While treating a college athlete who wasn’t recovering as expected, taking the time to understand her story uncovered new details that informed her care.
A first-year college student, far from home, arrived ready to fulfill her dreams of being a college athlete. She’d trained her whole life for this experience and had sacrificed all of her free time. Because of this, she earned a starting position on the college team. One match, she went up to block a ball and her knee gave out upon landing. As the team physician, I later evaluated her injury. After the MRI, I had to tell her the devastating news that she’d torn her ACL and would miss the rest of the season.
She tried to remain hopeful as she recovered from surgery and worked hard on her rehabilitation. However, after three months, she plateaued. Her evaluations, labs, and images didn’t reveal any explanations and she continued to regress. Upon further questioning, she exhibited depressive symptoms. She felt far from home and no longer felt very connected to her teammates. These factors contributed to a slower progression of healing, but I felt like there was something else going on.
Diving into deeper questioning, we talked about her previous recovery from injuries. We discussed general college life, her classes, and her typical daily activities and food breaks. I learned that she didn’t prepare full meals. Instead, she usually snacked on food between classes and rehabilitation. This new information led me to question her menstrual history, which revealed several months of amenorrhea. The athlete didn’t realize that her eating habits and menstrual irregularities were abnormal. Her nutrition intake was insufficient to maintain her reproductive hormones and promote other aspects of healing.
A new treatment plan was devised, which centered around nutrition and mental health in order to improve her underlying condition, rather than simply focusing on her knee injury. Over many months and frequent meetings together, she was able to overcome her eating disorder. The focus then returned to progressing her ACL rehabilitation to get her back on the court.
As a new physician, my experience with this student changed my approach with patients. It opened my eyes to look beyond each person’s injury as an isolated event and to take the time to understand their full life story. Here’s what I learned:
1. Ask the hard questions. Sometimes that means digging.
Patients may not disclose information during your first visit together, especially if it’s sensitive information. Furthermore, patients are more likely to open up when they are asked directly. Sometimes they don’t realize that one aspect of their life that’s not obviously connected to their injury contributes to their inability to heal.
2. Listen to what the patient is saying and what they are not saying.
Patients hold the key to the whole story, but it’s up us to piece together the verbal and nonverbal communication to complete the picture.
3. Trust your intuition.
If something feels off, explore your instincts.
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.