The Art of Medicine: Hidden Agendas

In the clinical setting there are always hidden agendas. It takes an astute clinician to identify them. Many times students operate on a different wavelength entirely. Readers of the same novel will often come away with different takes on the narrative. Medical practice is no exception. more»

Interested readers can now access my latest Art of Medicine column — Hidden agendas — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.


2 comments on “The Art of Medicine: Hidden Agendas

  1. Andrew Snider says:

    I’m a student, and admittedly, I think this article went over my head. Was the mother seeking pain meds? What’s with the pica? Please explain!

  2. BTM says:

    Admittedly, there are any number of undercurrents running through this piece.

    By and large, students have a tendency to focus on the primary reason for the visit that is presented by the patient: in this case, trauma to the child’s foot. The girl’s pica is a side issue that the mother brings up privately, not wishing the child to be a part of that discussion. The supervising physician does not make the chief complaint (foot pain) clear to the PA at the outset. Through some subtle remarks it appears as though the mother has her own agenda: the need to call attention to herself, to her own suffering, both physical and perhaps emotional as well.

    In this interaction the student did not pick up on the mother’s personal agenda. He focused only on the clinical presentation of the foot trauma and the pica.

    Many times in clinical encounters interactions ebb below the surface. Although subtle, these interactions can impact the dynamic of care. It is important for the clinician to be aware of them.

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