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September 29, 2009



My rheumatologist, who I've been seeing for 7 years, always has residents with her. It's true that on some days I'll see more of her residents than I will of her, but in general she manages to strike a fairly comfortable balance.

One way in which she does this, I think, is by involving the patient in her care and guidance of the resident so that it becomes a three-way conversation. I find it effective and, often, enlightening. I feel listened to, and when she explains things to the residents I usually end up learning something new, as well.


Thanks for the suggestion. Can you give an example of how she gets you involved?


Often it's as simple as ensuring she speaks to both of us throughout the exam. For example, she'll show the resident some of the bone erosion in my wrist, and then have me explain the associated pain and inflammation, and the progression of the damage. Of course, this occasionally means she repeats herself in different appointments, but I don't mind and I don't imagine many others would. When she notices something new, she explains it to both of us. Often, she'll have the resident do the physical exam while she watches.

It's important not to let the patient feel like he or she is an exhibit by talking only to the resident. This has happened once or twice with other specialists, and it left me feeling like some kind of medical curiosity. You can prevent this by taking a moment here and there to explain things in laymans' terms to the patient. This is especially important if you notice something new. Several times a doctor has pointed out some abnormality or other to the resident, and I've thought, "What? I didn't know about that!". So, if you want to point out something that you and the patient have not previously discussed, take time to explain it to the patient first.

I know my rheumatologist is incredibly busy, and so I'm grateful she makes the effort to ensure I don't just feel like a number. It sounds like you're doing the same. I hope this helps a little.

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