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SMS Unplugged

Medical Education, SMS Unplugged

Why does “just doing medical school” feel like it’s not enough?

Why does “just doing medical school” feel like it’s not enough?

stethoscope on book - 560

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

A friend from home came to visit me a while back. I hadn’t seen this friend in years, so we traipsed off campus, to a café I love, and nursed our lattes as we caught up on each other’s lives. She told me about her recent travels, highlights from her college years, her plans for the next several months and more. And then she turned to me and asked me what I was up to these days. I described what my typical day was like – workout, go to classes, study, repeat.

When I was done, she asked – “So… outside of med school, what else are you involved in at Stanford? Start-ups? Student organizations? Research?”

I felt a slight flush come over my cheeks and found myself saying, almost sheepishly, “I’m mostly just focusing on med school.” Just. Just med school. 

We continued our chat, but when I came home later, my thoughts wandered back to that “just” and why I felt so guilty about not having many outside commitments in medical school.

I knew part of it was the knowledge that I had never been a one-task kind of girl. In high school, there was debate, science Olympiad, Indian classical dance, and more. In college, there was Camp Kesem, a fusion dance team and research. I poured hours and hours into each and every one of these activities, but something in me shifted when I came to medical school.

That mental transition was and continues to be such a difficult one for me. I know Stanford is an incredible place – with start-ups blossoming every which way and the word “innovation” being uttered somewhere on campus every minute (probably not an exaggeration). Everyone around me seems so impressive – with multiple research publications, various awards to their name, travels abroad to assist with surgeries, and so on. Don’t get me wrong, I love this passion at Stanford, this drive to change the world – it’s why I came here, and why I hope to stay here as long as possible.

But it’s also easy to look at every other person and wonder how they’re doing it all, and more than that, wonder why graduating  not only with an MD (after all, everyone in the class gets one of those!) but also a string of additional achievements, feels like the baseline expectation for med students.

In just a few weeks, my classmates and I are going to be done with our pre-clerkship years and those of us who aren’t taking one or more research years (myself included) will directly transition to clerkships. I can’t wait to spend hours speaking with patients, working in a team to figure out diagnoses, and brainstorming treatment plans. I can’t wait to experience that excitement when I realize what aspect of medicine I want to practice for the rest of my life and feel that puzzle piece slide snugly into place inside me.

And I can’t wait for the moment when I can leave out the “just,” to see that same friend and happily say, “I’m mostly focusing on med school. And I wouldn’t change a thing.”

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by Dr.Farouk

Health Disparities, Health Policy, SMS Unplugged

Minimum wage: More than an economic principle, a driver of health

Minimum wage: More than an economic principle, a driver of health

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Gallegos minimum wage sketchI admittedly don’t understand much about the intricacies of economics. But I don’t have to in order to recognize the significance behind Wal-Mart’s decision to raise the minimum pay for its lowest paid hourly employees. In the week following the company’s announcement, plenty has been written about the impact that such a move will have on the company’s success and on local economies. It goes beyond that, however. What I see is the impact that an increase in income can have on the health of working individuals making a minimum wage.

Let’s do some quick math. Current guidelines list the poverty level at $24,250 for a household of four. Federal minimum wage is $7.25/hr. A full-time employee earning minimum wage therefore brings home $15,080. The working class individual, whose spouse stays home to care for their two children since childcare is unaffordable, incredibly falls $9,170 below the recognized poverty level.

This April, Wal-Mart will increase hourly pay to $9.00 and follow this with an increase to $10.00/hr in February 2016. Even then, a family of four with only one working parent will still fall more than $3,000 below the federal poverty level. Yet, the true hardship of poverty can’t be quantified so easily.

What can’t be measured is the stress that surrounds a working family’s paycheck – especially in matters of health. The difficult decision that my patient makes to skip work in order to bring their sick child to clinic, sacrificing a day’s pay, and – worse – their job security. Weighing feelings of worry for their ailing child against the stress of providing financially for the family. Or my patient who struggled through an upset stomach because she couldn’t afford both the medication and the food that she should be taking it with. Choosing health while enduring hunger.

