Saturday, September 4, 2010

Those Who Have No Stripes

This post could get me into trouble, but hopefully, not too much. For quite some time, long before I became a medical student, I've reflected on what I thought clinical education should include. Often as not, these contemplative moments occurred while I was working as a hospital-based therapist and had the opportunity to observe third-year students doing their psychiatry rotation through my department.

What intrigued me was their tendency to stick close to the physicians. This only makes sense; if you're going to move up the ranks, so to speak, you want as much time as you can in the company of those who've already earned their stripes. Well-intentioned as it is, however, this can turn out a limiting factor in your education. The reason is, much of the blood and guts patient care that takes place on psychiatric, as well as primarily medical units, is done by non-physician staff. The things they know.

Consequently, I've come to believe students should have to spend a portion of their time working under the direct tutelage, not only of doctors and nurses, but also mental health counselors, unit secretaries, social workers, and recreational or occupational therapists -- those who have no stripes on their "uniforms." I realize a four week rotation provides barely enough exposure to begin getting one's feet wet, but closeness to the other team members broadens the learning experience tremendously. For one thing, it gives a person an idea how the other half lives.

What I mean is, it's easy to get locked into ivory tower thinking about hospital staff roles and patient care. Doctors have traditionally been at the top of the food chain, and frankly, working with non-physician types nurtures a healthy sense of humility. The initials we place behind our signatures say a lot about us but what speaks even louder is the way we treat the people under our authority. Doctors who are beloved tend to be those who are more interested in supporting the contributions of the rest of the team than they are in being impressive. A little modesty goes a long, long way.

And if someone is not naturally inclined toward a modest self-estimation, rotations are a place to learn its value. I may have gotten four years of college and more of graduate school but it doesn't make me special. Special is the nurse who, instead of going home at the end of the day, works an overnight shift to cover for another who's ill. Special is the unit secretary who catches the error in your prescribing orders, saving you from having to explain yourself to your attending. Special is the janitor who cleans up after the detoxing patient who's vomited in the bathroom. Becoming a doctor is an honor, not because we're entitled to recognition, but because we're privileged to work with people like these and be counted among them. That's what's special.

(Creative Commons image "4 Stripes" by ianmunroe via Flikr)
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