Playing doctor

It’s Halloween, and everyone is playing dress-up. The funny thing is that I feel like I’ve been playing dress-up every day for the past year. I alluded before to how the practice of medicine is, in large part, about putting on a show, and I feel like, as a medical student, this is more true than at any other stage of training. We’re not only trying to convince our patients, our residents, and our attendings of how competent we are, but I think, to an extent, also ourselves. It’s no wonder that impostor syndrome is rampant among the med student population.

When I was doing my clinical rotations as a 3rd year, I was often told that I should strive to have my patients regard me as “their doctor.” It wasn’t rare for my superiors to introduce me as “Student Doctor” (which, though technically correct, is a title that is, in my opinion, designed to mislead patients) or “Doctor,” and I occasionally even dared to use the “Student Doctor” moniker to refer to myself. The truth is that I’m closer to being a “real” doctor than I’d like to think. But until then, I’ll keep putting on my costume and playing my part. Fake it ’til you make it, right?

Process of elimination

The studying continues, despite the fact that I’ve forgotten quite a bit of the medical knowledge that I once had. I’ve made it a point to try to do a set of practice questions every day and, despite the fact that I feel like I have no idea what I’m doing when I stumble through the questions, I seem to be doing better than I expected. I find that in most cases when I get the correct answer, it isn’t because I know my stuff. More often than not, it’s because I had some vague intuition that one of the answers felt more friendly than the others. I guess I should be glad that the questions are multiple-choice!

Medical knowledge during med school

So… I’m still studying for USMLE Step 2. I’ve been slowly but surely making my way through my admittedly over-ambitious stack of review books and practice questions and, as I’ve been doing so, I’m realizing more and more that I’ve forgotten an enormous amount of information since I took Step 1 a year and a half ago. It would have been bad enough if I had gone straight through to 4th year, but taking a research year means that my brain has become quite the rust bucket in these past few months. I hope that I’ll be able to brush off some of these cobwebs in time to not fail.

Meanwhile, my 4th year friends seems to be in much the same state as myself. Many of them have already completed their important rotations are now cruising along toward graduation. They say that 4th year is like having a vacation for half a year. I certainly hope that that will be true for me next year. Is it too early for me to have senioritis?

On (failing at) practicing what you preach

One thing that every health professional is always trying to do is to convince patients to change their behavior. Whether it’s the woman with diabetes who could really benefit from losing a few pounds, the guy with heart failure who needs to lay off the BBQ, or the teenager who just won’t take his meds, we spend a good portion of our days touting the virtues of whatever lifestyle modification it is this time, and probably an even bigger portion complaining to one another about how much healthier everyone would be if they just got off their asses and took more of an interest in their own health.

Of course, it’s easy to get self-righteous when we’re talking about other people. I’m pretty sure that if I had a chronic illness and had to take medications on a daily basis, avoid certain foods, etc., that I would be just as non-compliant as many of the patients I’ve seen in the hospital. You’d think that being highly educated (and not only that, but being highly educated in medicine and health) would motivate me to make healthier decisions (and I do try, I really do), but knowing the nitty gritty pathophysiological details gives me plenty of room to rationalize how this or that general recommendation doesn’t apply to me. Ironic, isn’t it?

The White Coat hierarchy

When I jokingly posted about the White Coat effect several weeks ago, I got a number of comments from other medical students about how their hospitals give out white coats (long and short) to everyone from physician assistants to nurses to dental students. So I started thinking about all of the white coat-clad people that I’ve seen wandering the halls of my own university hospital system, and there are actually quite a few. More, even, than I had the patience to include in my comic above.

White coats have long been a symbol of the medical profession, and surveys indicate that “easy recognition by patients and colleagues” is a chief reason that doctors and medical students choose to wear white coats. One thing that I don’t think I ever thought about or realized before I started medical school is that medicine is as much about putting on a show as it is about interpreting test results and handing out prescriptions. We perform mysterious physical exam maneuvers, speak using an unnecessarily complicated vocabulary, make small talk, smile, and yes, wear white coats, all (at least in part) to convince our patients (and sometimes our colleagues and superiors) of how smart or competent or compassionate or kind we are. We need to be able to make our patients trust us as much as we need to to actually be able to take care of them, and wearing white coats has traditionally been part of that equation. In fact, studies have shown that patients are more likely to trust physicians who wear white coats.

Of course, if the white coat inspires confidence, trust, and respect among patients, it’s no wonder that every health care professional under the sun (or anyone with any connection at all to health care) would want to wear one. But the white coat is as much a symbol of hierarchy as it is a symbol of competence. At most institutions, medical students like myself are required to wear short hip-length white coats, while residents and attendings wear long knee-length white coats. Some institutions have gone so far as to introduce different white coat styles/identifiers for med students, interns, residents, chief residents, attendings, and so on. As other health care professionals join the fray, the need to distinguish them from one another and from physicians at all levels of training, sometimes results in even more elaborate variations.

A friend of mine suggested that all the doctors and medical students should start wearing capes, just to see how quickly it would catch on in the rest of the hospital.