Editor’s note: Names and identifiable details have been changed.
Some distill medical education down to the phrase, “See one, do one, teach one.” After completing one year of medical school, I will say that while I have learned many skills, I am not a master of them just yet. I can take a decent patient history and give my best attempt at palpating the liver. For now, I like to spend a lot of my time observing, personally amending the phrase to “see a million, do occasionally, teach maybe someday.”
This story centers on a particular observation from early on in my first year. The setting was a crowded emergency room in New York City. The characters included two nervous medical students (myself included) and a seasoned emergency medicine physician, Dr. Altman. We entered our patient’s room in a line. Margaret, an eclectic 65-year-old woman, sat perched on the exam table.
Margaret’s blue-black hair with the occasional coil of gray contrasted greatly against the tan table. Her thin body was draped in a green animal print wrap dress; she had on a full face of makeup and bangle bracelets covered almost every inch of her forearm. Later we learned that she was a designer and colors filled her with joy. In the corner of the room sat a baby stroller holding a purse.
Dr. Altman started off the encounter by asking Margaret for the reason of her visit. She described her years-long struggle with tinnitus and palpitations; the frustration in her voice was clear. When asked what impact this was having on her life, Margaret told us how she was filled with fear of dying alone in her apartment, for she had spent the past few days without leaving her bed. It turns out that the stroller was how she stabilized herself to walk down the sidewalk because she doubted that she could make it to the emergency room without falling.
Dr. Altman continued down the list of questions and conducted a physical exam, concluding that there was nothing urgently concerning and that she should follow up with her neurologist. We shuffled out of the room, but before closing the door, I could hear her bangles ringing as her hands fell with defeat into her lap.
Behind the closed office door, Dr. Altman gave us his three-word assessment: “She’s just crazy.” He went on to say that Margaret was clearly an anxious older woman scared of living alone; she needed attention, so she came to the emergency room. Her outfit seemed to be further proof to him that she was outwardly impulsive and sought the attention of others.
I spent the subway ride home reflecting on this unsettling interaction. Dr. Altman’s assessment of Margaret — that her symptoms boiled down to her being “crazy,” and therefore there was nothing we could offer — combined ableism, ageism and sexism for a trifecta of dismissal. True, perhaps her case was not urgent, and he certainly had many years of experience with patients to call upon when making his clinical decisions. Nevertheless, I still think back to how easily he stamped the label “crazy” on our patient after an interaction that could not have lasted more than seven minutes.
Words matter. Language shapes reality and future action; as physicians, this can have huge implications on the care we provide to our patients.
When people say “see one, do one, teach one,” I think they forget that this also applies to the culture of medicine. Medical students are like infants; we watch everything that our teachers do, then we mimic and experiment until we learn. From this interaction with Dr. Altman, “seeing one” taught me to observe and judge. Now with every patient interaction (“do one”), I have a decision to make: will I go for the “simplest” answer based on labels we put on people or do I keep probing, asking more questions?
As I think ahead to my future career — when it is my turn to “teach one” — I hope that my students will not leave thinking that our patients can be simplified to a three-word assessment that doubles as a dismissal. Our patients are never “just” anything; there’s always more to know and more to do.