What is medicine.

Having just finished the second term (in Dartmouth’s quarter system, where the fourth term is the summer one), I am now learning what medicine really is. And what it means to be a physician.

Yes, I did successfully pass all the courses during this finals season again, but more and more am I finding out that all of the biochemistry and physiology that we are learning is not really all there is to being a doctor. There is way much more.

Starting a medical school is an incredible transition. Not only because everyone is adjusting to a pace of academic curriculum that is in most cases significantly faster than that at college, but more importantly, students are also exposed to completely new social and ethical situations, unlike anything they have experienced ever before. That, I believe, also becomes the new and most significant stressor in our lives, one we definitely have to and eventually do get used to.

Here’s what I’m talking about:
-    Learning how to treat our patients, both verbally and physically, by role-playing with our classmates. Sharing our own bodies as a tool of practice for the physical exam by our peers. And then meeting standardized patients. And then real ones.
-    Studying “the physicians’ language.” Our professors keep reminding us that our vocabulary will double by the end of medical school, enriched by Latin and medical English terms we have never heard before. And inside jokes and puns no one else will understand.
-    Coming into the anatomy lab to “meet the donor” for the first time – in other words, seeing a dead body and then also touching it. And then dissecting it with a scalpel, right away. And then meeting the living relatives of the donor, who put them into a real-life context for us by sharing their memories of them. “A body” becomes “a person.”
-    Walking around the hospital in our white coat and being greeted with respect we are yet to earn. Being asked about a diagnosis. Being told the most private information, that which would not be shared with anyone, not even a family member – in hope that we could help.
-    Realizing that sooner than we’d like to think, a life could literally depend on us.

In short, shortly after a few role-plays and simulations, learning the basics of CPR (Cardiopulmonary Resuscitation), and signing the HIPAA (an agreement to non-disclosure of private health information), I started seeing real patients in a real clinic. Typically, I am the first one to talk to a patient, ask them about all of the information relevant to their problem, and then I go talk briefly to the physician who is in charge to see what could be done – and then, together, we go and do that. Once I started wearing the white coat, patients immediately treated me like a real physician – even though I always introduce myself as a first year medical student; it almost doesn’t even seem to make a difference in their minds. The white coat is what defines me.

And so, during my rotations, I have heard a middle-aged mother talk about her incontinence. I was talked to by a diabetic who had problems with weight. I saw a surgeon tell a patient that as a result of their heavy smoking, they would have to have their thumb amputated, if not a part of their leg as well. I have seen a man with genital warts and I examined a breast cancer survivor. All of that in mere seven months of medical school. And I haven’t even mentioned what it is like to meet a patient outside, in “real life,” after seeing them at the clinic. (Which is rather likely to happen in a town as small as Hanover.)

Overall, therefore, this has been an exceptionally emotional and humbling experience. Though it is, of course, an immensely rewarding one, too. Just the other day, I received a “thank you” note from one of the patients, whose severe back pain improved the day after he came to see us. I am absolutely thrilled I can go through all of this practical training, as any future physician should. Most of all, though, I am probably learning more about myself than about anything else – and, boy, that’s something!

 

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