Progress Notes

Not just a medical student

Julia McGuinness, MS3By Julia McGuinness, MS3

“I would have done anything you told me to do.”

Many people, I imagine, would welcome these words. Power is seductive, after all. Coming from the mouth of a patient, however, this sentence struck me dumb with fear. Why would anyone listen to me, an MS3 stumbling through her first month on Medicine wards? Didn’t my patient know how utterly incompetent I was?

I suppose he hadn’t had much time to discover that for himself. He left against medical advice, i.v. still in his arm and Holter monitor attached to his chest, soon after I took my initial H&P. He had presented to the VA with unstable angina and a known history of coronary artery disease, and that had earned him a trip to the cath lab. The problem was, he didn’t want it. In fact, he was terrified of the procedure.

Panicking after hearing my attending’s recommendations, he had stayed silent when she asked if he had any questions and had instead bolted from the hospital after she left the room, leaving my team puzzled and concerned for his safety. We mentally retraced our steps, trying to explain how and why this calm-appearing man had reacted in such a way, but we couldn’t. So, we tried every contact number we had in our system, each team member calling multiple times in an attempt to reach him. That is how I came to be speaking with him over the phone the following afternoon, on the receiving end of a very powerful declaration of trust.

How had I, the least seasoned member of my team, earned his confidence? I certainly did not exude the expertise of a cardiologist. I could picture my performance of the medical student version of the cardiac exam, fumbling with a stethoscope that had gotten caught on my unwieldy (and, might I add, unflattering) white coat. My patient, reading the question suspended in my silence, answered it for me. “You were the only one who really listened,” he said. “I could tell you cared. I knew you would look out for me, and I would have gone through with the cath if you had told me to do it.”

There was truth to this, I realized. The rest of my team had certainly done nothing wrong, but they had not had the luxury of time that is afforded to a medical student. I had spent probably half of my interview asking him about his life, learning of his family troubles and past struggle with depression and encouraging him to reach out and take the help offered to him. I had established a real relationship with him, and in my own quiet way I had inspired his faith in me.

I recently discussed this experience with a handful of students and faculty who had gathered to discuss the meaning that we find in the practice of medicine. An attending in Internal Medicine recounted a similar anecdote, in which a patient had genuinely asked a medical student for his professional opinion (“Hey doc, what should I do?”) even after the attending himself had discussed his own recommendations at length.

After witnessing this deep bond between patient and medical student, this attending began to give the following advice to all of his students: Never say “I’m just a medical student.” The student’s role is uniquely powerful and beautiful. Cherish it while it lasts, and carry the tools you acquire with you when you become a bonafide physician.

Medical students often feel like imposters playing dress up in doctors’ clothes. Insecurity certainly drives our quest for knowledge, but perhaps we should stand up a little straighter, a little taller, and a little more confident in our short white coats. After all, we’re not JUST medical students.

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