It seemed like a typical Monday morning. I was a fourth-year medical student on my year-long immersion in ophthalmology. At morning report, the first-year residents spoke assuredly about the patients seen over the weekend, giving the impression that all was business as usual. Another corneal abrasion here. Another ruptured globe there.
Afterwards, I walked to the waiting area and saw someone sitting there who looked quite familiar. What was she doing here? Should I examine her? After all, she was the dean, beloved by medical students. Eventually, I asked, “Is it okay for me to take an initial history and exam?”
“Yes, of course,” she replied.
Gathering the history was daunting. As she vividly recalled her symptoms, I attempted to ignore my distracting thoughts. Are my questions open-ended enough? Am I making appropriate eye-contact? I could sense she was worried, and I tried to provide what answers I could.
The thought of laying hands on her eyelids made me feel uneasy, but I carried on. First, a test of vision. Check. Next, pupils and intraocular pressure. Check and check. Still, I secretly hoped that the slit lamp’s luminous beam would conceal my heightened self-consciousness.
In medical school, I’d been taught the essentials of treating all patients with equal dignity and respect. However, when my dean was the one sitting in the patient chair, I fought the urge to display exceptional empathy, respect, and understanding; it no longer felt like business as usual. I think it is easy to be seduced by the familiar rhythms of daily practice, but it is also easy to forget sometimes that every patient–provider encounter leaves an indelible mark on both the patient’s and the provider’s fabric of life. For that reason, patient care should never be business as usual.
I aspire to practice medicine with an established standard of care while always paying attention to the uniqueness of each individual, each dean and each patient alike.
Roles are reversed in the blink of an eye. Literally in my case, as I found myself sitting on the other side of a slit lamp from a fourth-year medical student, one of my medical students as I am the dean of students at his medical school.
In the waiting area, I sat worrying about my left eye. Two days earlier I had seen a brief flash of light, and the following day a large, dark floater obscured my vision. I ruminated on the worst outcome—permanent vision loss. A smiling and familiar face appeared. Seeing someone I knew in this terrifying situation was comforting. He took me into a room where he dilated my eyes, tested my vision, measured intraocular pressures, and was present both for my diagnosis of retinal tear and for the laser treatment that followed. He was calm, reassuring, always sitting at eye level, explaining what he could and assuring me that his preceptor would explain more.
This experience brought to mind a vivid scene from years ago when I visited a former residency director in the hospital after her treatment for breast cancer. The door to her room was ajar, and I saw her leaning forward engrossed in the words of her oncologist, who had been a resident with me in her program.
We practically pounce on first-year medical students to impress upon them the importance of professionalism. We want them to grow up in front of our eyes and understand their new role as physician-to-be. They often come to us wearing their flip-flops and backward baseball caps. We hope that by steeping them in pathophysiology, applying white jackets, and engaging them with patient-centered care, they will become the professionals we would want for ourselves or our family members. In our hearts, we know the journey from premed to professional is a process with fits and starts that takes time. Performance on objective structured clinical examinations is a surrogate marker for the knowledge, skills, and attitudes that we hope they will accumulate and practice, but we may never know for sure.
One day, however, we will walk into a room feeling vulnerable, needy, and scared, and see a student or former student or a colleague’s former student in front of us. At that moment, we must believe in the process and put ourselves in his hands.
Wei Gui and Nancy R. Angoff, MD, MPH, MEd
is a fourth-year medical student, Yale
University School of Medicine, New Haven,
Connecticut; e-mail: firstname.lastname@example.org.
is associate dean for student affairs
and associate professor of medicine, Yale University
School of Medicine, New Haven, Connecticut;