A raise in minimum wage has direct impacts on health. It means the ability to deal with an unexpected expense without risking basic living standards like food, shelter, and transportation. It means having the luxury of buying fresh peaches instead of canned fruit. It means having a warm coat and shoes for winter. It means buying that prescription that’s been pending for months. It means securing the monthly bus pass to get you to work in the first place. For many, however, even the near 38 percent raise announced by Wal-Mart will not lift their families above the federal poverty line. In a situation where pennies and dimes add up, there will still be a significant deficit that will continue to make it improbable (read: impossible) to earn a way out of poverty.

Countless articles can be found online and in print about the need to increase minimum wage. Recently in the political sphere was a push for a $10.10 minimum wage under the Harkin-Miller Bill (Fair Minimum Wage Act). Unfortunately, the bill didn’t pass the Senate. While the bill may not have represented the necessary increase, it was an acknowledgement by some of the direction we need to take- and not just for economic purposes. We must recognize that reductions in financial hardship through fair wages provide a pathway for addressing health disparities and improving health outcomes.

Moises Gallegos is a fourth-year medical student. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Sketch by Moises Gallegos

Patient Care, SMS Unplugged, Technology

Why technology won’t destroy the doctor-patient relationship

Why technology won't destroy the doctor-patient relationship

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

doctor in iPadMany aspects of medicine have changed over the course of human history. Schools of thought shifted from humorism to evidence-based medicine, while the standard of care evolved from bleeding to our modern cornucopia of interventions.

Yet across centuries, the doctor-patient relationship has remained relatively constant – a physician would physically interact with the patient and then come to conclusions on how to treat him or her. However, new technologies and innovative delivery models have begun to erode this cornerstone of medical practice, raising questions about whether they are ultimately helpful or harmful.

I was first introduced to non-traditional models of medical care the summer after my freshmen year of college. I worked with a doctor who has an extensive background in telemedicine, which broadly implies the use of technology to expand access to medical care. In practice, that might mean seeing patients via videoconference, having patients take pictures of lesions, remote monitoring, or a number of other applications. Moving forward, it may even allow patients to conduct their own physical on a smartphone.

Inspired by my experience, I started to explore other ways we can reach patients without bringing them into the doctor’s office. One strategy is to use social media to engage patients. Another is to make use of retail health clinics – clinics in shopping centers or pharmacies that are equipped to handle one-off, minor medical complaints. (If you’re interested, I have written in more detail about each of these models here, here, and here).

Almost invariably, the first criticism brought against these strategies is that they’ll interfere with the doctor-patient relationship. It’s true that they can influence the dynamic between a patient and physician and should be evaluated carefully. But in my experience, critiques tend to overlook three major aspects of technology that actually improve the doctor-patient relationship.

First, new tools in health-care delivery don’t replace the physician with a technological brave new world. To the contrary, they create a doctor-patient relationship for patients who otherwise wouldn’t have a doctor at all. Many of these tools are targeted towards patients who live in underserved communities and give them an effective way to communicate with a doctor.

Take rural populations as an example. Suppose a patient has a condition that requires a specialist consult. Do you think the patient would rather: (1) take a day off from his or her job and drive three hours to a tertiary care center; or (2) remotely connect with a specialist who can clear up the problem? Most patients would likely prefer the second scenario, and may defer care if they don’t have that option.

Second, the doctor-patient relationship is especially relevant to patients who have complicated medical issues. If patients are able to handle minor complaints outside of the doctor’s office, physicians will have more time to spend with the patients who need the most help.

Finally, these approaches empower patients to take responsibility for their own health. Once again, let’s consider this in in the context of an example. One common stereotype in medicine is that of the non-compliant patient – maybe someone who has high blood pressure, high cholesterol, etc., but doesn’t take his or her medication, make diet modifications, or exercise. At present, a doctor might require this patient to come in for a check-up every few months. And yet nothing changes.

But if the doctor gives that same patient the tools to monitor their health on a day-to-day basis, the patient may take on a greater sense of ownership for their well-being and start making some changes. As medical students, we regularly hear that we’re in an era of patient-centered care. Technological tools that give patients more health information don’t hurt the doctor-patient relationship; they serve as another means to connect us.

