One sunny weekend morning early in my third year of medical school, I drove to my local gas station to refuel my car. While I was sleepily trying to press the right sequence of buttons on the pay-at-the-pump device, a woman in her mid-60s approached me. “Excuse me,” she said, “can you help me start my car?”
I hadn’t seen her coming and wasn’t expecting to talk to anyone during this transaction, so I was taken aback. “I’m sorry?” I said.
“I’ve forgotten how to start my car. Can you help me?”
I had just finished my neurology rotation, and it was still fresh in my mind. My first thought was, She has an apraxia! Parietal lobe lesion! Fragments of the Mini Mental Status Exam flashed through my head. Take this piece of paper in your right hand, fold it in half, and place it on the floor. I tried to critically assess her. She appeared reasonably well dressed and groomed, but I had strong concerns about her driving. I tried to stall a bit, asking her if she was feeling okay. She became increasingly irritated. I eventually started her car. I watched her drive down the road until she was gone, and then stood there another minute, stunned, listening for a crash. There was none, and I went home.
This incident was a defining moment in my “professionalization.” As a new clinical clerk, I was acutely aware of my transformation from college student to student physician, but still maintained the illusion that this change was solely professional. At the gas station, I suddenly realized that my acquisition of medical knowledge had increased my insight, and therefore my responsibility, in some everyday situations as well. My basic knowledge of apraxias caused me to feel an increased responsibility for the woman and anyone she might injure with her car.
Situations requiring professional ethics in nonprofessional settings can be difficult for medical students, who are accustomed to operating at the bottom of a hierarchy of supervision. When I told this story to a group of third-year medical students, their immediate response was to wonder whether I as a medical student would be legally liable if the woman injured someone with her car. My encounter with this woman occurred at the beginning of my clinical training, when I was still uncomfortable in my proverbial white coat and appropriately hesitant to make decisions without a resident’s approval. If I had it to do over again, I would intervene by asking the woman’s permission to call her physician, and, if she refused, calling the police. As this, of course, isn’t possible, the best I can do is learn from the experience. This was my first independent (non-) clinical decision, and led me to recognize that my medical education impacts not only my career but also my relationship to society.
Kelly Register-Brown, MD