Notes From A fetal MD
Jake Berman, M'10
To be a Physical Diagnosis II student is to negotiate a strange, intermediate stage of doctor-ly development. Gone are the youthful days of Patient Interviewing, in which first-year medical students chat with patients, express compassion, and vaguely explore the rudiments of a medical history. Still ahead are the days of clinical integration, where diagnostic reasoning and scientific knowledge empower clinicians to render medical services to their patients. Instead, PD II students navigate transitional waters, armed with enough knowledge to be borderline conversant, if not yet useful, and bearing responsibilities to their attendings and to each other, if not directly to their patients.
Strange things happen in this milieu. One day you’re sitting in a sterile lecture hall absorbing a barrage of slides about renal disease; the next you’re watching some guy get wax blasted out of his ear. One day you’re completing an exam with a #2 pencil and a bubbled Scantron form; the next you’re performing an exam by prodding someone’s liver or listening to a patient’s lungs inflate and deflate. There are obligations here: train your senses, practice proper techniques, ask the right questions and understand why you’re asking them. Above all, you must document as you’ve never documented before.
The impact on the psyche of having responsibilities, no matter how unrelated to patient care they might be, is considerable. An acute sense of empathy and a drive to express compassion naturally animate the medical student's response to patients. Yet now, with clinical learning to be done, these good instincts and associated skills are filtered through the challenge of gathering the necessary information with precision and expedience. As we learn to take a good history and perform a proper physical exam, there is less and less time to linger over incidental conversation. And, as it turns out in many cases, to express empathy requires a delicate touch: one must sincerely recognize and address the patient’s concerns without distracting from the professionalism, focus, and economy essential to the task at hand. This involves a level of meta-learning that parallels the acquisition of the skills which are the course’s putative focus.
Every Wednesday is an interesting one and every week our new skills are tested and honed by new situations. We may be a long way yet from doctor-hood, but we are a long way, too, from the first day of Biochemistry.