Medicine is a constantly evolving field. New strategies have the potential to change the way we practice. But it’s worth remembering that a different doctor-patient relationship can be a better doctor-patient relationship.

Akhilesh Pathipati is a second-year medical student at Stanford. He is interested in issues in health-care delivery.

Photo by NEC Corporation of America

Pain, Patient Care, SMS Unplugged

Comfort care: “We always have something to give”

Comfort care: "We always have something to give"

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

15952622460_20fb32e76a_z A hospital can be full of discomfort. My patients tell me that the food is unappetizing. The beds hurt their backs. The noise echoing through the hallways at night makes it impossible to sleep. And for those patients near the end of life, the treatments being offered may no longer be of benefit, causing more pain than good.

The answer to discomfort for those who are very ill is comfort care, the use of palliation when life-advancing measures are no longer indicated or desired. These measures include things like giving morphine to dull the pain and ease the breath, applying lip balm over cracked skin, offering ice chips to revive the mouth, adjusting blankets or fans, deciding not to press on someone’s chest, to stifle their airways with tubes, if their status declines. The decision to turn to comfort care often means that a patient can receive a private room in the hospital for family to stay close, to feel sunlight through a window. The triumph of comfort over the many indignities of being away from home.

Death does not need to happen in a hospital, yet too often it happens here. In January, I saw two people die. One was old. He had lived a full life; his room was decorated with photographs from his youth, his tall form in a service uniform, or in a tuxedo on his wedding night, half-cropped face suspended in a laugh.

When I met him, he was on a morphine drip, no longer able to speak. To gauge the adequacy of his pain control, we looked at his heart rate, his blood pressure, scouring for signs of bodily agony. He was tucked into a warming blanket, yellow hospital socks on his feet. Every morning we circled around him, whispering hello into the room where he slept, taking stock of the fluorescent etches of the vital signs monitor, the coolness of his legs.

When he passed, we pronounced him after checking for a pulse and listening for a heartbeat. I felt solemn, but also grateful for his smooth passage.

The second person I saw die was young. She had been full of life and her death ripped up all those who loved her. As she became more ill, and more confused, her family made the brave decision to transition to comfort care. There was nothing gratifying about it, her loss was unspeakable. But perhaps the final moments, free from the blinking of machines, the infusion of drugs that upset her bowels and irritated her veins, carried a dim current of peace.

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Health Policy, Medical Education, Patient Care, SMS Unplugged

The downside of a free lunch: Incentives and the medical student

The downside of a free lunch: Incentives and the medical student

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

money on hook  smallDoctors are people, too, and they respond to incentives. That was the message we got from a recent health-policy class session that discussed various ways of paying doctors for their work, and how this can play a role in patient care. In an ideal world, physicians would be motivated only by what is best for their patients; however, the reality is that doctors, like all people, can be influenced by external factors such as money, autonomy, and time.

This got me thinking about the incentives that currently shape my life as a medical student. While we would all like to say that the choices we make are determined only by our own internal desire to maximize our learning and become the best future physicians possible, even the most idealistic student among us would have to admit that incentives, big and small, influence our decisions every single day.

On a day-to-day basis, incentives determine how we budget our time and focus our efforts. For example, given the huge demands on our time and our budgets, the promise of a free lunch provides a strong incentive for us to attend lunchtime seminars and panel discussions – even if the subject matter is not of immediate interest or relevance to us.

In class, because of the Pass/Fail grading system during our pre-clinical years, our external incentives are not our class grades, but instead the standardized board exam that will play an important role in our residency applications. Our collective ears perk up every time our professors say “This always shows up on the boards,” even if we are told that the particular information is rarely (if ever) applied in real-world clinical practice.

In the bigger picture, as we begin to explore various specialties and avenues for practicing medicine, it is impossible to ignore the reality that average salary, lifestyle, and autonomy vary hugely from one specialty to the next, and from one type of practice to another. Not feeling very passionate about private-practice urology? Does that change when you find out that urologists make about twice the annual salary of a family medicine doctor?

