“That was great, but next time don’t ask them about back pain or nausea unless they bring it up. Pregnant women complain about everything, you’ll be in there forever.” The resident rapidly exhaled this advice as we walked briskly back to the physician workroom, my eyes widening as I processed this understandable but also horribly insensitive remark.
I had just finished my first exam of a pregnant patient on my OB/GYN rotation. As a third-year, I didn’t know much about what labs to order for my patient’s gestational age, or even what symptoms were normal or abnormal for how far along she was, so I settled on asking all the basics surrounding pregnancy. Have you had any nausea? Vomiting? How’s your back holding up? Are you walking normally? Eating normally? Any strange cravings or unexpected changes in your body?
The woman was a new mom, this was her first child, and she was 37 years old. I could tell she was excited about the whole process and eager to talk to her doctors about it. I mirrored her energy, let her lead the conversation and left the encounter knowing I got the information I needed and the patient seemed happy.
Maybe it wasn’t the nature of what the resident told me — I get that a medical student’s history is going to be unnecessarily verbose when compared to the more finely tuned, practiced history of a resident. What makes that moment stick in my mind is the clear, unfortunate juxtaposition in mood between the two of us. This resident chose a career in counseling women on pregnancy, and yet couldn’t be bothered with that exact task. We all hate logging notes in the computer or ordering labs or being on the phone with various points of care all day long, but one thing most clinicians have in common (I would hope) is a desire to help and work with patients.
This is where seasoned doctors roll their eyes at me. Listen to this med student! She’s probably working only 9 hours a day, gets to get a full night’s sleep, has only seen a handful of patients and has dozens of safety nets to rely on.
I don’t argue this point.
What I instead ask is: How does this happen? How does the med student mindset of eagerness, a desire to help and a curious mind fizzle out for apathy and bitterness? Who said this is normal, expected in fact?
I sense a shift in how today’s medical students approach their careers compared to the more seasoned physicians we often learn from. We live in an era that prioritizes wellness and self-care. As such, we have adapted our goals and willing sacrifices accordingly. In the past, students were expected to arrive before the resident and stay until after they leave even if there was absolutely no utility to such a task. Today, we reject this idea. Suffering for the sake of suffering is not something we accept, yet it clashes with the hallmark characteristic of clerkships — doing whatever it takes to impress your evaluators.
And I get it. Medicine is not supposed to be a simple path, and a lot of the now-considered ‘needless’ sacrifice is something we may one day reflect on as an important aspect of our growth. We will eventually decide which sacrifices we want to make and which are not worthwhile, but we can’t really know the difference until we experience each variety — even when ‘experiencing them’ feels on occasion like a special kind of hell.
I think the problem with the above scenario is that it’s difficult to articulate meaningful vs non-meaningful suffering both to a medical student and as a medical student. Residents are too close to the situation — they remember their experiences, are likely going through their own new stages of growth and are meanwhile inundated with work that makes it hard to have the time, energy or even hindsight to buckle in the wide-eyed, terrified medical student.
Faculty are perhaps too far removed to lend the exact help medical students need. They ‘made it’ through everything. Med school, residency, even years in practice. And like with most tumultuous life experiences, time is a gift that softens the unforgiving, sharp moments we endure.
To top it all off, this is of course happening against the backdrop of an increasingly competitive and relentless medical education system. Average board scores have substantially increased over the past twenty years, (from an average Step 1 score of 212 in 1997 to 231 in 2019), while leisure time has dropped sharply, highlighting students’ immense pressure to perform. No, these times are not easy.
So there I was, standing in the clinic hallway sweating heavily into my mask, wondering how to present this patient to the attending without saying too much or too little. And somehow, the weight of my years of experience and support wasn’t enough to alter this moment from one of panic and self-doubt to a much more palatable ‘learning opportunity.’ The cognitive dissonance between what we’ve been taught and told to expect versus the ‘real world’ was too strong, and there I was in the current, being pulled out to sea.
Do I have a solution to this dissonance-inducing anxiety? Hell no. I’m still riding the waves of clerkship myself and giving advice would be a bit ridiculous given my own predicament. What I can say is: med students, if you’re reading this, we’re all in it. And we all have the power to change it. Remember these moments you experience now. The fear, the feelings of worthlessness, the idea that you’re the dumbest person to have walked the halls and everyone knows it. While these things are all obviously false, their mental impact could not be more real. And similar to the famous Alcoholics Anonymous mantra, I have to say, “the first step to affecting change is recognizing there’s a problem.”
So in that moment with the resident, should I have called her out? I’ve pondered this heavily. “Hey I’d actually rather get to know my patients a bit more by taking this extra time,” or “I actually was taught it is important to ask those kinds of questions to ensure you cover everything.” While this might have fluffed up my feathers for a hot second, I honestly can’t say I would have or would recommend doing the above. We’re not here to start a catfight from a clearly subordinate position. Let’s face it, that doesn’t usually end well.
However, if I have a patient who wants to share with me her new-onset love for Chips Ahoy since getting pregnant, you better believe we’re having a chat about it.
Remember why you’re here. Remember what you value. Decide what your ‘meaningful suffering’ is and don’t waver. For if we do, we too may one day find ourselves running down the hall, away from the very reason we decided to become doctors.
Image credit: Created by Christina Chopra for this column.
While nontraditional paths to medicine come with their own unique perspectives and hurdles, often overlooked are the nontraditional experiences that color our paths once we make it through the medical school doors. Whether it’s questioning our motives or finding purpose while blundering through the hospital halls, the off-book lessons we learn as med students are often the most valuable, and deserve some time in the spotlight. With this in mind, Christina’s column seeks to unpack the anxiety and find the humor in pursuing a notoriously tough career path.