At medical school, the importance of introducing yourself to the patient was continually emphasised. The first box on any OSCE (objective structured clinical examination) mark sheet was devoted to this simple, but fundamental tenet of being a doctor. For a “clear pass,” one had to state one’s name and role and clarify the patient’s preferred form of address.
These were easy marks to be had, so I learnt a spiel by rote: “Hello Mr/Ms ……, my name is …., I’m a medical student, would it be alright if I examined you?” I must have repeated this, or some variation thereof, hundreds of times during my three years as a clinical student. I remember during one mock OSCE practice, the doctor leading the session enthusiastically congratulating us on introducing ourselves clearly. I thought this a bit over the top, but he went on to say that many doctors doing postgraduate examinations often forgot to introduce themselves and launched straight into examining the patient or taking the history. I thought this unlikely, given that introducing oneself is something learnt on the first day of medical school. How wrong I was.
Thus, one afternoon I found myself going to prescribe intravenous fluids for one of our postoperative patients. I already knew the patient; I had met her on the ward round every morning for the past week, albeit scribbling notes hurriedly at the end of the bed. I picked up her fluid balance chart and started asking her about how much she had been drinking and whether she felt thirsty. I was trying to calculate her fluid balance when she asked: “But what’s your name, doctor?” I paused in the midst of my calculations and answered her question somewhat sheepishly.
Subsequently, I reflected on this incident and its implications. I was surprised that I had forgotten to introduce myself—something that just a few months earlier would have been unthinkable. I knew that I had become more efficient during my first few weeks as a doctor, due in part to my being able complete the same tasks in less time. After my first week on call, I no longer sat down to take a history; instead, I wrote my notes after seeing the patient, and my examinations became slicker and more focused. The second reason for my new found efficiency was that in the transition from medical student to doctor, I had discarded things I considered unnecessary—tactile vocal fremitus, for example, practised obsessively for finals and forgotten soon after. This episode, however, forced me to reconsider this enthusiastic pruning and to wonder whether, far from being efficient, I had already discarded too much.
So I have taken a step back and try, especially when I am busy, to pause, take stock, and think about how I might have approached the situation as a medical student and whether I should be equally thorough now. And I have resolved to introduce myself properly to all patients, although I accept that most cannot pronounce, let alone remember, my name.
