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What med students learn when their teachers disagree

reflex hammer - ShutterstockThe question, asked to me by a new first-year medical student, seemed simple enough: “There are a lot of different types of reflex hammers out there - which one should I buy?” As with so many things in medicine, however, I knew that my answer wouldn't be so straightforward.

As I prepared to answer, I flashed back to one of my first days in medical school, when one of my clinical teachers said, “It’s not about the size of the hammer, but rather how you use it." I was told that with enough practice and skill, reflexes could be tested using even the most rudimentary of hammers. In fact, it would be in our best interest to refine our technique without relying on a big, heavy hammer.

Suddenly, my mind jumped forward a year or so, when a neurology fellow took one look at the reflex hammer I was using, told me it was too small and too light, and said that if we were on the neurology service in the hospital, he wouldn’t believe the results of my testing because of it. (Somehow, this seemed less than ideal.) This is how I learned that different types of doctors have divergent views about the “best” way to practice medicine.

Naturally, these kinds of disagreements among doctors aren't limited to questions of equipment; indeed, they extend to every conceivable realm of medicine. To check a patient’s peripheral vision, should I hold up numbers, wiggle my fingers, or both? When giving a verbal report on a patient, should I mention all of the lab test results, or only the ones that were abnormal? When placing an IV line, should I hold the needle by the wings, or grab on to the needle directly? Ask different physicians, get different answers.

When you’re completely new to medicine and you don’t have any experience to draw upon, these kinds of uncertainties can be incredibly frustrating. After all, how are we supposed to know whether one method is better than another when we don’t have years of our own personal experience to fall back on? Most of us enter medical school thinking that it will be all about memorizing facts, but it occasionally feels more like a crash course in the ability to critically appraise (sometimes contradictory) information.

The good news is that these very same skills end up being some of the most important elements of becoming an outstanding physician. My best preceptors distinguish themselves by being adaptable to different situations and receptive to alternative ideas and possibilities. They bring this flexibility and humility to every patient encounter and teaching session, modeling how to demonstrate confidence and competence without ever assuming that their way is the only way.

So, getting back to the question at hand: Which reflex hammer should you buy? “Well, it’s actually a little complicated. Do you have some time to sit down and talk about it?”

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category. 

Nathaniel Fleming is a second-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo by Shutterstock

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