Saturday, August 01, 2009

What third year is all about.

During the third year of medical school, the med student is a rare form of human being.

"You are here to learn" they tell you. What they don't tell you is that you are here to help out, but don't get in the way and don't be too overzealous. You are here to report your findings but no one will actually listen to you, they will only wonder why your presentation isn't exactly how they like it (and everyone likes it differently). They will quiz you on the stuff you learned in the first two years, and when this happens, a couple of things become clear: 1- you know more than the residents, 2- you are being judged for every stupid answer you give. They ask you questions, but you're not supposed to always answer them, because then you're a know it all. But if you don't answer the questions, you are not a competent medical student. You have to be professional, be on time, and be okay with standing around with no clear directions on what you're supposed to be doing. You have to meet the expectations of all of the different attendings in each of the different specialties- some will let you do everything and others make you follow them around and never leave you alone with the patient. Some want you to present the patient to them as a whole, and others just want to know about the patient's particular disease, right now, today, and everything else is extra information that the idiotic med student is giving and wasting everyone's time with. Some of them want you to go and do all sorts of irrelevant physical exams "just for pratice," regardless of the degree of distress the patient is in. Some patients know this, and they've already had 2 other people come in and do their physical exam, so they refuse to let you touch them. And then when you go back and say what happened, it's your ass. Why? Because "this is a teaching hospital and patients know that." It doesn't matter that the woman in room 4 is depressed and alone and scared. Go make her touch her nose and your finger and ask her to repeat 3 words back to you and make her walk on her tip toes and listen to her bowel sounds and poke her all over.

On the other hand and on a brighter note, the third year med student gets to sit in the room with a patient for an hour or more. No one is relying on the third year med student to write any orders or actually take care of anyone. It is a chance to connect in a way that no one else on the team can. The third year medical student is learning every day. Learning and integrating the past two years of hard work. Seeing why we needed to learn every cross section of the brainstem and the names of all of the major drugs and drug classes and the reasons why certain diseases do what they do.

The learning goes beyong academics, though. You also learn, through first-hand observation, what kind of physician you want to be, and what you don't want to be. I have seen some truly insensitive, awful physicians and residents. The things that scares me the most is those physicians who have forgotten to look at people in the eyes. Or maybe they never did. The ones who have forgotten that each patient is a person, not a disease. The ones break awful news, such as "you tested positive for HIV" without asking the patient if it's okay to say that in front of a family member who is in the room. Without asking the patient if it's okay that 2 med students and 3 residents are also in the room. Without any concern for the fact that on the other side of a thin curtain, there is another patient in the room. Without going through anything that looks remotely similar the breaking bad news protocol, SPIKES, that we learned in our second year of med school. I can't remember what SPIKES stands for (ok, shame on me), but essentially, you prepare the patient to hear the bad news, you ask them what they know about the disease, you ask if they're ready to hear it. You show a shred of human emotion and look them in the eyes when you tell them.

I understand that for the sake of efficiency and in order to be fair to other patients, physicians can seem a bit cold and impersonal. But just because I understand it doesn't mean I will accept it.

I look forward to meeting more and more physicians who are not monsters, who are not jaded, who are not cold and impersonal. I have already met a few role models, and I am excited to meet a few more. Even the non-role models are good to have. They serve as reminders of what NOT to become.

1 comment:

Daughter of Night said...

I think this is a wonderful post. One you'll look back on, I bet.

And I wholly agree with you - there is something to be learned from EVERYONE, even if it is only learning how you DON'T want to be.

You're a great doctor already, because it's obviously the human factor that still interests you, even as a third-year med student.