This morning started off like any other. I parked my car, walked into Starbucks and pulled up my iPhone app while waiting in line. The usual suspects were already there – the elderly fellow that always flirts with the baristas, the business man with his freshly pressed suit and the tired-looking mother. As I approached the counter, I ordered my usual summer morning beverage and went through the motions to pay.
As I meandered toward the pick up counter, one of the baristas grabbed my attention: “Hey, Amanda! You’re in medical school, right?”
I stopped in my tracks and turned my attention toward him. Immediately, I braced myself for the worst; in our Medical Humanities course, the professors warned us that upon entering the profession, family and friends would suddenly start turning to us with their medical questions. We were cautioned that because there would be no escaping the situation, we needed establish an appropriate response to the request. But never did I imagine that as a first year medical student, an acquaintance would turn to me for advice.
“Yes, but …”
He cut me off. “I have lower back pain that radiates down my leg …”
The gears in my head started turning. I thought back to my latest clinical experience – one of our patients described a similar chief complaint and during our discussion with the preceptor, we discussed differential diagnoses for that particular symptom. I tried to clear the cobwebs clouding my knowledge of Anatomy and Neuroscience and considered the nerves that could be affected. I wondered if there was an inciting event that precipitated the pain. But in the end, although these thoughts raced through my mind, I never had any intention of sharing them.
“… and I was wondering …”
As I stood there listening to him, it struck me how entering medicine was almost synonymous with being entrusted with a stranger’s thoughts, feelings and ultimately, their life. We are taught how to ask open-ended questions and how to probe for the whole story. We are told to trust our instincts if something just doesn’t feel right. But for the most part, patients come prepared to talk about what is bothering them because it is embedded into our culture to have an unspoken confidence in physicians.
As a medical student, we reside in a paradoxical limbo. In order to become a competent physician, we need to interview patients and suggest diagnoses. We need to try procedures or practice them to obtain perfection. However, because we have little to no experience, patients tend to shy away from our (supervised) care. Additionally, at this early stage of training, most of us do not feel confident in our knowledge to provide even basic explanations of diseases.
When he continued with, “… what kind of doctor should I go see?” I let out of a sigh of relief and directed him toward his internist. This time, I was posed with a question that I could answer. But the situation gave me an opportunity to consider how I would respond to future questions that I am not qualified to answer. In class, our professors explained that when faced with a medical question outside of the hospital, they defer to the patient’s internist because they do not know the details of their medical history. Today, had I been faced with that situation, I would have responded the same way but with the added note that I am just a medical student; I am not a doctor.
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