MEDICUS May 2022

Having conversations that matter Nathali Lagus President Curtin Association of Medical Students D rip. Drip. Drip. Water seeps through the dilapidated wooden ceiling of a riverbank squatter dwelling. Under it, a child sleeps on a sheet of dried seagrass leaves woven by the hands of the dreamless few in her settlement, unbeknownst to her family’s fears that the rising waters might seep into crevices they don’t belong, and lodge into places that breathe life. In glaring contrast to white picket-fence suburbia are realities such as this for the estimated 689 million people living in poverty worldwide. 1 In two sentences, one can clearly pick out a great number of determinants of health that will prove long-term challenges to overcome for that child. It’s easy for many, especially health-literate individuals like medical students, to say “Well it’s their fault they’ve got [condition] because they do [action against advice],” in the future. But, unsurprising to most, is that the truth lies in a systemic failing of people in a social, political and economic capacity. The way these factors tie into the individual’s health can be summarised into a pathway like poverty  distress  harmful coping behaviours  morbidity  premature mortality, which often cycles through generations. 2 This is the type of justification that may, anecdotally, be easy for many to acknowledge yet difficult to implement into practice. Because a medical student who’s already got their own issues to deal with, may often choose to sacrifice areas of study involving social justice, population health, emotional intelligence etc, in favour of more STEM-based disciplines. And is it right to blame the medical student and junior doctor cohorts that are expected to always exercise compassion, when the education and training pipeline itself could do with a lot more kindness, empathy and understanding built into its systems? Our education as medical students boasts of culturally safe practices, patient-centred care, holistic management, and other frameworks. So, as future health professionals we’re fortunate to build our careers around a workforce that values and continually looks to improved clinical communication skills. But what of non- clinical communication skills? As a medical student who has been a patient in the public hospital system, I believe the best way to connect with anyone, be they a patient or a medical student, is to listen to their stories, their life experiences. The pathway from poverty to premature mortality has been shown to present opportunities for all levels of prevention, 2 so it’s important that as doctors, we listen and look for the factors influencing coping behaviours that our evidence- based research condemn. There is a patient survey sheet called the ‘sunflower tool’ being used at a hospital I volunteer at, where each petal pertains to details about a patient’s life outside of the hospital. Every day these get filled out for each new patient that we’re able to talk to, noting down their likes, dislikes, their pets, family, hobbies and all else that make up their life. It’s helped not just the volunteers, but other staff on the wards, find connection with the patients under their care. Hearing a patient talk about the things they love is just as worthwhile as achieving appropriate diagnosis and treatment. Addressing worldwide poverty is an issue that requires work in every sector of society. And something we can action to help alleviate some of its consequences is to engage in a patient’s storytelling. Because without these conversations, how could one know that this author was that sleeping child in that riverbank squatter dwelling? ■ References 1. World Bank. 2017. Monitoring Global Poverty: Report of the Commission on Global Poverty. Washington, DC: World Bank. World Bank. https://openknowledge.worldbank.org/handle/10986/25141 License: CC BY 3.0 IGO. 2. Price, J. H., Khubchandani, J., & Webb, F. J. (2018). Poverty and Health Disparities: What Can Public Health Professionals Do? Health Promotion Practice, 19(2), 170–174. https://www.jstor.org/ stable/26746916 And while being able to achieve a diagnosis, provide treatment and positively contribute to someone’s health can bring its sense of fulfilment, there’s nothing more warming than the curves and creases on someone’s smiling face when they talk about the things they love most. 42 M E D I C U S M AY 2 0 2 2 O P I N I O N