Friday - Making Rounds: White Coat Imposter
“Why is it important to know the 10 different lung fields to auscultate?” asks Dr. McDonald.
I really have no idea. I take my best guesses.
“Relation to the dividing bronchi?”
“Distribution of blood supply to lung lobes?”
Finally Dr. McDonald answers the question himself. “So you look like you know what you’re doing.”
Dr. McDonald is especially attuned to patients’ perceptions because his whole body—arms, legs, mouth, everything—is affected by cerebral palsy.
“Just think how freaked out parents get when I come stumbling in, and they find out I’m in charge of their kid’s care. But they calm down once it looks like I’m capable. So make sure you look capable when seeing patients, or they won’t trust you.”
“Fake it till you make it” is a phrase med students often use to describe the clinical years. Only after spending time on wards did I come to appreciate the truth of the statement. At this point in 3rd year, I’ve got the looking-like-a-doctor part down. In my white coat, stethoscope to your lungs, telling you, “Deep breaths, through your mouth, please,” I put on a very convincing “don’t worry, I’m a doctor” performance.
The problem is, I only sort of know what I'm doing. Unlike Dr. McDonald, who’s got 20 years of experience in the ER and ICU, I’m currently operating on half a clue, and it’s going to be years before what I know catches up with how I look.
This disconnect between how I'm viewed and what little knowledge I possess really does make me feel like a fake! Especially when, after examining a patient, they ask, “So, what do you think it is? Am I OK?” Generally, my assessment of what it could be is not only mistaken—it probably includes something life-threatening. So, in the interest of not alarming patients (and creating more work for everyone), my usual answer is, “Well, I’m just the medical student. I’m not really sure. We’ll have to see what the doctor thinks.”
I can’t help but notice the slight disappointment I get from patients in return. As if they’re silently saying, “Well, that was a waste of time! After all those questions you can’t even tell me what’s wrong? What good are you?”
I promise I’m not just “playing” doctor. Really, I’m working on it. But realistically, I’ll need to start residency training before my skill set includes more than just looking useful. So until then, like I said before—fake it till you make it.
Right now, I’m so stressed out about “making it,” I forget that my ability to successfully “fake it” also took time and effort to develop. Thanks to the 2nd year med students, every so often—when I catch them trying to interview patients—I get a nice reminder: with their nervous smiles, and uncomfortable “What are we doing??” expressions on their faces, patients would never mistake these students for doctors.
“Wow. Was I really that awkward?” I always think. Unbelievable…
I wonder if one day, when I’m actually a doctor, will I look back at this blog and think the same thing?