Medical schools around the country remain closed due to the current COVID-19 pandemic, swapping hands-on learning experience on wards and within the operating room for Zoom lectures and telehealth visits. Ten months ago, this was the furthest thing I imagined as I began my third year of medical school, filled with nervous excitement to move on from the relentless studying required for Step 1 and start seeing patients. With our interactions with patients a fraction of what it was, an expression preached to my class during our clinical orientation, “spend time with your patients; they will be your greatest teachers,” seems even more poignant as within the last ten months the patients I met taught me more about the type of doctor I aspire to be than any textbook ever could.
Third-year students have the unique privilege of being just competent enough to see a small handful of patients, but not competent enough to carry a full caseload, giving me a large amount of downtime mixed in throughout the day. During my week of internal medicine overnights, as new consults came in, they would first be seen by the medical student, then the resident, and then finally the attending. One of the first consults I was sent to see in the emergency department was Mrs. PeriCardi, a middle-aged woman with breast cancer currently undergoing chemotherapy who was experiencing shortness of breath, and subsequently found to have a large pericardial effusion.
After gathering a thorough history from Mrs. PeriCardi and slowly completely a comprehensive cardiac exam I was trying to remember from OSCE as a second year, I presented my plan and assessment to the resident. I then watched the resident go through the same series of questions and exam, and answer Mrs. PeriCardi’s questions about what was happening and what to expect. While the resident’s answer was in lay terms and simplistic, Mrs. PeriCardi still did not seem to fully grasp what was going on. We left for a short period of time during which the resident presented Mrs. PeriCardi to our attending before the three of us headed back to ED to repeat the history and physical once again.
During this third encounter, I spent more time watching Mrs. PeriCardi’s body language and expressions, her high anxiety and stress almost palpable as soon as we entered the room. As with most patients, the frustration from answering the same questions repeatedly was becoming more apparent. When asked what questions she had, Mrs. PeriCardi asked the same questions the resident had already answered, and our attending patiently explained her condition and likely scenarios that may follow. We then left, leaving her alone in her emergency department room, as we set off to complete the admission orders and to tease out the teaching points of the case, the assessment, and management of pericardial effusions, classic findings, and various interventions/treatments. Approximately thirty minutes after leaving her room, with the admissions order in and the teaching complete, my resident released me until the next consult came in for us to see. My first reaction was that I should go study, but the anxious and confused look I saw on Mrs. PeriCardi’s face earlier compelled me to go back to the ED.
I knocked on the door, reintroduced myself, and said a phrase I found myself saying a lot throughout my third year “I just wanted to take a moment and see how you’re doing,” and then we just talked. She told me about how anxious she was being back in the hospital once again, about her fear of how this may impact her future chemo treatments, about how her cancer diagnosis affected her, and went into further detail about what her hospital course might be like. We talked about her most recent vacation, dispelling her worry that her current condition was related to having one too many margaritas, and her favorite part of her trip. After spending fifteen minutes in her room, my phone rang with a text from my resident: “New Consult – Headache ED Bed 23.” I asked if there was anything else I could do to help before I leave, and she said, “No, I feel better. Thank you for spending the time to come and talk.”
This was not a single unique experience during my third-year rotations, but one that occurred on every service. Whenever I was free or had the opportunity, I would check in my patients, not to inform them of a test result or a lab value, but to see how they were doing and coping with everything going on. Before the start of the third year, my favorite aspect of medicine was the puzzle, piecing together symptoms and signs like jigsaw pieces. As I reflect on my experiences during the last year, I realize my favorite part of medicine isn’t the science, but having the opportunity to have a positive impact, no matter how small it may be on someone going through a difficult time.
As I look at the residents and attendings at my institution whom I admire greatly, I see exceptional, brilliant, compassionate, and caring physicians who do everything they can for their patients. These doctors find a way to maximize the time spent with every patient to ensure the patient knows they have been heard. However, the reality of the time constraints and endless tasks requiring their attention makes this increasingly difficult. As I move forward with my training, the opportunities to “just take a moment” and talk with patients will become less and less frequent, and I must capitalize on these chances while I can. While the time spent talking to patients may not teach me the correct answer for a board exam or shelf exam question, it has shown me the humanity in medicine and given me a sense of purpose as a student pushing me to focus on treating the person, not just the disease.
Alec Kellish is a medical student.
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