It’s worth it. It really is. For all the thousands of hours we spend studying medicine, it simply takes a few great patient encounters to remind you how much you love it all. During the first and second year of med school, it’s easy to get caught up in – or, sometimes, overwhelmed by – the endless details to memorize. All of sudden, though, you realize how much you’ve actually retained and how wonderful it is to go in and make a difference.
Earlier this week, I worked at the Delonis Clinic, which is in a homeless shelter operated by Washtenaw County. I walked over to the shelter wearing my white coat, entered through the main doors, and was immediately approached by an elderly man who grumbled, “Ah, you’re the lady I need to see.” Resisting the urge to say “No, no! I don’t know anything! I’m not a doctor yet!” I instead smiled and said, “Of course! Looking forward to seeing you this evening.”
I climbed up to the second floor, wandered through rows of cots, and found that I was the first student or doctor to arrive at the clinic that night. Once the attending physician, the physician’s assistant, and the other med student arrived, we went over logistics. I made sure I knew where extra intake forms were, practiced taking blood pressures, and looked through the list of patients who’d signed up for the first few time slots. With only one doctor each evening, most of the history-taking and face-time with patients is up to the med students.
It. Was. Awesome.
I talked at length with a woman who complained of knee pain, alcoholism, and STIs; I tried to deflect the awkward flirtations of a middle-aged man with an upper respiratory infection; and I consoled a man who’d just been discharged from the hospital, was worried about injecting his new blood thinner, and was confused about his prescriptions.
As I “presented” each patient to the attending, I realized there were certain parts of the history I was either skipping or spending too much time on and that I was embarrassingly unfamiliar with certain classes of drugs. By and large, I spent the evening learning. It’s important to recognize that for every one thing you can do there are a million that you can’t; being humble is really the only way to progress. I asked the other med student to help me find the pulse in the right place, I asked the PA how she’d decided an infection was viral and not bacterial, and I asked the attending if he’d remind me which pain relievers might be most harmful to the patient who had Hep C.
More than anything, though, I learned directly from the patients. Certainly the homeless shelter gives you a unique subset of the general population, but they impart wisdom that is generally applicable to medical practice. You can tell when you have their trust, when they enjoy talking to you, and when they’re beyond frustrated. I found that a lot of what we did was educate patients about how to help themselves. It’s a truly spectacular feeling to find yourself in a position to teach patients how they might alleviate their pain, to explain the differences between medications, to encourage them to make healthy lifestyle changes, and to affirm how impressive you find the strides they’ve already made. Seeing patients on my own and finding that I’m able to make a coherent (albeit preliminary) assessment and plan is very exciting.
After the last patient left, the notes were completed as efficiently as possible. It was late, after all, and the attending was already behind schedule to get to his ice hockey game. I walked home with a huge smile on my face, knowing I’d remember each of those patients for years to come.