The reality is that our intrinsic motivations to make the world a better place by becoming the best possible physicians do not always align with the incentives that medical school, and the larger health-care system, provide. We are incentivized to spend time and effort on things that will not help us be better doctors, and in the long run we might even be incentivized to make decisions that will reduce the amount of good we can bring to the world. Is it the job of policymakers and medical educators to better align incentives to create the desired outcomes for our health-care system? Or do we, as future physicians, need to shoulder more responsibility to do the right thing, passing up the literal and figurative “free lunch” in the process?

Maybe there is an ideal middle ground for each of us – a place where the incentives align at least reasonably well with our own internal goals. In that case, one of our tasks as medical students for the next several years will be to find it.

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

Photo by Tax Credits

Infectious Disease, SMS Unplugged

The bacteria that nearly killed my grandmother

The bacteria that nearly killed my grandmother

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Staphylococcus aureauMagnification 20,000“Hefur þú lært um Staphylococcus aureus?” I almost don’t recognize the bacteria name because my grandmother pronounces it differently in Icelandic.

“Já–” I’m about to translate my microbiology flashcard for her when she interrupts, her hands busy kneading the cookie dough and her eyes on my little sister near the oven.

That’s the bacteria that almost killed her eleven years ago, she tells me. I can hear her words building up. This is a story that has been waiting to be told often enough to be reconciled.

They did not know what was wrong with her. They thought maybe cancer, maybe tuberculosis – and I almost interrupt her story to tell her about Pott disease. That’s when tuberculosis from the lungs goes through the blood to the vertebrae and causes back pain, fever, night sweats and weight loss. I memorized the flashcard a few weeks ago.

My little sister stops doing handstands in the middle of the kitchen and comes to stand next to my chair. Together we watch Grandma roll the cookie dough as she continues talking.

It took the doctors a whole long time to figure out what was wrong with her. In the meantime, she was in so much pain from her back that she had to be on high doses of morphine. Codeine.

She could hear them yelling at each other in the next room, my great uncle and the other doctor. The two internists had very different approaches. My great uncle wanted to identify what was going on before putting her up for surgery. The other doctor yelled at him that he was going to wait so long the woman would die.

My grandma stops her cookie cutting and sits across from me. She looks at me for a moment over her glasses and tells me how terrifying it is to know that your doctors don’t know what’s wrong with you.

My poor great uncle, I tell her – he was just trying to make sure that they didn’t make you worse by operating.

My grandma nods and describes how when they finally did agree to have her undergo surgery, my great uncle called the best surgeon in town and had him come back early from vacation to operate on her the next day. And good thing too, for when they did, they found that three of her vertebrae had been turned to dust.

With an infection like that, the surgeon said she was hours away from death.

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SMS Unplugged

Six thousand words to describe my decidedly non-medical winter break

Six thousand words to describe my decidedly non-medical winter break

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

This past winter break was all about me NOT being a medical student. For three blissful weeks, I didn’t have a copy of First Aid for the USMLE Step 1 anywhere near me, I didn’t log on to Coursework (Stanford’s online course system), and I barely checked my email. This is a snapshot, worth 6,000 words, of what happened instead.

Top left: I met up with a friend from high school and we baked bread from scratch! I’m not much of a baker, so the fact that this bread ended up being edible is a huge accomplishment. My younger brother ate pretty much half the loaf all by himself, which could only be a good sign.

Top middle: New Year’s Eve was spent playing a cutthroat game of Pictionary. Sadly, my team lost. But on the plus side, the game helped me stay up past my 10 PM bedtime to ring in the New Year!

Top right: Under my mom’s guidance, I managed to FINALLY learn how to make my own lattes – not that that has prevented me from spending $3 a day on coffee from the med café…

Bottom left: This picture, taken in front of Universal Studios in LA, will very likely be my only red carpet moment for a while.

Bottom middle: I got to spend an entire day with these two adorable twins. They’re entranced by a show called Peppa Pig. If you haven’t seen this show, I highly recommend you check it out on YouTube!

Bottom right: During my time in the LA area, I went with friends to not only Universal but also Downtown Disney, where we stopped by the LEGO store and created this masterpiece – and left it there for the next person to find and wonder who the heck I am.

Thus passed my winter break. And now, back to the grind – just 9 weeks till my classmates and I are done with our pre-clerkship years!

(Side note: I was struggling for a blog idea, when I remembered this entry, written by a fellow MIT alum – Elizabeth C. – back when we were both blogging for MIT admissions. All credit for this entry idea goes to her!)

