Sometimes I just sit very still and let the wonder of this whole process roll over me. After all, I worked toward THIS for nine years.
I guess I kind of figured I’d spend the first two years cramming information into my brain, then the second two years learning how to actually use all that info in practice. My experience has been very different than that, and that more than anything is what daily blows me away.
As I’ve written about previously, a big part of my medical school experience is spending 20 hours a month with my mentor from the very beginning of year one – a practicing physician who has agreed to let me follow him while he sees patients. Theoretically, this is considered “an observership”, one tiny step up from the shadowing I did as an undergrad. However, it very quickly turned into much more.
This past Tuesday, I arrived at a small university health clinic and almost immediately my mentor and I were moving from room to room, addressing headaches and plantar warts and completing study-abroad papers. My ‘job’ was to complete the EMR note, and I’m getting better at listening to my mentor rattle off the diagnosis and medication / dosage without having to say, “could you repeat that please?” Thirteen patients seen in a little over two hours.
And then it happened.
As we were with the last patient, freezing a particularly recalcitrant plantar wart on the foot of a determined soccer player, the nurse stuck her head in. “Any possible chance you could see one more patient? He just walked in and looks really miserable…”
And the doc looked at the nurse, smiled, and said, “My student can see him.”
I cannot begin to describe my moment of panic. I’m a first year student. That means I say “I don’t know” a whole lot. I follow, look over my mentor’s shoulder, ask questions. I’m partway through learning long lists of bacteria and viruses.
I’m sure my panic was written all over my face as my mentor reassured me, “I’ll double check once you’re done – just think, you are going to be SO PREPARED by the time you hit clinicals! Here, use my stethoscope…”
And just like that I found myself knocking on the next exam room and reaching out to shake the hand of a miserable-looking young man who didn’t care in the slightest when I introduced myself: “My name is R, I’m a medical student. How can I help you today?”
I pulled up the EMR record, glanced at vitals the nurse had entered, then started right in. The patient was complaining of a sore throat for the last four days. No fever, no nausea or vomiting, no headache. Just the sore throat.
I tried to remember the ‘right’ order of things. Check the eyes, ears, nose. Look in the throat (yikes that looks really painful!), check sinus pressure, feel for swollen lymph nodes, listen to heart and lung sounds (so nervous I truly couldn’t hear a thing omg I’m messing this up so bad!), then have a brief conversation with the patient.
I’m a student so Dr. J will come in to confirm. But at this point it looks like you’ve got viral pharyngitis, basically a sore throat. Since its a virus, it won’t respond to antibiotics, but I know its super uncomfortable. You’ll want to drink plenty of fluids, get lots of rest, treat the discomfort with over-the-counter meds like Ibuprofen and maybe a throat numbing spray like Chloraseptic. Do you have any questions?
(I’m secretly praying he doesn’t. Don’t ask me anything! I promise I don’t know anything!!) But he asks how long before he feels better, and I reassure him that his body should fight off the infection in another 3-5 days. If he starts feeling a lot worse, or develops a fever or other symptoms, please come back to the clinic.
My visit with this patient took less time than it just took me to write about it, although at the time it felt like I was taking way too long. Then back to my mentor to report what I knew. Try to remember those TV shows I used to watch (back when I had time for TV), students reporting on a patient to their Attending. Run through the patient’s complaint, my exam, try to describe the throat (it doesn’t look like the strep or mono sore throats we’ve been seeing – more like areas of ulceration or something) and then the doc is peering in my patient’s throat, glancing at my SOAP note, then leaning back against the counter while he confirms everything I just told my patient.
And now I know what a coxsackie virus throat infection looks like.
Once the patient is gone, my mentor looks at me. “Two things”, he said.
First, get your own stethoscope.
Second, make peace with the fact that most often (both now and for your entire career), you’ll feel like you’re operating more from life experience than from your med school information. Trust what you know. You’re really good at this.
I could have hugged him. But I didn’t… enough to know I’m on the right path. This is a “first” I’ll remember … for the rest of my life.