students who spend all day studying and are constantly immersed in the material. It is not a fair expectation to assume that patients will recognize the significance of and be able to apply health recommendations without a clear and thorough explanation by the caregiver. Patients are real people, and this recent encounter reminded me that entering medical settings is a vulnerable situation that requires physicians to acknowledge their experiences with care and compassion.