Medical students are part of each patient’s health care team

I realized last week one of the hardest mindset transitions that I’m having to make as a medical student. It has to do with not really feeling like I belong, and the need to really make my patients … well, MY patients!

As a medical student, you can actually function reasonably well without ever having to actually see a patient.

You can read the chart, read what the nurses wrote, read what the nurses and doctors who saw the patient thought, evaluate the vital signs that are charted, look up their lab results, etc, all without ever stepping foot into the patient’s room. Based on that, you have a pretty good chance of getting the diagnosis right! You can look great on rounds when presenting the patient, and even write progress notes.

As horrible as it sounds, I’ve been guilty of this at times. This was especially common when I was first starting out. The thinking often goes like this: I read that the patient was admitted from the ED at midnight, spent all night being poked and prodded for this test or that IV. And by the time I see them in the morning, they’re just finally asleep. And then the rationalization starts, “Oh, just let the poor dear sleep! I’m on a medical student, after all. My physical exam doesn’t really mean anything.”

This week, it was patients on isolation. I had 3 patients to see in the morning. I found the first door, and a big sign was posted, “Contact Isolation.” This means, to see the patient, I have to put on a gown, sterilize my hands and put on gloves before I see him. What a hassle! I decided to see that patient last. I went to the next door … same thing! I decided to try the last patient … “Contact and Droplet Isolation.” That means I have to wear a mask, too. Do I even have time to see these patients before rounds start?

Even when I do go in to see the patients in the morning, I don’t always do the best exam. If they’re sleeping, I’ve sometimes just timidly asked them if they’re feeling alright, do they have any abdominal pain? May I listen to their heart and lungs really quick? And then tiptoe out. After all, what does it matter. I’m just a student.

I had a patient a few weeks ago with severe cerebral palsy … a 23 year old male. That hit close to home. This man, my age, was in a crib, wearing a diaper and playing with a rattle. I’ll admit it, flat out … I was scared. I was very uncomfortable, and I’m ashamed to say, my first day as his student, I chickened out, and didn’t go in the room. The next day, I worked up the nerve and did my exam. Removing the diaper and seeing pubic hair was a real shock. I tried to be very respectful, but also keep in mind that this was my  patient, my responsibility, my privilege to see and touch and diagnose and heal.

I’ve come to a point where I never allow myself these excuses anymore. I do try to be thoughtful of the need for patients to sleep, etc. At the same time, if they’re my patient, I go in and see them. Even if the nurse is in there already. Even if they’re asleep. Even if they’re on isolation. Even if they have mental retardation. No matter what. I’m taking ownership of my patients. What a privilege I have to see these people, to care for them and help heal them. There have been times in the last few months that I have caught findings that went unnoticed by the rest of the team. A new, concerning heart murmur in a child that prompted a visit to the ED when I mentioned it to the attending. Worsening lung sounds that heralded the onset of pneumonia, etc.

I can no longer see myself as “just a student.” I’m a part of each patient’s health care team, and I vow to devote myself to their wellbeing and recovery. Even if that means waking them up at 6 or 7am so I can push on their bellies and look in their throats.

“Doctor” Matt is a medical student who blogs at
“Doctor” Matt’s Musings.

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  • http://skepticalscalpel.blogspot.com/ Skeptical Scalpel

    Interesting and thoughtful post. I have two comments.

    One, the electronic medical record is further distancing the medical student from the patient care team. In many hospitals, it is difficult if not impossible for students to make entries on the chart.

    Two, “Doctor” Matt describes the frustration and eventual avoidance that many of us feel when faced with multiple isolation patients. I have written about this (http://is.gd/vfH3rO). It is a major problem that is only going to get worse.

  • http://drsamgirgis.com Dr Sam Girgis

    Medical students are an integral part of the patient care team. The student’s main goal is to learn, but they make key observations that are sometimes missed by others. The trend today is to use the computer first and then talk to the patient, but medicine is practiced at the bedside, not by the computer side. We need to instill this thought process into the future generation of physicians and nurses.

    Dr Sam Girgis
    http://drsamgirgis.com

  • Beth Havey@Boomer Highway

    Great post. Standing at the bedside and assessing or talking to the patient, if the patient can respond, is the only way to truly learn about caring for another human being. In nursing school I spent only a few days at a county hospital working with ventilator patients, but I remember that experience more than many others–like Dr. Matt I had to take ownership of my patient and it mattered to me and to him.