What They Don't Tell You About Becoming a Physician - Part One

When you think about becoming a doctor you think of wearing a crisp white coat with your name on it that has a million pockets with all types of medical gadgets. Since you've dreamed of this moment for at least a decade they don't have the heart to tell you that the ‘white coat effect’ wears off quickly. Before you actually own one, you may daydream of wearing it all the time. Now that I actually have a white coat or two (or three…) I can tell you that unless it is required, I’d much rather leave it on the hanger or in the backseat of my car because it is a guaranteed spotlight. Might as well be a walking billboard that says: PLEASE COME TALK TO ME, I KNOW STUFF. In reality, I am a student that has no idea of all the stuff so I’m in a short white coat. When things get serious you’re going to have to go find an adult i.e., someone in a long white coat that has a degree, a medical license, and the expertise to handle the situation. The student has the minutiae of the science fresh and ready for the test but the real doctor has the clinical experience that you're looking for. 

What they tell you about being a doctor is true: you will earn a comfortable salary while doing very meaningful and rewarding work. They also often say that nothing prepares you for medical school. What they don’t tell you is that being a doctor is literally keeping up with every molecule in the human body forwards and backwards at all points in time. I’ve used this exact phraseology with many physicians and they all respond similarly: “Yeah, that’s a pretty accurate description!” 

Here are some points that they all too conveniently omit:

I. You Will Become Ambidextrous

You may have a preferred hand for note-taking but when taking a manual blood pressure you better be good with both hands. The first several times I took a blood pressure were nothing short of comical. I'm expected to hold the bell of the stethoscope in the cubital fossa, feel for the radial pulse, listen to what is (and is not) happening while I squeeze the pump AND watch this tiny needle shoot from 200 straight to zero? Of course I completely miss the diastole so I have to start the entire process of obliterating the pulse which means squeezing the crap out of this poor patient all over again. In a frenzy of apologies and anxiousness I do it again focusing so hard getting the bottom number that I miss the systole, the number that goes on top! Meanwhile the MD is asking me what’d I get - Sir, all I got was a headache because the logistics of getting this basic vital sign is a nightmare. Nevermind a dominant hand, at this point I need eight tentacles. 

II. There is No Such Thing as TMI or Personal Space

Taking a medical history is arguably the most important thing you’ll do in the patient encounter. After all, the patient came in because they want to know what is wrong with them and hopefully get better. The only way to get to the right answer is to ask the right questions. A good medical history is at least a hundred questions and some of them are extremely personal. I want to know everything that has gone in and come out of your body over the last several days. These questions are not to judge, there is an entire algorithm of flow charts and check boxes that I am working through and the color and consistency of yesterday’s poop could be pertinent information in getting to the right diagnosis and treatment. If the medical history is not the most important part, then it is definitely the physical exam. What you tell me is subjective but what can be seen, felt and measured are objective. 

Standardized patients are real people who follow a script, actors if you will, that help students build their clinical skills. The best way to learn how to do a physical exam (or anything really) is practice. So yes, they are gracious enough to let us poke, percuss, and palpate on them all day. The MD explains and demonstrates first then the students take a turn. There was one occasion where she instructed us to check for conjunctival pallor which meant peel down the patient’s lower eyelid to visually inspect. Yes, you read that right. PEEL his lower lid meaning stand directly in front of him face to face, and use my thumbs to gently pull the skin away from his eyeballs. Dumbfounded, I looked at the doctor and said “I don't even know this man!” which she thought was hilarious and explained that I won’t know any of the patents but still have to get up close and personal to do a proper physical examination. Not only did I lower his lids, but later in that same encounter I removed his socks and squeezed his feet in several places. That may sound absurd but to be honest the feet touching is a part of most every physical exam but I’d been in med school long enough to have gotten used to that aspect. You literally touch the patient from head to toe and I think I knew that beforehand but just really want to underscore that fact so you know what you’re signing up for. 

III. Buy Orthotic Shoes 

The doctor walk is an olympic sport. I am not exaggerating when I say a physician told me to follow him, turned on his heels, and he created a breeze that had his white coat, and subsequently me in the tailwind. By the time I had processed the short conversation he’d taken all of four steps and was down the hall! I had to damn near jog to catch up and keep his pace. I remember thinking to myself that this man must either float or teleport because no normal human walks that fast that effortlessly. Even in slacks, a button up and a tie, he had on sneakers rather than dress shoes because I guess loafers don’t come standard with a turbo modification. At that moment I had to laugh because this guy was such a doctor and I knew I wanted to be like him when I ‘grow up.’ Generally, people know that doctors walk super fast but what you may not know is that my doctor walking pace now has theme music: Doctor walk doop doop da doo, doctor walk doop doop da do doo…

The practice of medicine is sacred so obviously they can’t tell you all the secrets. These are some things I would have liked to have seen in the handbook or whatever (because apparently there may be a secret handbook that I don’t know about because I have not yet unlocked that level…). If you want to answer the calling that is medicine, I am not here to sell you on the dream nor do I want to rain on your parade. It’ll rain either way, just try to make sure there is a pancho in one of those many, many pockets.