Article by Miriam A. Knoll, MD | “Doctor’s Orders” curated by editor Sasha Yakhkind
The hierarchy of medicine is most obvious to the medical students, who see each required step towards the next rung on the ladder very clearly. It takes time, though, to learn the cultural rules and nuances to do things the “right” way. During the learning process, many students spend time observing and avoiding making waves. But regarding safety, it’s important to speak up no matter what. Two stories during my training have solidified this for me.
While on my neurology clerkship as a third-year medical student, I came early to pre-round on my patient. After a few moments of speaking to him and inquiring how he was feeling, I began to see how agitated he was. I immediately felt unsafe, but I was unsure what to do. Do I leave in the middle of the pre-rounding without even doing a physical exam? I was nervous what my resident would think. I decided to walk out anyway. I told my resident that the patient was agitated and I felt uncomfortable being around him. My resident wasn’t angry (thankfully) and decided to go talk to the patient alone. Sure enough, the patient punched my resident in the face! I realized that even had the patient not proved to be physically threatening, I still did the right thing by trusting my instincts.
During my internship two years later, I was taking a history and physical from a patient who presented with hemoptysis. I spent time gathering information with the use of a translator, and I found out he had been also experiencing a chronic cough and fevers for months. I discussed the case with my resident and mentioned that I thought he probably had tuberculosis. I suggested we should put masks on before re-entering the patient’s room. My resident disagreed with my concern and did not put her mask on. My dilemma was: should I put a mask on because I’m worried for my safety or should I follow my resident’s lead because she is my superior? A few days later, the patient’s diagnosis of tuberculosis was confirmed.
As a medical student, you may have more information than your superiors. You may have more time, more knowledge or just may have been lucky in finding out something no one else knows. If you are concerned about your safety, don’t discount it because your superior doesn’t agree. You may wonder why no one else is walking out of a room when a portable X-ray is being taken — it may be because no one else noticed. You are your own best advocate. In the hierarchy of medicine, nothing is superior to safety.
Dr. Miriam Knoll, MD (“Mimi”) graduated from NYU Medical School in 2011 and is currently a radiation oncology resident at Mt. Sinai Medical Center in New York. She has three children with her husband, Abe, who is a radiology resident. Her interests include medical education, oncology, social media in medicine, and work-life balance. She can be found on Twitter @MKnoll_MD.