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photos by Hamsika Chandrasekar

Health and Fitness, Patient Care, SMS Unplugged, Technology

“Nudges” in health: Lessons from a fitness tracker on how to motivate patients

“Nudges” in health: Lessons from a fitness tracker on how to motivate patients

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

fitness trackerIt was 11:47 PM. That meant that I had 13 minutes to reach my pre-set goal of  “activity” that the fitness tracker on my wrist had been registering throughout the day. If I met the goal I would get a “trophy” on the accompanying app. I probably looked pretty funny bouncing around my living room doing a squat here and a sit-up there, punching a pretend opponent, and running in place. But I made it minutes before midnight. If I hadn’t – well, then I would have just blamed the piece of technology on my arm for not working.

The tracker was a gift from my cousin Steve. Steve is impressively fit; he runs marathons, tackles obstacle courses, and races road bikes. A few years back at Christmas dinner, Steve challenged me to a pull-up contest – I was super hyped and ready for it until, well, I lost. Every holiday season since then, I’ve spent the weeks prior to heading home logging extra push-ups, pull-ups, and bicep curls just in case a re-match comes up. Without knowing it, Steve inspired me to get active. Now, with blinking lights and status reminders, the fitness tracker he gave me does so more frequently, more annoyingly, but in a way, more enjoyably and effectively.

The fitness band on my wrist doesn’t tell me to go to the gym or go for a run. The periodic updates on how far I am from my pre-set goal, however, “nudge” me to get up during a commercial and do a set of push-ups, to get out for a walk, or to take the stairs. I’ve even turned to running in place or a set of body squats whenever I find myself yawning to make sure I get enough points.

In the past, I’ve been good about working out, even doing stretches of two-a-day gym trips. But this doesn’t last very long as I use the busy “medical school” schedule as an excuse. After getting the fitness tracker, it’s been a string of random, spontaneous, and unstructured “work outs” throughout the day. While I may not have achieved Mr. America status, I’ve felt good about meeting my daily goal and racking up “trophies.” It’s even become a bit of a game to see how high I can actually make my numbers go. I’m competing against myself. This may sound weird, but at least I know my opponent and understand what I’m up against, right?

Wearing the fitness band reminded me of the concept of nudges. Nudges, as discussed by Richard Thaler, PhD, and Cass Sunstein, JD, describe how a person can be steered toward making a particular decision without hard instruction. An individual encounters small pushes towards doing something that is desired of them, unaware that they’re being led in that direction. Commercial companies have mastered this in form of advertising, making us feel as if we “need” their product. This fitness band has me thinking that I’m playing a game; the soreness in my legs and looser fitting clothes would indicate that I’m working out.

My experience with the fitness tracker has reminded me of the importance in framing conversations with patients. We often resort to telling patients, “You should work out and eat healthy – if you don’t you’ll get this or that disease.” It’s easy to frame things in the negative and use scare tactics. But rather than give constant reminders of what they aren’t doing, conversations with patients should contain nudges of encouragement. Nudges such as aligning goals with patient priorities, setting check-in time-points, and incorporating social networks for accountability. If we could do for chronic-disease management what the fitness band tries to do for working out, our patients might have an easier time.

Moises Gallegos is a fourth-year medical student. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Photo by Vernon Chan

Health Policy, SMS Unplugged

A student’s reflections on the American Medical Association

A student's reflections on the American Medical Association

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

AMA picLast month, I had the opportunity to attend the American Medical Association’s interim meeting in Dallas, one of two annual conferences held by the organization. I went to the meeting to present at a research symposium, but I stuck around for a few extra days because I was curious about the inner workings of organized medicine. As someone interested in health-care systems and the delivery of medical care, I was aware of the AMA but wanted to learn more about its purpose and process. (Plus, I had heard they throw great conferences. They didn’t disappoint – among other things, I got to practice my lassoing skills).

To provide some background, the AMA is the oldest and largest physician organization in the United States and has historically played an important role in the development of American health-care policy. While membership has ticked upwards in recent years, the AMA has been struggling with a decades-long trend of declining involvement and fading physician interest.

