Interacting with Patients

Dr Suzanne Donnelly, Director of Clinical Education       

Your clinical training in medicine may seem overwhelming at the start.  There may seem to be many rules and guidelines to be followed, but it is important that you take time to become familiar with them and act accordingly.  You will come to understand that while they protect patients, they also protect you from unintended upset or error and any consequences thereof.

Before you approach a patient, ensure you are compliant with the clinical dress code, that your name badge is clearly displayed and WASH YOUR HANDS

When you meet a patient, introduce yourself by name and identify yourself as a UCD Medical Student attached to the medical team caring for them. Shake hands unless there is an obvious reason not to do so – for example painful hand arthritis.

Seeing patients as a clinical student requires that you use your initiative.  This is vital to your success as a clinical student, but you must always remember that patients are not primarily in hospital to facilitate your learning, they are in hospital because they are ill.  Respect for each individual patient should be the fundamental guide for everything you do as a clinical student.

Remember the ‘3Cs’ of patient contact are paramount in all patient encounters whatever the setting; these are Choice, Consent and Confidentiality.

Choice:

Patients contribute to your learning of their own choice.  You must not expect that a patient will engage with you because you are attached to the team, and all patients should be asked whether or not they are happy to do so before you proceed.  Understand that ill patients will not always feel up to talking or being examined. In the hospital setting, if they are eating, having physiotherapy or have visitors, you should return when these have finished. If patients decline (and in reality, few do) express your respect of their wishes and, if you consider it appropriate, ask if you might return when they are feeling better. Never imply that a negative choice might impact on their care in any way - it does not- and never try to coerce a patient to consent to an interview or examination against their wishes.

Consent: 

As a student you must ask a patients permission for history taking or examination. You should not “tell a patient what you intend to do”, rather you must explain what is involved and ask patients for their consent to do so. First, explain what you wish to do e.g. “I would like to examine your abdomen, that means you would have to lie flat for a time while I press on your tummy.”  Then ask “Will that be ok?”  A patient may have further questions about what might be involved and may need reassurance that you will not hurt or otherwise discommode them. You should only proceed when the patient agrees ,and if they decline you may not do so. Do not be disheartened by a negative response, it is simply likely to reflect the patient’s current circumstance, so quickly choose another patient and try again. You might find it helpful to have a team member witness your interaction if you are having difficulties and always ask for feedback.

  • No student should perform a vaginal or rectal examination unless directly supervised by a registrar or consultant and the patient has given verbal consent to the examination.
  • No male student should perform a breast examination on a female patient without a chaperone in attendance, preferably a qualified doctor or a nurse.

Confidentiality:

This is a cornerstone of the doctor patient relationship and a key professional behaviour highlighted by the Medical Council guidelines which state:

As a medical student you should:

  • Never discuss individual patients – or partners, relatives, and friends of patients – even anonymously, within earshot of the
  • Understand that discussion in this context includes, but is not

I draw your attention to situations in which you must be particularly aware of the possibility of unintended breaches of confidentiality.  Discussion of patient ‘stories’ in ANY public space inside or outwith the hospitals and clinical sites is expressly forbidden and reports of such will be investigated immediately. Remember that patients may be recognisable to friends, family and neighbours by their stories, even if names are not mentioned. Buses, trains, pubs, restaurants, hospital cafes & shops, canteen queues and hospital elevators are all areas where you must be particularly careful.

Take all opportunities to spend time with patients and ensure you adhere to the guidelines in this booklet and those of your supervising team, ward or clinic managers.  The Medical Council guidance on “Personal and Professional Interactions” also contains very valuable advice that will help you succeed in the clinical arena.