Fillers A memorable patient

Using patients for teaching can enhance their lives

BMJ 2003; 326 doi: (Published 05 June 2003) Cite this as: BMJ 2003;326:1255
  1. Martin Rhodes, general practitioner

    The students were in the last firm of their first clinical year, so I asked them if there was something they wanted to do that they hadn't covered. The answer was kidney disease. Now the trouble with kidney disease is that there often isn't much of a history, and, until it gets to end stage failure, there aren't many signs. We base our teaching around patients, and the only patient we had in the practice with anything worthwhile to show the students was a rather depressed 80 year old woman who was struggling with home peritoneal dialysis. I didn't think she would be amenable or a very good example for the students.

    However, they were insistent so I telephoned the patient to ask if I could bring the students around, and her surprising response was “Oh yes please!”

    When I turned up at her bungalow with six students we were met by a smiling face, a best frock, and a new hair do. “Please come in, would you like a cup of tea or a coke? I have been waiting to do my dialysis until you came to show you what was involved. Would you like to help me?” And so she did. I hadn't seen her looking so well in 15 years. In her youth she had been a dancer, and suddenly she had come alive again with a different audience.

    The dialysis process took an hour, during which time she was able to tell her story, how she and her husband coped with a life of peritoneal dialysis, what drugs she took and what they were for, and the diet she was allowed.

    For three years, I came every six weeks with a group of students. She soon picked up what the students were meant to know and gradually took over the session while she used a mixture of charm and a Socratic approach to teach the students all about renal failure. I sat at the back as she demonstrated the aseptic technique necessary, asked them why the opaque bag with draining dialysis fluid had a window in it (to detect discoloration that might indicate infection) and recounted the horrible experience of a peritoneal infection. The students' evaluation was that it was a powerful learning experience.

    However, the best thing was the renewed vigour and excitement in life for the patient noticed by her family and friends. It is perhaps sad that the most enjoyment she received was teaching students for an hour every six weeks, but it was very important for her self esteem that she was able to make this contribution.

    Eventually she slowed down, had difficulty concentrating, and shortly after teaching the last group of students in the year she died.

    We have lots of patients who are happy to be available for the undergraduates who attend our practice, but what I learnt from Mrs H was that teaching students can enhance the quality of life for the patient.

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