By Suzanne Minor
The student used the phrase “my patient” six times during the brief patient interaction: “I don’t like my patients to not exercise.” “I like it when my patients eat healthy.” “I like it when my patients take their medications” and so on. Many students use this phrase occasionally, but this was striking. I wondered what his motivation was. Was he nervous? Or did he think the patients were his? After the interaction, I debriefed with him, asking him what went well and what he could improve. He did not bring up his use of “my patient” so I did. He was unaware of his saying “my patient” and could not reflect on why he was doing so. I asked him what he thought this phrase might mean to the patient.
“The patient”, he queried, “what does that have to do with it?” I was frustrated, somewhat aghast that this third-year student, steeped in patient-centered interviewing throughout his first two years of school, missed that the patient had something to do with their own care and that the phrase “my patient” might claim ownership of another person or their attributes, such as soul, physical being, or responsibilities…
I asked him, “Who is responsible for the patient’s care?”
“I am,” he responded quickly. Specifically relating the discussion to patient autonomy from his clinical skills training, he voiced some understanding that the hypothetical patient shared some responsibility for her care, but could not imagine this actual patient playing a chief role in their well-being as he felt that was his role as the physician-in-training.
I left the discussion unsatisfied and shared the interaction with a fellow health educator that evening. She said that as a social worker it was important to avoid this phrase because it meant that person is the only person responsible for the patient’s care, negating the patient’s ownership for her care as well as the interprofessional team members working to improve the patient’s well-being, such as the social worker, nurse, dietitian, and physical therapist.
I then discussed “my patient’ with residency faculty. One physician detailed orienting residents that the patients were their patients rather than her patients, impressing on residents that they were responsible for the patient’s care, not her. “My patient” represented accountability and ownership of the role of physician.
Not long after the “my patient” interaction in clinic, I said goodbye to my patients. Yes, “my patients!” I had been seeing some of them for 10 years; it was difficult to say goodbye. I completely accepted responsibility for my part of their care and strived to not claim responsibility for their roles. These patients were a part of my life. It felt incomplete and disrespectful to call them “the patients” rather than “my patients.” I think this was a way of honoring our relationship. It felt uplifting to put to words this connection to another human being, however humble it may be. I felt like I’ve come full circle, from ownership to relationships.
I think this phrase, “my patient,” has struck me so because of this value of connecting to others. Just as I encouraged the student to open his mind to other meanings, I can open my mind to the intricacies of our language. I love that I can continue to evolve as a physician, educator, and person. As much as possible, my goal now is to empower the patient by helping them to take ownership for their care and well-being and to empower the learner to be the patient advocate as well as empowerer. I want to empower patients to take responsibility for their well-being, their care, their bodies, their selves.
Suzanne Minor, MD, FAAP, is the Director of Clinical Faculty Development and an Associate Professor at the Florida International University Herbert Wertheim College of Medicine