End of M3 year…
“She’s going to make a great physician!”
It’s a sentiment that I’ve heard from more than one patient, usually said when the attending and I are in the room after discussing the patient’s case and deciding on our recommendations. The first time I heard this said I didn’t quite know how to react. A small part of me was proud, thinking that my behind-the-scenes work of ear peeping and note writing had finally paid off, and in front of the attending no less! Another part, the larger part, was embarrassed. I could just imagine what the attending was thinking: “A great physician? Because she takes a mean blood pressure? Yeah right!”
The truth is, I’m not that smart. My shelf scores hover around or slightly above the average in my class. I did do well on my boards, but I’m sure it took significantly more time and energy on my part than my colleagues. I worry every day that I’m not going to get into the residency program of my choice because of “numbers”. On the wards I’m only slightly better. I’ve been told my presentations are alternatively “scattered” and “too organized and detailed.” I keep trying to gather my thoughts into a concise formulation of assessment and plan but usually end up falling short. It’s not that I don’t know the pathology or that I don’t care; it’s that I don’t know how to spit it out so it sounds like I’ve been doing this my whole life and takes yet only a second. It’s a different experience for me; someone who has done well in academics her entire life. It feels unbalanced and unfamiliar to not be at the head of the class.
I do have some unexpected strengths, none of which are conventionally measured. My last attending told me that I have the “unique ability to identify a patient’s barriers to care and help confront them.” I have an extraordinary ‘third-sense’ about things or, as it’s more commonly called, clinical judgment. And, most surprisingly, I’ve become good at comforting people. I’m not a comforting person. I’m not very emotional and I really don’t know what to do with people who are. But throughout this year I’ve learned to say phrases such as “I understand that this is difficult for you” and “We are all here to provide care and support “ without sounding like I’m faking it. And I’m not (faking it, that is). I really do mean it because despite my hard exterior, I care so much about what happens to these people. My attempts to identify my patients barriers aren’t to get them out of the office. Rather, it’s to help them feel well as fast as they can so they can get back to living this glorious life.
The patients that tell me I’m going to make a “great physician” aren’t the ones I’ve spent the most time with, but they are the ones who I’ve listened to. We all know the type: People with multiple medical problems who have been through the system, seeking care and something else. These people want and deserve a “cure” to whatever ails them, but they also are looking for comfort, reassurance and someone to listen to them. Whether or not that job falls on the physician is a question that’s been debated. In today’s world of 15-minute office visits and mountains of paper work a physician is hard pressed to find the time to be the support system for their patient. It’s easier to punt to social work or support groups or non-existent friends and family members. But the truth is, it doesn’t take much longer than 5 minutes to ask “Tell me what’s bothering you” and then offer some phrases of comfort. People argue that a physician’s our job is to cure the body, not heal the soul, but these patient encounters tell me otherwise. They don’t care that my attending and I have no new ideas or medicines to offer them and that we still have no idea what’s going on. They say I’ll be a great physician because I listened, cared, and tried to help them help themselves.
I’ve always favored reading over socializing, math over social studies, analysis over memorization. I can spend hours taking apart a problem and putting it back together or researching a diagnosis and trying to find a solution. I’ve never been good at talking to people about their problems and never really wanted to be. Nowadays, I find myself in the opposite situation. I am learning medicine, but I’m not excelling at it the way I have in my past studies. However, somehow during the course of this year I’ve mastered is what’s been called the “humanistic” side of medicine, the part that was always lacking for me in the past\. I have a long time to iron out the kinks in my presentations and fill the holes (thankfully not gaping) in my knowledge. But what I’ve learned about connecting with patients couldn’t be taught to me through books and numbers and it’s something that will stay with me throughout my career to becoming a “great physician”.
