The Year of Privilege, Part 2

Last Updated on June 26, 2022 by Laura Turner

In my last article, I wrote about my perspective on the third year of medical school and how it has evolved over the course of this year. Medical education is unfortunately sparse with free time, which makes it difficult to reflect; writing these posts has been one way for me to slow down and process all the things I’ve seen, the knowledge I’ve gained, and the relationships I’ve built with patients. It was the process of doing this that led to last month’s article, highlighting some of the amazing things I’ve gotten to do this year and some general themes about the clinical side of medical school.
I want to expand on some of the ideas I shared last month and hopefully draw some connections that will further showcase this “year of privilege” and how it has allowed me both to learn and care for patients. I’d also like to connect some of these ideas to the overall theme of this column, which is to say, the process of choosing a medical specialty. This is a complex process, and I’ve been able to address some of the theoretical and academic ideas that go into the decision. Here, I’d like to write about the factor that really makes the decision: the patients themselves.  Conversations with patients are a large determinant of specialty choice, and medical students should pay attention to these conversations when considering a specialty.
During third year, we get to spend a lot of our time talking to patients, particularly during inpatient rotations (in a hospital). This is often where the decision to pursue a given specialty, or rule it out as an option, can really take shape. One of my residents, a neurology intern, told me about how she had expected to be a pediatrician throughout medical school, even during her pediatrics rotation. She loved kids and felt that it would be the best fit for her. Early in her fourth year, however, she did a rotation in neurology. She realized that she found the disease processes and learning material to be much more fascinating than she had found pediatrics. She even found that she liked talking to the patients about their conditions, more so than the children whom she’d treated. It wasn’t that she didn’t like pediatrics, or working with children, but that the patients she saw on neurology drew her to the specialty.
The act of speaking with patients is not unique to any given specialty, but the type of patients, the disease processes, and the nature of the conversations all vary among the different specialists. Some specialties, such as pediatrics and geriatrics, stratify patients directly by age. Other specialties do so by default, because of the typical disease processes seen by those doctors. For example, nephrologists see many older patients, because they tend to be the population that require dialysis or other treatments for their kidneys. Medical genetics, by contrast, works with closely with pediatrics due to the fact that genetic diseases typically present in children. Beyond this, physicians have conversations with patients about topics within their field, which vary widely among the specialties. The nature of the interaction between a patient and a urologist, a general surgeon, a psychiatrist, or an endocrinologist will all be quite different.
Some of my clinical experiences have highlighted the nuances of each specialty by allowing me to talk with patients. This has been a great privilege, because hearing each story has helped remind me why I chose medicine and discover what kinds of conversations I enjoy having. I have had powerful discussions of life and death with surgical patients as we referred them to palliative care. I have talked about nightmares, sleep terrors, and hallucinations with a twelve-year-old girl trying to make sense of what she was seeing. I have had conversations about infertility and the joy of conceiving a child with excited soon-to-be parents. Each of these conversations has moved me in a different way, but they also display the diversity of medicine and the opportunity we have, as medical students, to meet people across the spectrum of life.
One of my favorite conversations with a patient began during psychiatry and continued into family medicine, which were back-to-back clerkships I did earlier this spring. While working on the psychiatry consult service, I met a patient who was post-operative from a back surgery and was barely able to walk. This was causing her significant distress, as would be expected, but through talking with her I discovered many other stressors as well – social issues, a latent history of PTSD, severe anxiety, and interpersonal concerns with her boyfriend, children, and new grandchildren. After speaking with her and beginning a new medication, she was immensely grateful to me and to our team, mostly for someone to actually talk to her and ask about topics most doctors hadn’t. She was eventually discharged, and I didn’t expect to meet her again.
While on family medicine, however, I worked at a clinic in a more rural area, about 15 miles away from the hospital, and one day in clinic she was the patient we were seeing. She recognized me before I recognized her, and promptly said, “I love you.” She proceeded to tell my preceptor how much I had helped her during her difficult post-operative journey. This struck me – I had talked with her, but what else had I done? Not much, and yet this was enough for her to remember me and feel that I had helped change her life. I was moved, as I often am when I stop to consider, at the beauty of what we get to do as physicians.
Speaking to patients happens in all specialties, but there are different types of conversations throughout medicine. The third year rotations I have finished highlight this fact, and the conversations I have enjoyed may offer a clue as to my own specialty choice (which I am still working on!). As I’ve stated, medical students should pay attention to the differences, because they may offer a clue – or the whole answer – as to where and how that student would best be suited to practice. Medicine is an others-focused field, patient-centric, and our privilege is that we get to talk to them. If we choose well, we will enjoy these conversations throughout our whole career.
Central to the skillset of every physician is the differential diagnosis; this is the process by which new patients are evaluated to establish the most likely diagnosis. Similarly, the first clinical year of medical school is like a differential for each student, except instead of a medical diagnosis, students are seeking to determine which specialty they will choose. This column explores this differential: experiences from each rotation by a current third year student.
About the Author
Brent Schnipke is a third year medical student at Wright State University Boonshoft School of Medicine in Beavercreek, OH. He is a graduate of Mount Vernon Nazarene University with a degree in Biology. His interests include medical education, writing, medical humanities, and bioethics. Brent is also active on social media and can be reached on Twitter @brentschnipke.