Notable Quotables: Sir William Osler

"One of the first duties of the physician is to educate the masses not to take medicine" 

- Sir William Osler 

If you haven't heard of Dr. Osler yet I would recommend clicking here to read a little bit.  He basically invented the idea of residency training and was the first guy who thought maybe medical students should get some bedside training and get out of lecture halls.  I think the sentiment of this quotation is fantastic, it really drives home the core of practice which shies away from the idea of overmedication and really medication at all.

Medical Jargon Demystified II: Pecking Order

Something that I have always found incredibly confusing until I became a part of this structure myself was the hierarchy of medical education. I thought it may be useful to just clarify who is who and how far along in their educational journey in a post.

• Attending (This person is definitely a doctor, they are what we usually think of when we say doctor. Undergrad + Med School + Residency (depending on the field, fellowship))
• Resident (All of these people are technically doctors, they have an MD or DO after their name)
• PGY (INSERT #) (post graduate year) depending on how long their residency training program is this could be PGY 1 - 10)
• PGY 1 (these guys are the interns, they are the lowest of the low in the MD totem pole.  They are first years that were medical students between 2 and 10 months ago and act fairly clueless for the better portion of the year)
• Medical Student (These people are not doctors yet, they DO NOT have MD or DO after their name)
• M4 (4th year student, operates at a similar level to a PGY1)
• M3 (3rd year medical student, fairly clueless but depending on how far along in their 3rd year are closer in performance to an M4)
• M2 (2nd year medical student.  Still in the didactic learning years with minimal clinical exposure, have net to no idea what they're doing)
• M1 (1st year medical student.  In their first year of didactic learning, little to no clinical exposure, has absolutely no idea what is happening ever)

I hope that little snippet helps give a better understanding of what all these weird letters and titles really mean. 

Teachable Moments I

**please note: names have been changed for reasons of privacy**

Finally, no more shadowing and awkwardly stumbling around while my overly dressed up self scrambled to follow a doctor from room to room, nope because I’m a medical student.  It was time for me to get assigned to my preceptor for the year!  If you’re as confused as I was about what that is let me explain: physician shadowing, except this time you get to wear a white coat and a stethoscope.

 As first year students we come equipped with a severe lack of any clinical knowledge juxtaposed with a strong desire to act cool in clinic.

 A memory I know that I will reference for a long time in the future, as a yardstick for measuring how I have connected with a patient and family is from a day that I spent in the hospital with my preceptor rounding on patients on the Family Medicine service.  The day was essentially over and he decided to go check up on a few patients before heading out for the day.  One of the last patients we saw was an older African American man who was recovering from a brain surgery after a severe stroke.  The following is my recollection of that encounter:

“Hi, I’m Michael Parker, I’m one of the physicians taking care of your loved one today”.  Can we stop right there? Have you ever heard a doctor introduce themselves as not doctor? I feel like by the time we complete all of our training we wear our title of doctor not as a badge of honor but rather a triumph.  Maybe it was unintentional, maybe not, but in knocking on the door and simply stating his own name he put himself at the level of the patient and his family.  It made him immediately accessible.  There were two women and one man visiting the patient and he was wavering in and out of consciousness.  He was not able to interact at all, at that point the doctor would probably not have much to do, right?

Dr. Parker took the time to introduce who I was to the family and ask if it would be okay if I stepped into the room, they were more than happy to allow that.  He then inquired about how the patient was recovering from surgery and the family related that they were unsure how he was doing because of the unstability of his consciousness.  

Here it comes, teaching moment for life.  Dr. Parke proceeded to relate to me how difficult it can be for a family when they are going through a recovery process from such a major surgery especially when the course of recovery can be so varied.  He addressed me but also engaged the family in the conversation and they could be heard expressing hushed agreements—“mmhmmm” and “that’s right”—and nodding along as Dr. Parker conversed with me.  He then turned back to the family who had been listening to him with rapt attention and asked them again if they had any other questions.  The woman sitting at the patient’s bedside echoed some of the sentiments that Dr. Parker had shared with me while the other family members nodded in agreement.

It was amazing for me to see how in such a creative way he was able to express the uncertainty of the situation for their loved one without robbing them of hope or giving a promise of too much.  By the time we were ready to leave the room the patient’s visitors were wishing me the best of luck in my career and relating that they had a niece who had similar aspirations.  Before we left Dr. Parker thanked the family for allowing us to speak with them and noted that someone would check in with them again shortly. 

The lesson I’ve learned from Dr. Parker is that we will have an urgent responsibility as physicians not only to treat patients but also to effectively interact with the environment around them. In that conversation there was nothing Dr. Parker did directly for the patient, but he reinforced the support system that will be vital to this patient’s recovery, something that is integral albeit indirectly to the patients health.  In that moment he transcended race, gender, age, ethnicity and socioeconomic status.

It is of great surprise to me to know that no matter how much we prepare and study it will only be with time and an active desire to improve that we will come close to delivering optimal care to our patients, I think I now have a greater understanding of why we practice medicine.