In medical school, sometimes you have to curb your enthusiasm

I had never seen my young cousin sit so still.

“What did you do?” my aunt wondered, amazed that her hyperactive 12-year-old had been transfixed for nearly an hour. “Were you two playing video games?”

“Actually we were just talking about some of the things I learned in medical school. He’s really interested,” I told her. Indeed, he hadn’t even touched one of the delicious samosas we were eating. Every time he picked one up, he thought of another question or exclaimed, “OMG. The body can do that?”

He wasn’t the only one getting excited. I had barely been in medical school for a few months, and was being exposed to the wonders of human biology on a daily basis. Whether beautiful or frightening, it was all fascinating — and like my cousin, my classmates and I consumed it with the voracity otherwise reserved for a savory samosa.

At the same time, we learned to comport ourselves appropriately in the presence of patients, to contain our enthusiasm when faced with exotic diseases. First with patient-actors and then hospitalized patients, we learned to treat patients as people instead of diagnoses, and to be empathic even while being enthralled. Upon starting clinical rotations two years later, though, it became increasingly difficult to do so.

On one of my first evenings on call, I was sent to see a patient with appendicitis. “It should be straightforward, a really textbook case,” said the resident. The case was indeed straight out of a textbook, but not from the chapter about the appendix. I found myself staring at a man nearly seven feet tall, with the characteristic hollowed-out chest, spidery fingers and long limbs of — “Yeah, Marfan’s Syndrome runs in the family,” he said. “Every doctor stares when they first see me.”

I tried to never repeat my mistake, but sometimes it’s hard not to stare for at least a moment. In fact, students are often asked to do exactly that as part of the physical exam. Take the physical exam rounds, when a faculty member takes students to see patients with findings appreciable by careful examination. Even when those rounds are lead by the most empathic physicians, it’s hard to ignore the fact that we are not contributing to the patient’s care and do not even know much of their story. Rather, we walk into their room only to palpate a spleen or see a Babinski sign.

Not staring isn’t easier to do even on surgical rotations with less face-to-face patient interaction. During one operation, a neurosurgeon used an endoscope to navigate the deep recesses of the brain. While gazing at the anatomy that even the best textbooks don’t show in such rich detail, I forgot to breathe and nearly passed out.

Students are also encouraged to wear our doctoring glasses even outside the hospital. Many a senior physician will wax poetic about diagnosing strangers in the grocery store based on a characteristic rash or gait. (Some can’t resist walking up to the stranger and asking if their diagnosis was correct.) “Being a great physician means being a great observer,” they say.

While that’s true, sometimes the hardest part is observing our own behavior. Transitioning from preclinical to clinical student means no longer being at a safe distance from patient care, yet still maintaining professional distance. While it’s acceptable to show faculty your enthusiasm, it’s also necessary to put on a medical poker face during patient encounters. This challenge might be unique to medical students and residents, because we’re seeing many diseases for the first time. And over the years, maybe the most rare diagnoses will become routine.

But I think — and hope — that that this isn’t entirely true. From observing physicians who have been seeing patients longer than I’ve been alive, it seems that the wonder and enthusiasm they felt during their first clinical rotation is still there. It might be disguised behind a medical poker face, or frustrated by the layers of paperwork that come with any medical evaluation nowadays. Nonetheless, it’s still possible to detect a glimmer in the eye of a cardiologist when she discovers a new heart murmur for the thousandth time, or catch the surgeon saying “Wow!” even after decades in the operating room.

At this early stage in training, most of us are still picking our jaws up off the floor on a daily basis, trying to contain the enthusiasm and curiosity that motivate us to do this in the first place. Of course, respecting patients with professional etiquette has and always will be the highest priority. But sometimes in the privacy of the workroom or on the drive home, I’ll allow myself a moment to say, “OMG. The body can do that?”

Mihir Gupta is a medical student who blogs at Scope, where this article originally appeared.

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  • EmilyAnon

    Re: medical poker face during patient encounters:

    In my several hospital stays I would say most unknown (to me) doctors and rounding trainees who entered my room all had the same poker face. You might be taught that it conveys strength or confidence, but it can also come across as unfriendly, or even apathetic, discouraging any interaction from patient to caregiver.

  • meyati

    I have a doctor with a poker face. It sort of put me off, but he’s good. I talk like a cowboy with an odd syntax, where humor is built in- I felt like jello plopped on hot pavement– One day, he turned around, and said—I like you, you’re so funny and intelligent.