A Day in the Clinic
Stefan Tarnawsky Apr 09, 2014
At the end of their 2nd year of medical school, MD/PhD students at IUSM put their medical education on hold for 2-4 years and do research. This timing allows us to refine our research interests before choosing a lab. It also gives us sufficient medical knowledge to enhance our research and the work habits to thrive in an independent lab environment. However, the downside of this timing is that when I enter the clinic as a 3rd year student, I will have forgotten much of what I learned as an MS1 and MS2.
To minimize this loss of knowledge the MD/PhD program requires students in the graduate years to spend a minimum of one afternoon in clinic every 6 months taking patient histories and performing physical exams. As an MS2 going to clinic every week I thought that one afternoon every 6 months was insufficient. I imagined myself volunteering in the clinic every other week. Yet, 9 months into graduate school, I suddenly realized I have not yet seen a patient. I emailed my former ICM-2 preceptor, and arranged an afternoon last week to work with him in his hematology clinic.
Walking to the clinic I felt uneasy. Would I remember how to speak to a patient? Instinctively, I started reciting my H&P checklist but I fumbled over my now-forgotten sequence. When do I ask about the family history: before or after allergies? Vague mnemonics came to mind – CLOSER – but their importance did not. What did the ‘E’ stand for again? Inside the clinic, the surroundings were foreign and I kept finding myself in others’ way.
I was not the only student in the clinic. I worked alongside a former MS3 classmate, one with the advantage of 9 months of clinical experience. We sat down together to review a patient chart. He skimmed the pages muttering words whose sound was familiar but whose meaning and significance were not: porphyria, encephalopathy, steatorrhea. I barely had time to read the patient’s name before we headed off to her room. Inside, the MS3 took charge. The history was crisply taken and the exam was thorough but brief; we were done in under 5 minutes. I thought we’d head out to report to the attending but instead the MS3 stayed to chat with the patient. How are things at home? Is your family healthy? Are you getting on okay?
Rapidly, the patient’s story changed—her stoic demeanour melted into sobs. The pain in her legs from chronic inflammation was overwhelming. Her life was miserable. She just didn’t know how to carry on. I stood demurely by, sympathetic but not knowing what to do. I watched as the MS3 calmly sat down beside the patient and handed her a packet of tissues from his white coat pocket. She took a tissue and blew her nose and used another to wipe the tears off her cheeks. A minute passed in silence. Then she cleared her throat, thanked us, and we left to report to the attending.
That gesture – handing the patient a packed of tissues – had a transformative effect. It showed me that the purpose of my intermittent clinical experiences during graduate school were not to test my recall of MS1&2 nor were they meant to assess my medical knowledge. Rather, they should remind me that the end-goal of my research was to help patients. If an MS3 can relieve suffering with just a packet of tissues, imagine what a physician-scientist can do with a pipet, their curiosity, and a career devoted to helping patients.