Playing doctor

Two weeks ago, I had the opportunity to attend a cardiothoracic workshop hosted at the Duke School of Medicine. Along with a host of other undergraduates, I crowded around the sterile examination table and listened attentively as medical students and a resident in cardiothoracic surgery explained the basics of the cardiopulmonary physical exam. First, look at the patient. Do you see any abnormalities at first glance? Is she breathing normally? Next, check her vital signs—temperature, blood pressure, heart rate, respiratory rate. I watched as the resident swiftly moved his stethoscope across different points on the student’s chest, seamlessly checking to see if all portions of her heart sounded normal, and then her back, listening to the rhythmic flow of air through her lungs. The entire exam took about three minutes.

After asking the rest of us if we had any questions, the resident thanked us and let the medical students take it from there. During the next portion of the workshop, I was paired with a third-year medical student, J., and another undergraduate to try out the techniques—on each other. As I fumbled with the stethoscope for the first time, I clumsily put the ear tips in the wrong way. “No,” J. chuckled. “The tips point inward, toward your ear drum. And make sure you first palpate the area where you’re going to be listening—you want to be above tissue, right in between his ribs.” Humiliated, I reoriented the ear tips correctly, hesitantly pressed the diaphragm against my partner’s back and listened. I didn’t hear anything. I pressed again, and still I didn’t hear anything. Just as I began to think that I was going to be a terrible doctor, I heard a soft “whooshing” sound, like the sound of air flowing over a bird’s wings—just barely detectable over the sound of the other students’ voices in the room. I was listening to the sound of air flowing into his lungs and back out again, bringing oxygen and life to his body. It was beautiful. I calmly asked my partner to take a deep breath in and out, methodically moving the stethoscope in a number five pattern across his back and around his sides. I repeated this process for the cardiothoracic portion of the exam. Wincing at the clamorous, amplified sound of my nervous fingers on the chest piece, I finally oriented the stethoscope right above my partner’s carotid artery to listen to his heartbeat—a steady lub-dub—confirming that the valves in his heart were opening and closing correctly. The entire process took me 20 minutes.

Besides learning about the cardiothoracic and pulmonic parts of the physical exam (and finally understanding what doctors were doing to me all these years), I witnessed another essential part of medicine—its learning hierarchy. Just from my workshop, I witnessed the flow of information from the more experienced residents, to the medical students, to us undergraduates. Medicine essentially operates by a “see one, do one, teach one” motto. However, an uncomfortable dilemma arises when attending physicians are confronted with the choice of providing the best possible care for patients or allowing a first-time resident or medical student to have hands-on practice, knowing that the patient may suffer as a consequence. There is no question that patients would be better off under the more experienced hands of attending physicians; however, if future physicians aren’t trained, everyone will be harmed. We see evidence of this learning machine in every clinical setting—surgeons using a new surgical tool after practicing once on a pig, new residents sewing together a colon for the first time, newly jacketed medical students sticking in their first IVs. There simply is no way to educate future physicians without letting them practice on patients.

As a daughter to parents and grandparents who will likely need invasive surgeries and procedures in the future, I cannot honestly say that I would feel comfortable with a first-time resident cutting around their aortas or stapling one vessel out of five similar ones in an area. But when I, or anyone else, walk into the doctor’s office, we simply have no way of knowing whether the person to whom we’ve delivered our loved ones will be able to ensure their safety and recovery back to health. I can only ask that all pre-medical and medical students, residents and practicing physicians remember this: Guard against your most human fallibilities and remember that the family in front of you has entrusted you with the life of their loved one.

After playing doctor myself, I have begun to understand why medicine is called a “practice;” and consequently, I’ve developed a greater appreciation for the responsibility that comes with this field. Just like anything else, being a doctor requires skill and confidence learned through experience. As Dr. Atul Gawande said, “Like the tennis player and the oboist and the guy who fixes hard drives, we need to practice to get good at what we do. There is one difference in medicine, though: It is people we practice upon.”

Georgia McLendon, Trinity ’14, is a Duke pre-med. This column is the 13th installment in a semester-long series of weekly columns written on the pre-med experience at Duke, as well as the diverse ways students can pursue and engage with the field of medicine.