Medical Student’s Perspective: Respecting Your Patients and Compassionate Care

“The patient has been transferred to 5 North,” Dr. Martinez* said with a laugh during morning rounds. It was approximately 8 o’clock instairway to heaven the morning. I had been awake since 5, and even though my brain was affixed to the messy handwritten words scribbled onto printer paper regarding the overnight activities of my assigned patients, I still had the wherewithal to know when something didn’t make sense. I took a sip of my chai latte and my mind wandered. What on earth could be so funny about a patient with congestive heart failure?

Dr. Martinez had been my senior for two weeks during my Internal Medicine Core rotation. He was knowledgeable and generally favored among the attendings, but he had a downfall – he was arrogant. His head was so big I was surprised he could fit through an average-sized doorway. When the residents gathered in the main conference room for afternoon lecture, Dr. Martinez could sit there and answer each question correctly, and then comment extensively on the research that helped come to the question’s conclusion. The movie in my mind always played out a scene of him in a dark room reading cardiology textbooks and throwing darts at photos of his classmates on a corkboard wall. I would smile, and then continue listening as another resident struggled to get a word in edgewise.

As a 3rd year med student on the wards in my very first rotation, I learned quickly that the young residents to whom I was assigned had their individual ways of teaching. Some of them would let us ask the questions, some would give topics for us to research, and some would just brush us off and let us get home to study. “You guys have enough to worry about with Step 2,” they would say.

But somewhere between Step 2 and residency, there was a distinct change in the attitudes the students had towards their patients. For we medical students, each one was like a new piece of cake that had a slightly different flavor each time we sampled them. Mr. X was admitted for chest pain, and Mrs. Y in the next room over had rectal bleeding. We bounced eagerly from room to room asking them how they felt, manipulating them into the correct auscultating positions, and then smiling reassuringly that the medical team would be by to discuss their plan of care.

The residents, on the other hand, would treat each new batch of patients like a load of dirty dishes to wash. Mr. X was a repeat customer who never took his medications, and Mrs. Y was a hypochondriac who hopped over to the ER whenever she felt a cough or headache come on. I would watch them do a physical exam hastily and then run to the computer to type up their findings. On long call days when residents got very little sleep, the stress would shorten their fuses to the point that the patients would confide in me later on that they wanted to switch doctors. I even listened as vegetative ICU patients were given nicknames with the word “veg” within their last names. “It’s not like they can hear us,” our resident would say.

But the students sure did.

It is sad to me that in a few short years in the medical field, I am expected to lose my compassion. I am expected to go from treating patients with a high amount of respect to making sure I get them well enough to be discharged so they won’t take up room in the hospital. The harsh reality is that in the 3-4 year period in which this plummet in patient respect occurs, experience has taken over and the initial reason we became doctors isn’t relevant anymore: instead, we inevitably chose a road where the problems of real people are reduced to mere descriptions on the discharge summary or bulletpoints on to-do lists. And as a student, this casts a large shadow on what was initially a bright picture of my future in the medical field.

“I’m sorry,” I repeated to Dr. Martinez, pretending like I didn’t hear him, “5 North?” I had spent only 10 weeks at the hospital, but I knew as well as I knew my own phone number that the inpatient wing – nay, the whole hospital, only had 4 floors. Barring the existence of a rooftop ward, there was no 5th floor. So then, where the heck was 5 North?

And then all at once, it hit me.

“We don’t need to talk about him anymore, Elizabeth. He had a celestial discharge,” Dr. Martinez said. “You know, transferred to the Eternal Care Unit?” The other residents and the attending joined in the cadence of giggles. Dr. Martinez stared me down with a hint of sarcasm and annoyance on his face. “He’s dead.”

Each little nickname for the dead patient’s new place of residence hit me as if I was being reamed with rotting tomatoes. After the third one, I was done.

“Thanks, Dr.” I said. “I get it now.”

How does one teach respect? Can we learn respect from a textbook or a test prep book? Can we find it on UpToDate or amongst the tiny print in those coveted little green binders stuffed into our pockets? The truth is that respect cannot be taught in the traditional sense. But in the eyes of a student, we learn respect from the examples put forth by the people who were in our shoes not too long ago. They are the people who once wore our short coats and nervously took vitals while the senior doctors stood by and observed. They are the people we tirelessly look up to, and that is why it is so important for residents to show us students that respect for patients should never go by the wayside. We might not be able to fully understand their level of stress until we get on the other side of the MD, but we can all remember what drew us to medicine when the going gets tough – the inherent need to be of service to others. And with these examples of respect by our predecessors, we students can better learn how not to lose it, and then carry on the knowledge to the student who we will one day teach. And as the shadow lifts, perhaps the nicknames and the cleverly-worded euphemisms won’t evoke laughter, but pity for the disrespectful person who chose to use it.

I took another sip of my latte and readjusted my ears to the discussion as rounds continued. We moved on to speak about another patient. At least it’s a new flavor, a new day, and a new chance for us to get it right.

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Elizabeth McKinnon

Elizabeth McKinnon

A lifelong lover of books and the stage, Elizabeth set out to write her first book in college and her second one while she was working as a medical assistant at a dermatologist's office. In her spare time, she writes plays and short stories and enjoys sharing them with friends and family. She plans to pursue a writing career in medical fiction and is currently working on her third book. Elizabeth is a Pathology Resident at Duke University in Durham, North Carolina.
Elizabeth McKinnon

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