Medical school gives us so many opportunities to doubt ourselves. Not just with the difficult course material but also with the tangible things that go along with being a doctor. For example, I still think putting on a blood pressure cuff is a little awkard. Compound that with a patient staring at you and wondering why this inept student is wasting their time, and things can really get in a tizzy.
As second years, we don’t have much clinical experience, but I did spend June doing a preceptorship in internal medicine. I was matched with Dr. J., an infectious disease expert and all-around awesome physician. He models everything I want my future-doctor-self to be: patient, having a positive outlook, and letting the bad roll of your shoulders. Many, even a majority, of his patients have been seeing him for decades and he has a first-name, very personal relationship with all of them.
My first day in clinic Dr. J. pointed me towards a patient room and told me to go do my thing. This was the summer after my first year. Sure, I had practiced on standardized patients but I didn’t have any idea what I was supposed to do with a real sick person. The good thing about real patients is that (for the most part) they are pretty forgiving. They don’t have a copy of the 130 point checklist that we are supposed to complete for every comprehensive physical. They don’t care if we ask the history out of order.
Practice necessitates a certain amount of fumbling, and the only way to become a competent physician is lots and lots of practice.
My favorite part of my preceptorship was working in an AIDS clinic downtown. Many of those patients didn’t have insurance, or even a home, and the demographic was quite different from what I saw in our private hospitals. What they lacked in resources they sure made up for in personality! I had a large, black, trans-gendered man ask me to call him “Michelle Obama” and to please vote for his (her?) husband. One patient continually referred to me as Dr. Annie no matter how many times I told him that I wasn’t a real doctor. (And my name isn’t Annie) A woman wrote down a brand of ear-wax remover I suggested. (It’s almost like prescribing meds!)
One man came in with calf injury down to the bone that looked infected. He wasn’t that bothered by it though. When Dr. J. asked him if he would like one of the nurses to re-bandage it for him he replied, “no, I’ve had it wrapped in this old shirt for a week and it seems to be doing fine”. Here follows my impressive, history-taking skills:
Me: So, that leg looks like it hurts, how did it happen?
Mr. Leg Booboo: Some (n-word) threw a log at me!
Me: oh…. umm….. ok. When did that happen? And how big was the log? (I also wanted to know where you find logs in the inner-city, but I never got there)
Mr. Leg Booboo: Well ma’am, can I be real honest with you?
Me: Of course.
Mr. Leg Booboo: I was intoxicated. And I have no idea what happened.
Another patient came in with a large bag and asked me if I wanted to know what was in it. I didn’t. He told me anyway. Fireworks!! He carries fireworks around to “scare people off”! When I asked Dr. J. if we should take cover or at least call for security he acted like I was way over-reacting. At some point in his career a patient had brought a taser gun into his clinic. Fireworks are pretty mild in comparison, I guess.
In later days I met a patient who had a t-cell count of 4 (not good, full AIDS) who confided in me that he couldn’t afford his medication because he used his salary to pay his mom’s rent. Several patients told me that they hoped they would get to see me again at their next visit.
It feels good to be told that you interact well with others and that you had some (small) impact on their care. It makes this journey rewarding.
On a more serious note, my grades aren’t so hot so I’m hoping my sparkling personality and charisma will make patients like me. And that all my attendings have a sense of humor.