Let’s talk about that infamous transition to third year. This is a precarious time in your medical school career when your resolve faces its greatest challenge yet. After weeks of self-imposed exile to prepare for Step 1, you finally take that dreaded exam. Before you even know whether or not you’ve passed, you and your colleagues scattered to the far corners of the earth to begin clinical rotations.
But hey — you’re a medical student, and never one to shy away from a challenge. So you tuck away any trepidation to the back of your mind and give it that old med school try. With your white coat freshly washed and stuffed to saddlebag proportions, you take your first steps out onto the wards.
What you find can be a complete culture shock. After weeks spent studying esoteric things like liposomal storage disorders, you find yourself struggling to master the basics, like where’s the bathroom, what do all these acronyms mean and how am I underfoot all the time? It’s an environment that constantly pressures you to be on top of your game, but leaves you feeling like you’re always the rookie.
As the year wears on, your resolve continues to take hits from the rigors of your rotations. There’s the Sisyphean task of starting over at yet again at yet another new clerkship site; the insidious, but persistent nature of sexism, racism and all manner of prejudice in the workplace; the isolation of being both physically and emotionally separated from your loved ones, but too overworked and overtired to do anything about it.
Here’s the bad news: in the existing framework of our medical school training, much of the above is an inevitability of the transition to clerkships. These experiences threaten to erode your resolve, leaving you burnt out, depersonalized and unable to empathize with your patients. Without empathy, without a sense of purpose, your journey through medical school can be unbearable.
To paraphrase Nietzsche, “He who has a why can endure almost any how.” I won’t pretend that I can change the how of your training, but what I hope to do is empower you to reclaim your why. For most of us, our why begins and ends with our patients, so my prescription for you is to do the following: connect, educate, and advocate.
The importance of connection cannot be overstated. As medical students of the 21st century, we are matriculating into an era of modern medicine, in which a providers’ time is divided between the patient who sits before them and the patient who exists on the computer screen. The latter patient termed the “iPatient” by Dr. Abraham Verghese, tells us all we need to know about the what of our patient — what is the blood pressure, what is the potassium, what is the MRI finding — but what the iPatient fails to reveal is the why. Why is my patient angry today, why is she non-adherent, why does she keep getting readmitted? Without knowing the answers to these questions, you can find yourself frustrated and feel that your efforts are futile.
As a medical student, you are uniquely positioned to combat this source of burnout. For perhaps the last time in your career, you are non-essential personnel, and though this can leave you feeling like the least qualified person on your team. It, in fact, affords the time and opportunity to sit with your patients and really connect with them. So while your attending has to run off to address her other clinical and administrative duties, and your residents are busy putting in orders, you can sit down with your patients and cement that invaluable physician-patient relationship. Even though you may not have all the answers, even if you’re the least experienced on your team, this is the first step in feeling like you can really make a difference. Your patient will start to look to you for advice and introduce you to their visitors as their “doctor.” In this process, you’ll shed the imposter syndrome and find yourself rising to the role of provider. You’ll learn your patients’ values and can incorporate that knowledge for motivational interviewing to incite lifestyle changes. You’ll learn their challenges and frustrations and can use that knowledge to inform your approach during a difficult encounter. And finally, you’ll learn that often your patients’ problems extend beyond one visit, one admission or even beyond the domain of medicine. So when no other treatment suffices, you can take comfort in knowing you at least provided the therapeutic power of listening.
Connection sets the stage for education. But here’s the kicker: when we started medical school, we were used to being in the 99th percentile, always the smartest ones in the room. In first and second year, we quickly realized that the 99th percentile was just average. By third year, I can assure you, I felt like I was the dumbest one in the room. Sure, I studied, and I studied hard, but every day, every failed pimp question, every shelf exam that felt like it came out of nowhere just left me feeling like there was so much I had failed to learn. My confidence took a hit, and my sense of self was challenged. I didn’t feel like I had anything to offer my team — let alone my patients.
What I failed to realize, was that the years of training had actually given me a basic fluency in the medicalese and discussions that can leave a patient feeling like her head is spinning. Once I started talking with my patients, I realized that even the knowledge I took for granted could help fill in some profound gaps in health literacy. See, disease strips patients of their feeling of control. Their own body betrays them, and often they don’t know why, or what they did to “deserve” this. When you take the time to educate your patients, you give them back that sense of control. When you demystify disease, you restore hope in wellness.
Now I’ve just preached the merits of connection and education, but these measures can only go so far. Wellness is not only the province of clinics or hospitals but also extends out into the communities where social determinants of health impact up to 80 percent of health outcomes. The paradox here is that those who are most disadvantaged by these forces are often the least able to do anything to change their circumstance. That’s where advocacy comes in. Advocacy is a proud, time-honored tradition of medicine. Throughout the centuries, physicians have leveraged their social capital to give a voice to the unheard and elevate the downtrodden. As millennials in medicine, this is our time. We are in the brave new world of social media, where medical student advocacy is more accessible, more viral than ever. We’ve participated in campaigns like #endtheban and #thisisourlane. And in doing so, we have changed the national conversation on gun violence. We’ve taken to the streets and marched against inequities. We’ve joined forces in our medical societies and have propelled our collective efforts from the local to the state to the national level. So whatever your medium, whatever your method, never forget your power to fight for your patients and effect change on the communities around you.
I won’t lie to you. The journey of the short to the long white coat has its growing pains. My sincere hope is that no matter how difficult the how, if you remember to connect, educate and advocate, you will make a difference and in doing so, hold steadfast to your why.
Danielle Verghese is a medical student.
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