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Thursday, September 01, 2005

Doctor De-Mentor

The Medical College just called. They got your new brain—whoops, wrong conversation. Let me start over:

The Medical College just called. They want me to take on a new medical student. I agreed. I’ve been a mentor for first and second year students for about eleven years now. The idea is to take fresh students, and in addition to tons of histology, anatomy, and biochemistry classes, to stick them into a real doctor’s office to get the feel of what practicing medicine is actually like. Once a month or so, they show up over here and I get to twist their little minds until they act like me. OK not really.

Overall it’s been a good experience. I get them young, when they are still human beings. And I see my job as trying to keep them human as they increase their knowledge of medicine and transition from laymen to professional clinicians. I try to keep them grounded and give them perspective. I remind them that the patient is not just a list of drugs and diseases, or a stat sheet of electrolytes and blood cells. There is a person here, one that they will get to know over the next few years and who will get to know them.

Many of you may be saying, “duh, of course you have to show them that medicine is practiced on human beings,” but until maybe 20 years ago this was not routinely done. Students went from college into medical school, where they learned basic and advanced science and stayed out of clinical situations. Then after 2 years they were thrown into teaching wards with the sickest of the sick and told to learn on the job. By the time the average physician left residency, he had a very de-humanized view of the patient, and there was a big rift between him and the one entrusted to his care.

Enter the Introduction to Clinical Medicine, which hoped to prevent this schism. The idea being to keep students in touch with the personal side of medicine, even when they know nothing about. It’s interesting to watch from my perspective. They come to me very green. They sit in my office with their clean white half-coats and their stethoscopes and manuals and don’t know what to do. They have not learned anything yet about disease or cure. Often they know very little about talking to patients and almost nothing about examining patients. They are laypeople. No more qualified to practice medicine than the patient. Mostly they follow me and observe me. And then we talk for a while afterwards. Sometimes I ask them to go talk to a patient first and find out why the patient is in the office. This is intimidating, because, having no knowledge of medicine, they have no idea what they should be asking. But they are wearing the uniform, so the patient expects them to know something.

This is OK. I tell them that I don’t expect them to ask the right questions. I don’t expect them to know what endocarditis or atherosclerosis or tenosynovitis is. I don’t care if they ask stupid questions. My goal is not to get them to ask a battery of questions and then leave the room. I just want them to talk to the patient. I want them to listen to the patient. I want them to learn how to let the patient tell them what is wrong. They have to learn the art of listening. If I can get them to pick that up early enough, then the rest will follow much more easily.

Over the years I observe them. The dress becomes more casual, the attitude to me and the clinic more relaxed. They start learning the right questions to ask to get to the correct diagnosis. They learn to spend a little less time getting the information they need, without making the patient feel like he was rushed. I get to see the transition from layperson to professional. My patients get to know the students as well. Often I sense some pride from some of the older patients, as they watch the young man or woman gradually become more confident in his or her practice. When the students leave, my patients ask about them, as if they had helped train them as well.

Which of course, they have.


Wickwire said...

That reminds me of the very end of that movie called, "Doctor" starring William Hurt.

I'm glad you are one of the mentors. There is a doctor in our health clinic who I hope and pray is NOT in that program. ;)

muse said...

menchkeit is the most important medicine