Isobel Cammish is a 3rd year medical student at the University of Oxford. She is on LinkedIn
She hesitated before answering, watching my face. The conversation was turning towards something harder to say, and I had debated asking this question. I tried not to flinch as I asked it, aware of my hands in my lap and whether my expression holds the right balance between concern and composure. Did I seem like someone she could trust?*
The patient starts to cry. I lean forward to offer a hand to hold, while wondering if I am performing my role of medical student correctly. I’ve moved on instinct, hoping I still look professional, but my sincerity seems to earn the patient’s trust. Her story unfolds as she speaks. I learn a lot from it.
When I move too quickly onto a new topic, the patient’s answers shorten. When I introduce medical language, I increase the tension between us… less like two people talking.
I am learning something else too. When I move too quickly onto a new topic, the patient’s answers shorten. When I introduce medical language, I increase the tension between us, as if the words push our roles back to medical student and patient, less like two people talking. I forget the name of the patient’s son: the moment fractures and I have to rebuild our connection again. I had thought I was observing the patient’s answers, but I am shaping them.
We are not always taught this explicitly, but it’s hard to ignore once noticed. I think back to consultations in which GPs make patients feel safe to talk, who notice when to pause, when to redirect, how to keep a patient moving without rushing. I watched GPs turn a screen away so as to look at a patient and let them talk without interruption, the patients able to communicate their priorities for care. They create space for patients to expand on answers and risk revealing important issues otherwise left unsaid.
There are other consultations that have felt narrower. Emotional cues are passed over, symptoms categorised and dismissed, and conversations steered back to what fits. In these rooms, patients shrink and their stories remain untold.
I have been a patient in both of these rooms. In one, I felt listened to and my pain acknowledged; in the other I found myself simplifying and editing my story, deciding what was worth saying and what was not.
Each interaction does more than build my clinical knowledge, but shapes the type of doctor I want to become.
Before a patient exposes something vulnerable, they are assessing us, deciding how safe we are to hold their most private thoughts. Patients notice more than we think: posture, eye contact, tone of voice, how we greet them, the language we use, the questions we ask. They notice if we skirt around an issue, or ignore its weight. They notice if we are uncomfortable. Patients adjust their answers accordingly.
It was only afterwards, doing creative reflection based on the consultation, that I fully understood this. Writing about my experiences, I had time to think about the small moments and analyse where the conversation had shifted. I kept returning to the same idea. We are not passive witnesses in consultations, we are active partners. What happens in a consultation is not fixed but co-created, and I am more responsible for that than I had realised.
Each interaction does more than build my clinical knowledge, but shapes the type of doctor I want to become. Not just what I know, but how I sit, how I ask questions, how I respond, and what I make possible for the person in front of me to say. We are taught to listen to patients. But we are also teaching them whether it is safe to speak.
*Author’s note: This is a fictional patient based on my clinical experiences as a medical student and as a patient and not a specific individual, alive or deceased.
Featured image by Hush Naidoo Jade Photography on Unsplash