There are a number of possible reasons for this decline. Some commentators cite an overarching shift in social norms, arguing that people today are simply less likely to join groups. Others attribute it to the changing needs of physicians. Physicians are now more likely to work for a hospital system rather than opening a private practice. Given that the AMA’s advocacy has traditionally focused on the interests of independent doctors, employed physicians may feel disengaged. Finally, the proliferation of local, state, and other national physician organizations have likely drawn members away from the AMA.

Such issues have brought up questions about the sustained relevance of the AMA. Going into the conference, I’ll admit I was somewhat skeptical about its continued impact. However, I came away feeling like participation in the AMA is highly worthwhile.

With reform underway and a health-care system in flux, it’s more important than ever for health-care providers to understand how policy approaches influence patient care. The AMA offers a forum that serves two major roles. First, it gives medical students and doctors a way to learn about issues in health care. Topics like payment reform, the implementation of new health-care technology, and organ-transplant restrictions don’t come up in medical school in any significant way, but they have a huge impact on what we can do for patients. Every medical specialty has its share of conferences to make sure providers stay up to date on the latest developments in that field. The AMA helps people stay informed about the big-picture issues.

Second, conferences like the one I attended allow students and doctors to not only learn, but also to develop and exchange their own ideas on how to address issues in health care. The policy sessions at the conference often featured lively debates. While some physicians feel like the AMA doesn’t represent their views (it certainly didn’t represent some of mine), the best way to change that is to participate in these debates rather than disengaging. The AMA remains the single most important physician voice in policy discussions. If individuals don’t contribute to that voice, policymakers will no longer take the physician perspective into account when making decisions on health care.

The AMA is by no means a perfect organization. Like any political group, it comes with quite a bit of bureaucracy and the self-importance was occasionally irritating. Regardless, it serves as one of the best ways for medical students and physicians to become aware of the issues that affect our profession, and come up with solutions.

Akhilesh Pathipati is a second-year medical student at Stanford. He is interested in issues in health-care delivery.

Photo courtesy of Akhilesh Pathipati

Medical Education, SMS Unplugged

When the white coat comes off: Is “medical student” a full-time profession?

When the white coat comes off: Is “medical student” a full-time profession?

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

P1000878In our transition to medical school as first-year medical students, one significant part of our learning has been adopting the dress of the medical profession. Twice a week, in our first year Practice of Medicine course, we wear professional attire and don our white coats, the famous symbol of the medical profession. As we learn how to interview and interact with patients, the white coats encourage us to fully embrace our new professional roles as physicians in training.

At first, the strong symbolism of the white coat made me highly aware of the different roles and personas that we occupy as medical students. If the white coat symbolized my role as a professional, wearing a T-shirt and shorts to my developmental biology class symbolized something decidedly more student-like. In many ways, being able to take off the white coat and hang it up for the day was a convenient way to demarcate our different selves: our professional persona on the one hand, and our “normal” (and more familiar) role as students on the other.

Over time, however, I began to feel a shift in terms of what that my “normal” self was. As I spent more and more time practicing clinical skills that involved helping people to feel comfortable, respected, and cared for, it felt only natural to adopt these qualities in my daily life. After all, after devoting a great deal of effort doing the little things to help make the lives of our patients better, did it really make sense to stop putting in the same effort when interacting with the rest of the world, just because the white coat and badge came off? Is our role as physicians only to help the patients who are sitting in front of us, or should we be thinking about our impact on the well-being of everybody we interact with, from our faculty and staff to the person answering the customer service complaint line?

In some ways, this idea of adopting the professional persona full-time is a scary one. Work-life balance is one of the most discussed concerns among medical students, and many (if not all) of us have fears of our work dominating our lives and keeping us from important things in our lives such as family and friends. Because of this, I have a feeling that the separation that the symbolic white coat offers will become more and more important for us as our careers progress and we become more immersed in our work lives.

That being said, I also acknowledge that, as medical students, the professional persona can help us to consider our daily impact on the world around us, which just might influence the health and happiness of a few extra people each day. For now, then, I’m willing to admit that perhaps there is a little more value to taking our professional mindset home with us than I first realized.

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

Photo courtesy of Nathaniel Fleming

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