It is natural for the student to be anxious when first approaching a patient. He fears that sick people will not welcome a nervous and clumsy beginner and that he can be of no help to them. This is the time for him to remember that many patients find comfort in the knowledge that their own suffering may serve, through the observations of students, to ease the burden of those who follow, perhaps even their own children. But the student can also be a messenger between the fearful patient and the awesome doctor. Time and again, students have discovered facts vital to diagnosis or management that had previously been withheld because of the patient's fear, the doctor's haste or the forbidding retinue that accompanies the physician on his round. The student should approach his patient with humility and gratitude, but also with quiet confidence in the responsibility which will be his for the remainder of his life.
Clinical medicine is above all a matter of communication between people, and the quality of the student's relationship with patients and colleagues could decide his success or failure as a physician. Sometimes even facial expression, tone of voice and manner of movement can affect the ability to elicit the patient's story and to lead him back to health. For it is in such outward signs that we display those attitudes of mind, which may act as a barrier to communication with others. In the presence of his patient the student must master his emotions, clear his mind of distracting thoughts and avoid all appearances of haste. His manner should be alert and attentive, yet gentle and sympathetic. Without these qualities, he will neither obtain the facts necessary for diagnosis nor effectively convey the advice essential to management. Before confronting the patient, the student should also anticipate, as far as possible, the probable attitude of the particular patient he has come to see. He must be ready for the resigned and sometimes resentful manner of the patient with chronic incurable disease, the frightened questioning from those with recent alarming symptoms, the desperate pleading of the patient in acute pain, the unresponsiveness of the seriously ill. He must also adapt himself to the patient's ethnic, social, educational and intellectual background and use forms of speech which he can understand.