Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.
As I write this article, I am thinking about how to compress all that I’ve seen and experienced the last several weeks into a few paragraphs. I’m not sure I’ll be able to do it justice, and if I wrote out all my thoughts it would probably exceed the page limits and the reader’s concentration. So I’m going to focus on a few aspects of this first month of being a third year medical student, and I suspect several themes will reappear and be expanded in future posts.
Learning how to be a doctor is a humbling experience. I haven’t made it very far yet, relatively, but I imagine this feeling lasts all the way up to retirement; there is simply always more to learn, and that alone is enough to humble anyone. Medicine by nature is a humbling field; doctors are privy to some of the most intimate parts of other people’s lives. These intimate parts might come in the form of a patient sharing concerns that he has never before voiced aloud; it might come in the form of a surgery, during which we are permitted to peer inside a patient’s abdominal cavity and see organs that she’s never seen herself. Patients are often not shy about sharing deeply personal information with physicians, which creates a high level of responsibility.
While this humbling aspect of medicine may be true to all who work in healthcare, I have felt it especially strongly this first month in the clinic. As a third year medical student, I am the newest and lowest member of the team, and as such I am not usually offering a whole lot to patient care. (I would like to and am trying to learn how to, but practically it is often difficult to contribute meaningfully with so little experience.) The patients I see don’t have to see me. If I interview them, they’ll usually have to repeat the interview with a doctor or several others; if I perform part of the physical exam, it isn’t usually being used for diagnosis, and will immediately be repeated by the doctor. Patients don’t have to let me do anything at all, but they often do. It is humbling to consider how willing most patients are to let me be present for everything, including difficult and uncomfortable moments.
Though I imagine this will carry to other rotations, it’s been exceptionally true in this first rotation, Women’s Health. I have spent two weeks on gynecologic oncology, two weeks on benign gynecology, and done two night shifts on the labor and delivery floor. In that time I’ve been able to participate in several surgeries, office procedures, deliveries, and clinic days. As a male, I find it especially amazing that so many women are willing to let me learn from them; it is a gift I will probably never be able to repay.
One such experience that sticks out occurred last week during the gynecology portion of my rotation. After seeing a surgery in the morning, I spent the afternoon in clinic with several of the OB/GYN residents. I followed one resident in to see a patient, and she conducted the interview while I watched over her shoulder. Within a few minutes of us entering the room, the patient was in tears as she recounted her deep-seated fears of developing cancer. The resident explained the procedure she would be having – a colposcopy, in which we would examine her cervix and if necessary, take a small biopsy to determine if the lesion was cancerous. We left the room to prepare for the procedure.
When we came back, the resident prepared to do the colposcopy, with a nurse assisting her. Also present was the attending physician, who was supervising and offering advice, and myself, who stood back watching. During the procedure, the patient began to cry, and I’m sure her emotions were exacerbated by having so many people watch the procedure. I stood there awkwardly for a few minutes, but eventually I brought her some tissues and stood beside her until it was over. It was the smallest way I could think to contribute, but I felt humbled to be a part of the team. Being present with someone in such a vulnerable state was difficult, but I found it rewarding as well.
Life as a third year student is humbling in many other small ways – figuring out where to stand and sit, where the bathrooms are, the ebb and flow of different teams of doctors and residents, and navigating the hospital. I often feel that I’m in the way, usually when I’m trying to do something helpful. Which is another reminder: doctors, nurses, and residents also give us a gift. They let us be in the room, standing in the way, scrubbing in on surgeries in order to do almost nothing, all for the sake of helping us learn. It’s been a beautiful experience so far, and I expect to have even more to share once I have another month under my belt.
About the Author
Brent Schnipke is a third year medical student at Wright State University Boonshoft School of Medicine in Beavercreek, OH. He is a graduate of Mount Vernon Nazarene University with a degree in Biology. His interests include medical education, writing, medical humanities, and bioethics. Brent is also active on social media and can be reached on Twitter @brentschnipke.
Brent Schnipke, MD is a physician and writer based in Dayton, OH. He graduated medical school in 2018 and completed his psychiatry residency at Wright State University Boonshoft School of Medicine. He currently practices in Dayton, OH. His professional interests include medical humanities, mental health, and medical education.