Author: Elina Kurkurina

The missing link: Interpretation and connection

Posted June 06, 2023

The 2023 Building Trust Essay Contest, sponsored by The American Medical Student Association and the ABIM Foundation, asked medical students to engage in a reflective writing exercise about their experiences where they or someone they know received, shared, or acted upon misinformation in a health care setting

“Are you sure?” The question was to my preceptor, but his gaze was on me, like he was searching for a second, differing opinion.

If we’re being honest, I’m usually not sure. The abundance of information available at our fingertips can be overwhelming. As a first-year medical student, I often struggle to trust myself, but I trust the process of my training. Since starting my pre-clinical years, my knowledge base has been tested, stretched, and built upon at an exceeding rate. Every other Tuesday, I get to see real patients, practice interview skills, and apply new material through a clinical preceptorship program. It’s in these clinical encounters that I learn about more than the organ system of the block. It’s in these clinical encounters that I witness fear and vulnerability turn into trust. It was also in one of these clinical encounters that I met Sergio.

Sergio was a year younger than me. A week prior he was helping a neighbor with a construction project where he inhaled some dust and debris. The exposure was brief and limited, but he was nonetheless concerned. He read online that vigorous exercise was the best thing he could do to “clean out his lungs following exposure.” Not only did it not help, but for the first time in years, it exacerbated his asthma. The next day, he noticed a new pain in his back right where his lung would be. He came to us anxious and convinced that lung scarring from the exposure would lead to a serious disease. As my preceptor worked through his list of concerns, reassuring him along the way, he’d push back.

“Yes, I understand, but…” he’d circle back to something else he read. It’s pulled up on his phone. He can show us.

The issue with online information is that it’s often out of context. Internet searches tend to identify rare or worst-case outcomes. Misinformation and misinterpretation often go hand-in-hand, and it’s hard to navigate this space alone. Caring for vulnerable patients requires trust, comfort, and thoughtful communication to help alleviate the anxiety often experienced by patients in these settings. Teachable moments in the clinic are an opportunity for these values to shine.

My preceptor is good at teachable moments. I’ve watched her pull up diagrams on her computer to show patients exactly what she is talking about when referring to anatomy. With Sergio, I watched her do what his online searches couldn’t. I followed along as she connected his medical history, experience, and story to his current symptoms. I listened as she walked us through her line of thinking.

We found out that he’s not usually that active and swinging a hammer in that manner was a new motion for his body. Most importantly, we were able to pinpoint a muscle group that aligned with where he felt the pain. To his relief, it wasn’t his lung.

We no longer have a stronghold on medical information, but we have the skills of empathy, connection, and context. The ability to assess, interpret, and contextualize signs and symptoms is a gift. For Sergio, it provided the reassurance he desperately needed in that moment. The amount of information available online can be overwhelming, but teachable moments can build trust for medical students and patients alike. It’s moments like this that engage patients in their own care and rebuild the foundation of trust and partnership.

Elina Kurkurina is a first-year medical student at the Frank H. Netter MD School of Medicine at Quinnipiac University. She is interested in the intersection between emergency medicine, geriatrics, and primary care. Prior to medical school, she worked in quality measurement and holds an MPH degree in Social and Behavioral Sciences from the Yale School of Public Health. In her free time, she can be found on a hiking trail with her husband and rescue dog.