What reflections do you have on what you learned or what you now think about the experience of being a patient after watching the movie? 

After watching this movie, I understand why “Interviewing and Counseling” is its own entity in the first semester of PA school at York College. While we have a lot of clinical information thrown at us, we cannot let what we learn in PA school take away from who the patient is that will be sitting in front of us. For example, this week we learned about atrial stenosis and how it may lead to many complications. It is also one of the more deadly heart diseases. Even though I know some of those complications, I would never label a patient “terminal”. It would be crucial to give them information on their diagnosis so they can learn more about what is going on. It’s also crucial to address the patient’s family members’ concerns. The scene that resonated with me the most is when the wife of the heart transplant patient states that good qualities come from the heart. She is not referring to the cardiac output or overall health of the heart, she is concerned about the person who had the heart before. Whether she is worried about the wrong or right thing, Dr. McKee told her it was a “good” heart to make her feel more at ease. 

Please note specific examples of how physicians treated patients in the movie (how the main character, Dr. Jack McKee was treated and how he treated other patients) – in light of what you now know about patient communication.

In the first 9 minutes of the video, Dr. McKee saw his doctor and presented with the symptom of clearing his throat. The doctor performed a physical exam of the throat and neck area. He asks Dr. McKee how long the symptoms have persisted. Dr. McKee replies: “A while”. This is not specific enough as a “while” could mean many things. From my experience as a medical scribe, you must probe for more information. If a patient says “A while”, you must narrow it down to the number of months, weeks or days, that the patient has been feeling the symptoms. 

Dr. McKee treated patients as only patients he needs to “cut”. When Dr.McKee is talking to his interns, he specifically says “I’d rather you cut and care less”. However, he does try to make the patient feel better by making a golf joke. Also in this scene, Dr. McKee does not introduce himself immediately. He walks in with a look of concern and looks the patient directly in his eye. In this scene, there was some effort to display non-focusing skills.

Dr. Mckee decides to see another doctor (Dr. Abbott) for his symptoms. He attempts to introduce himself and shake her hand. Instead, she instructs him to sit down. Dr. Abbott begins to examine his throat while asking him what his complaint is. As a patient, Dr. Mckee downplays his symptoms and does not tell her about him coughing up blood. She continues to examine his mouth but does not let Dr. Mckee know what she is doing. You can tell the discomfort he is in while being examined and honestly it made me uncomfortable as well. Dr. Abbott sprays an anesthetic in his mouth without letting him know what it is or telling him what she will do next. Overall, when Dr. Mckee is the patient, there is little to no communication.

Things are just getting started as he needs to get a biopsy of the growth in his throat. The most important thing to note is that when the man who first attended to Dr. McKee after he was slightly awake. The man called him “Mr. Brown” and gave him an enema. This is because the man was working with the wrong patient. Of course, it is difficult to confirm the name and DOB of the patient while they are asleep, but it does not seem that an effort was made.

Another example of how Dr. McKee was treated was the lack of communication from Dr. Abbott and Dr. Reed. Dr. Reed told Dr. Mckee that the tumor is the same size, then Dr. Abbott told Dr. Mckee that the tumor is getting bigger! 

Dr. Mckee is starting to understand how a patient feels after being misled multiple times. A few scenes later, one of the interns calls a patient “terminal” and Dr. McKee gets upset because the patient labeled him dead when the pt was not. This seemed to be the beginning of the transformation into a better doctor. 

 In the last scene where Dr. McKee has an exercise for his interns where they have to be in the role of patients: What do you think they would learn from the exercise? How do you think it might make them talk to patients or treat patients differently?

The interns would overall be surprised by the way they are treated in the hospital system. First, the patient would learn that many doctors treat their patients as a number, and not a person. A doctor may read an x-ray but not consider the patient’s medical history, which may lead to an incorrect diagnosis. Then, the interns would be subject to tests that may not be necessary. The lab tests and diagnostic studies may not just be a waste of time. They may also cause pain, discomfort, and confusion. 

After the exercise, the interns will talk to the patient with the memory of the exercise they just performed. In other words, the interns will start to use “patient-centered interviewing”, more nonfocusing and focusing skills. This would allow the interns to have a diagnosis sooner than later, especially when a patient has a life-threatening situation like June.

Extra Credit: Give some examples about how Dr. McKee’s approach was “Clinician-Centered” in the beginning and “Patient-Centered” after he had been treated for his cancer.

Dr. McKee visits a patient to remove staples from her chest. Without telling the patient that he will examine her first, he just takes off her gown. Dr. McKee does not indicate how much time is allowed when entering the room and does not make the patient feel comfortable (barriers). The female patient explains that she is worried about how her husband will feel about the scar. Instead of using the “N.U.R.S” model, Dr. Mckee then makes a joke about how the patient’s scar looks comparing her to a playboy model. Dr. McKee was clinician-centered and treated the complaint, but not the patient.

Towards the end of the movie, Dr. Mckee sees the heart transplant patient before the surgery. The patient’s wife notes that she hopes the heart is a good one because qualities come from the heart. Instead of giving her a clinical and scientific response about cardiac pathology, he addresses her, and his family’s worries by agreeing with her and saying qualities do come from the heart. Dr. Mckee treated the patient with a successful heart transplant surgery, and also addressed the patient’s family concerns and worries.

 It is said that health care providers sometimes spend too much time treating the disease and not enough time treating the patient. How is that idea illustrated in this film?

It is evident that health care providers sometimes spend too much time treating the disease and June is an example of that. First, she was told to take aspirin for her headaches. She returned because she was fainting while driving. The health care provider should have taken her medical history into account and known that was a red flag. June should have been ordered the appropriate tests which Dr. McKee said would have been an MRI. It was too late when June found out she had a brain tumor which led to so much emotional distress that she was screaming on the roof of the hospital. June’s life might have been saved if the health care providers treated her as a patient and not her just symptoms.