Confidence in a student’s ability to become a competent physician

by Timothy Dempsey

Looking in the mirror before heading out the door for my first patient encounter, I slouched. Something looked off. I had on my new, absurdly short white coat complemented nicely by the equally as new black stethoscope draped around my neck; yet the way I looked wasn’t the problem. It was the way I felt. No matter how well I dressed the part (and I must say I did quite a good job of that), I didn’t quite feel the part yet. This was a feeling that started the day I got my white coat: the belief that I would not be able to fill the coat well enough or accomplish my dream of becoming a great doctor. I hoped seeing my first patient would abate this growing feeling of worthlessness, and I have to say it did.

Striding in to the student-run clinic at my school 15 minutes before my team’s scheduled appointment, I did my best to look doctorly (however that might look). I constantly took my stethoscope off from around my neck and then put it back on, trying to decide if I was accomplished enough to pull of such a distinguished look. I finally relented to the peer pressure of my fellow classmates and left the stethoscope around my neck.

Slowly, my team of upperclassmen arrived and proceeded to fill me in on the details of our patient. He was a 26-year-old male with a congenital heart defect, which had caused him to have two heart attacks in his early twenties. On his previous visit, he had complained of a lingering foot infection and seemed to show signs of depression, which prompted our team to ask that a psychiatric resident be on call for that day’s visit. After receiving the past medical history, our patient arrived and we brought him in to the examination room. Before entering, the fourth year on my team asked if I had learned how to do a physical or interview yet. I told him I had just learned the interview the day before, prompting him to tell me in so many words to sit this one out. I felt a strong sense of relief, mixed with a slight feeling of inadequacy. Here I was all dressed up and ready to go (stethoscope around the neck and all!), yet my coach had just told me I was benched.

When we entered the room, I was shocked at what I saw: a man who could have been my brother. How was it that this relatively healthy person had already had two heart attacks? As I would soon find out due to the astute history taking skills of the third year on my team, this healthy-looking man was actually, well, not so healthy. For a little over an hour, he rattled off a host of issues ranging from depression to joint pain to a frequent urge to urinate in the middle of the night. Somewhere in the back of my head I wondered if medicine was this easy and if perhaps our patient was diabetic, a point my fourth year would later praise me for pondering, while informing me that our patient was not in fact diabetic.

After the interview, another medical student on our team conducted a physical, with the oldest student showing me how to mimic all of her actions. It wasn’t until this point that my feelings of worthlessness began to subside and new feelings of importance started to wash over me. I was actually (sort of) providing care for this patient! All of the techniques my doctors had performed on me, I was now (kind of) able to perform on my patient. As weird as I felt looking in the mirror before going to clinic, I felt just as comfortable now performing the physical exam.

After an unremarkable exam and a decision by our patient to forego the psychiatric consult, my team quickly presented to the attending physician on call and scheduled a follow up appointment. Upon returning home from the appointment, I looked in the mirror again. Though I was unable to do anything of value for our patient, I had been able to accomplish something very beneficial for myself: prescribe myself confidence in my ability to eventually become a competent physician. This time I saw something a little different in the mirror than I had before: a student in training who was able to stand just a little taller and feel just a little more confident in his future in medicine.

Timothy Dempsey is a medical student who blogs at Playing Doctor: The Journey From Med Student to MD.

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