Kindergarten & the First Year of Medical School
Reinforcing the Basics
Having successfully completed kindergarten 20 some odd years ago, and recently finishing my first year of medical school about 20 days ago, I can provide insight on the similarity of the two. While the differences are implied, you may not think they have very much in common.
Reading is Fundamental
The patient room is not the place to start reading. You started reading many weeks before getting to this point. Not only reading to understand but also reading to extrapolate - there is no way to fit everything you need to know in one textbook, or even 100 books! And when I say reading I do not only mean the Costanzo Physiology text or scholarly articles. You have to read current events, ever-changing laws, policies and procedures, contracts, and topics including but not limited to metacognition, ethics, and economics. Your outside reading is about the microscopic and macroscopic concepts of being a practitioner.
Once at the door of the patient room, you read the chart before knocking. It usually takes less than 30 seconds to look over the background information, vitals, and reason the patient is here today. The underlying reason that it only takes 30 seconds to review the chart and around 15 minutes to visit a patient is not because it is simple. After many many hours of reading, you have read enough to solve the particular problem. The practitioner knows what to do; it is not their first time seeing this concept and integrating it with prior knowledge. Familiarity with something facilitates pattern recognition; two words that I hear. Every. Single. Day.
Wash your hands
Now that we have a backstory, it is time to knock on the door. The moment I enter the exam room I am automatically headed to the hand sanitizer. This step has been ingrained into students at my school; skipping this step will result in a failing grade for the whole encounter even if everything else is done perfectly. This is to emphasize the importance of clean hands. But as a general rule, you should not handle people with unclean hands. It’s just rude. If you don’t do anything else - Wash. Your. Damn. Hands!
ABCs & XYZs
Being a physician means that when there is a medical emergency you are expected (and most times ethically obligated) to respond. All eyes are on you and people are waiting for your call. We did a simulated situation where the fake patient was coding; I appeared calm externally and in the moment but after my colleagues and I had tried all the steps and none of them worked I was internally freaking out. I worriedly asked the “nurse” (a physician acting as a nurse) if I push epinephrine will I kill him? His response will stick with me forever “Will you kill him if you don’t?” Asking a different question made the answer a clear, resounding YES! Action needs to be taken immediately. We ended up saving the “patient” but afterwards I remember having to sit in the car for 20 minutes before I could drive home. I cried. Not because I was sad but because I was scared. I do not know if I have what it takes to make these life and death calls under that type of pressure. And it was not a real patient but the learning experience in that single practice will have a lasting impact on the way I practice medicine.
When there is an emergency going on, we are taught to go back to the basics. Yup, we learned our ABCs of emergency response. Airway. Breathing. Circulation. In that order, every time. In our simulation the patient developed difficulty breathing as a consequence of heart failure. So the solution was to fix the circulation by helping his heart contract harder to push the oxygenated blood to the rest of the body. Deep down, I knew the answer because I had read it two days before but I wasn’t confident in myself enough to make the call. My fear of being wrong delayed me from speaking up. After we tried W and X treatment, Y was the next step (epinephrine), and then Z (using the defibrillator) was our last resort.
TL;DR - Too Long; Didn’t Read
The basic principles do not change between kindergarten to medical school. Know your ABCs, you're going to have to read and most importantly, and I cannot stress this enough especially after the pandemic, keep your hands clean.