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Key to first year of medical school: 'enjoy the ride'
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Editor’s
Note:
Chelsey Baldwin of Little River is a first- year medical student.
This column follows the journey of her class in becoming doctors.
 By some lucky
chance I made it to class early the morning the Crisis
Ministries sign-up sheet was posted in Baruch Auditorium. I have been
commonly disappointed to find that I had been beaten to the chase by my
classmates every time prior to this. My discovery did not go unnoticed
by others for long. A swarm quickly accumulated, and I luckily was able
to acquire a spot the same evening as a few of my friends from class.
As I have mentioned in previous articles, we are all too eager to see
real patients. I say “real” for the fact that we are extremely familiar
with the standardized patient. Standardized patients are trained to
play the role of a patient and then, often to my dismay, report back
detailed feedback about our examination and interviewing skills.
Real patients,
though, I was sure would be excited to talk to me and
never notice the subtle mistakes in technique that I would make or so I
had built up the encounter in my mind before arriving at Crisis
Ministries. In some ways my idealization of the interactions with
patients was correct, and yet in other ways I couldn’t have come close
to predicting the impact the encounters with the patients at Crisis
Ministries would have on me. I was right in thinking that these
patients wouldn’t be particular about noting the mistakes I would make,
however the attending physician was sure to note them. Making mistakes
is a great way to learn, and so for that reason I was thankful for the
constructive criticism. As for the enthusiasm of the patients to talk
with us, it was surprisingly low. I got the impression that this was a
situation of going to see the “doctor” or else.
Mrs. X, my first patient, informed me that she hates to come to see the
doctor. She went on to explain the horrible circumstances that landed
her at Crisis Ministries. While we were able to treat her for the
problem she presented with, I was saddened that we couldn’t do more for
her. Next I went on to see a patient in whom we were unable to
reproduce the symptoms of which he complained. Therefore we were unable
to do anything for him. His apparent disappointment translated into my
own.
Slightly downtrodden, I went to see the final patient of the night, Mr.
Y. This interview went surprisingly well, and I was sure that I had
picked up on a possible underlying presence of diabetes. However, this
was not the cause of the patient’s presentation to the clinic and
therefore was not presented to the attending physician. Instead, the
patient’s immediate condition was treated.
At first, I was satisfied with this approach for the fact that the
patient seemed opposed to any further examinations, especially those
associated with the word “diabetes,” the reason for which I would later
discover. I also feared the possibility of being wrong and therefore
wasting the attending physician’s time.
Mr. Y was examined by the physician, and then my second-year mentor and
I returned to explain the treatment plan to the patient. Mr. Y went on
to inquire about the meaning of high glucose levels noted in his urine
in the past. My stomach sank. I had incorrectly ignored my instincts.
Mr. Y explained that he avoided ever following up the test out of fear
that it could mean a diagnosis of diabetes. Mr. Y elaborated that he
had a family history of the condition and was afraid of having it too.
Being the final patient of the evening, and with the attending
physician having taken his leave after solving Mr. Y’s problems to the
best of this knowledge, we were left in a helpless state. I couldn’t
help but feel like we failed Mr. Y. I had let my own fears of criticism
and being made to look foolish keep me from speaking up. I made him
promise to bring up these questions next week when he returned for his
follow-up, and yet I feared that he would not.
Afterward, I rode home with my friends Tracy Tholanikunnel and Steven
Hill, fellow first-year students and dear friends. I opted out of our
plans to grab a beer afterward to reward ourselves for a long day of
hard work. Instead I went home to agonize over my time at Crisis
Ministries. It took me several days to see the good in the experience
that I had that night, and yet there was much to be appreciated. We
successfully treated two out of three patients. I had written my first
assessment forms of notes and prescription. Plus I was exposed to
ethical issues pertaining to patient autonomy. We cannot force our
patients to take treatment for which they do not wish to receive, and I
must be prepared for that. However, this doesn’t detract from the
saddening fact that those who need our help the most seem to be the
least willing to take it.
Finally, I learned that the support of my peers is endless, and I will
always be thankful for the sympathies and advice of my peers that
accompanied me to Crisis Ministries that evening.
Friday, Feb. 25,
2011
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