Not all who have a stethoscope
dangling around their neck and who don a white coat
are doctors. Unbeknownst to the general public —
and most healthcare workers — those of us with
short white coats are med students.
But despite the diminutive attire,
we fulfill many roles in a hospital. When staff physicians
don't want to admit a patient onto their service and
try to turf them off on another doctor, we become their
pages. Instead of talking to each other directly, the
doctors relay impatient messages through us.
In the OR, we act as retractors,
standing for hours trying not to cramp up from pulling
on the instruments at awkward angles. I hear robots
are starting to replace us in ORs across the country.
We always serve our residents with
the utmost attentiveness. Keenly, we hold their coffee
as they flip through charts, keep a stock of gloves
in our pocket in case they need to check a wound and
a stethoscope at the ready when they forget theirs at
home. Then there's the endless food runs when we're
on call.
In the emergency department, we
talk to the patients more than anyone else, grab warm
blankets for them when the nurses are busy, sometimes
sneak a cookie from the cupboard along with an Advil
when no one's looking. All this while sporting our short
white coats, singling us out only to those who know
the difference.
TIME'S
UP!
I had to wear that coat one last time for my final Objective
Structured Clinical Examination practical exam. Eight
stations, 10 minutes each, with two minutes in between
to read the scenario in front of the door. Anything
goes when you're being tested on how well you play doctor.
Sometimes we had to take a history
or do a physical. Other times we had to offer counsel
or interpret investigations. At most stations, I either
ran out of time or ended up with so much left over that
I frantically wondered what I missed.
I can understand how it would be
difficult to objectively examine our clinical skills
but one particular station stumped most of us indiscriminately.
A sign posted at the station read: "25-year-old female
university student complains of dry blurry eyes, weight
loss, difficulty sleeping and feeling agitated. Do a
focused physical exam."
I remember being taught that our
patient history should give us a diagnosis even before
the physical exam, but not only did I feel like I was
given a shoddy history, I only had 10 minutes to elicit
symptoms from an actor!
A couple of us got it right away
but most had absolutely no clue. I was part of the latter
cohort and proceeded to conduct a head-to-toe exam.
With the patient being a university student and all,
anxiety was at the top of my differential. I looked
for hyperhidrosis, palpitations and tremors. I didn't
know what else to do so I started in on the eyes, doing
fundoscopy and a cranial nerve exam when the examiner
told me to "refocus."
That's when it clicked: my examiner
was a general surgery resident, so the patient probably
had some sort of thyroid problem. I said, "I'm inspecting
for exophthalmos and lid lag." Then I ask her to hold
her hands out straight to observe tremors. BUZZ! Time
was up.
You know, if they had asked me
to do a focused hyperthyroid exam, I could've done it.
If they'd added "heat intolerance" or "hyperactive bowels"
to the history, it would've clicked. If they had given
me more time to do a full history and physical, they
might have had a better idea of what kind of doctor
I'll be. But I guess there's only so much you can do.
As I stepped out into the sunlight
post-exam, I couldn't decide whether to keep that jacket
as a reminder of the good years, or sell it to the next
upcoming doctor-in-training. I don't know. Maybe I'll
just keep wearing it until I'm ready for the long coat
and the responsibilities that come with it. I don't
feel like I'm prepared to have the "Dr" title yet, so
I'll have to trust that the university knows what it's
doing by unleashing me in the hospital with an MD.
|
