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SAN ANTONIO
MEDICINE

to find another patient to interview for my
project. I walked into the room and saw a
healthy-appearing, middle-aged female who
pleasantly greeted me. She had radiant skin,
a calm, soft smile, and an air of confidence
about her. She expressed how very excited
she was to help me and to be a part of my
project. This encounter seemed like it would
be routine. Towards the end of my survey,
the questions became sensitive. They were
adverse childhood experiences (ACEs) ques-
tions. Halfway through the ACEs, her atti-
tude shifted from an enthusiastic patient to
a tearful patient right in front of me. I was
nervous but kept my composure, set down
my clipboard, and comforted her through a
moment of silence and sobbing. I ques-
tioned myself: "Did I break her? What did I
do wrong?" She said through the tears:
"Growing up, I was gravely abused. I am still Developing an efficient yet genuinely empathetic
too affected by my past and sad, and I feel relationship with patients is vital.
like I just eat my feelings. I do not tell anyone
this. I am sorry." In her most vulnerable mo-
ment, I replied, "Please do not be sorry. I
want to help you." fective illness management. Food insecurities, mental health, trans-
After explaining to the patient that it is okay to feel these emo- portation issues and numerous other factors affect our commu-
tions and that she is not alone, she expressed a willingness to seek nity's health outcomes. I firmly believe that future health care teams
counseling and mental health services. I then sought out and and physicians must acknowledge this complex relationship for the
printed some resources for her. At that moment, whether either sake of our patients. Social determinants of health are critical, and
of us realized it or not, she instilled in me the value of empathetic I will strive to incorporate these into my future treatment plans as
understanding. a physician.
Years later, I still think of her. Our encounter marked the begin- I reflect on how my research, clinical experiences and the social
ning of my journey to appreciating and understanding the patient challenges that affect patients today have shaped me as a future
perspective. I often think about how composed and externally physician. I wonder about the issues facing the world today and feel
healthy she appeared. However, she truly felt distraught and was af- a renewed inspiration to act as an unbiased advocate for patients,
fected by many different social factors that impacted her diabetes who are at their most vulnerable during medical visits. I realize that
outcomes. Our interaction was a reality check for me. Since I saw developing an efficient yet genuinely empathetic relationship with
how an outwardly healthy person struggled with illness and abuse, patients is vital. Every patient has individual needs, especially those
I continue to rethink what I observe in an exam room today. Every- who are coping with a chronic disease. We must address their social
one is going through something and has a story, whether it is exter- needs to manage illnesses, such as diabetes, and to optimize health.
nally apparent or not. My experiences have set the stage for my clinical rotations and my
In today's world, effective treatment requires more than address- future career as a physician.
ing a simple disease or applying an algorithm. It requires under-
standing the intricate relationships among various social Edward Visnaw is a fourth-year medical student at the Long
circumstances that affect health outcomes. Throughout my clinical School of Medicine, UT Health Science Center San Antonio and is
rotations training, I find this to be relevant and applicable to ef- a member of the Bexar County Medical Society.

visit us at www.bcms.org 29