Narrative reflection written by Eva Martinez Luque – Clinical Experience for Engineers – July 2024

Meeting someone for the first time is like staring at a blank sheet of paper. Over time, you fill it with what you learn about them in a bidirectional exchange, where each of you gradually opens up. This happens every time we meet someone new. I’ve experienced it myself and observed it in others countless times. However, it never occurred to me how this dynamic would manifest between a doctor and a patient… I was thinking about this while I was waiting for Dr. T to meet me in the waiting area of Emory’s Brain Health Center.

Dr. T arrived, introduced herself and guided me to the motion analysis lab. She is a movement disorder specialist, and I was going to shadow her during one of her motion analysis sessions for patients with Parkinson’s’ disease and essential tremor. The lab consisted of a white room with multiple tracking cameras and a chair in the middle. The patient arrived early, and he was already in the room when I arrived. I felt the awkwardness, I think he felt it even more. Because they had to stick tracking fiducials all over the patient’s body, he had to change into a very tight (and uncomfortable looking) sports outfit, including a cap that from far looked like a swimming cap. He was sitting in the middle of this room, with all the cameras pointing at him and us looking at him too. I could feel how uncomfortable he was. It was Dr. T’s first time seeing this patient, but she had a full chart with all the patient’s information. At the beginning of the session, Dr. T went over the clinical history and then proceeded to evaluate the patient’s strength and muscle tone. Then she asked him to move to trigger the tremor. The vulnerability of the patient was impossible to miss, not only because of the strange setup but also because the session aimed to record his tremor at its highest intensity.

Mentally I went back to the waiting room and the thoughts I was having about meeting someone for the first time. Here, everything felt reversed and unbalanced. Dr. T was indeed a blank sheet of paper for the patient, but the reverse was not true. She knew about the patient’s disease, saw them in a state of vulnerability, asked personal questions, touched their body, and witnessed his struggles with basic tasks. Vulnerability is usually a precious gift we share with trusted individuals, making the doctor-patient dynamic an extraordinary exception in how we build trust and relationships. The patient chooses to trust a stranger with their most vulnerable aspects without apparent reciprocity. There is immense power and responsibility in such trust.

Dr. T had no pity in her eyes and navigated the situation with ease, engaging with the patient and offering assistance when needed but never assuming they required it. She would joke with the patient if she sensed they had a sense of humor, hold their hand when they were about to tear up, and give them space when needed. She did not ignore their vulnerability but refused to let it define them. The way she would describe and analyze the patient’s symptoms was the same way you would describe someone wearing a red shirt – no connotations involved, no judgement, simply an objective description, and yet full of empathy. She gained their trust in minutes.

I left the Brain Health Center feeling like I just witnessed something special, something like a “trust shortcut”. I was curious to see how this dynamic would play out between a physical therapist (PT) and a patient, as touch is typically a higher step in interpersonal relationships and harder to reach. A couple days later I shadowed Dr. C and her colleagues during a morning of physical therapy sessions with patients with stroke and movement disorders. Some patients were new, while others were not. Yet, I could not tell the difference based on how the PTs interacted with them. The PTs were friendly, warm, and had a contagious good mood. As an observer, the interactions felt more personal than in the more clinical setting that I previously observed; some even seemed like friendships. This made sense, bringing me back to the point about physical touch requiring a higher level of intimacy.

I learned that building doctor-patient trust is not as unidirectional as I initially thought. It is indeed very different from any other interpersonal interaction, but it is genuine respect, empathy, and kindness that builds such trust in the span of a single clinical visit or PT session. Interestingly, while as an engineer my initial excitement tends to be directed towards the technology that could be implemented in a real clinical setting, it was the relevance of human connection that struck me the most. While technology can enhance clinical capabilities, it should never replace the empathy and intuition that are crucial and should always be at the center of patient care. For technology to be effective in the clinic, it must support and enhance these human elements rather than overshadow them.