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The last thing to do before graduating medical school

There is an exhibit currently on display at the San Francisco Museum of Modern Art titled “Standardized Patient” by Kerry Tribe. It’s a seventeen-minute, cringe-inducing vignette that films a group of first-year medical students and their encounters with patients, who are actually paid actors.

It’s their first time interviewing any patient, real or fake, and their inexperience is on full display. They grasp for the right words to say. "Um"s and "hm"s pockmark the flow of conversation. They desperately reach into their memories to scrape for any bit of medical tidbit that might have lingered from watching "Grey's Anatomy" or from reading the back of a pillbox.

The patients are kind enough to play along, but it is a surreal exercise to witness — both sides are pretending to be someone they aren't and are wholly aware of the artificiality of the situation. Yet somehow, the students immerse themselves, ignoring the multiple cameras staring down at them from the ceiling or the booming voice from the loudspeakers reminding them that this contrived scene will soon come to an incisive end.

The students can't offer anything of medical substance so they instead compensate by doing only what they know how but is a rarity these days: to simply be a decent human being. Their voices turn soft. They offer words of reassurance. They take the time to ask about the personal lives of their patients and soothe their worries and fears. They touch their patients out of comfort, not for inspection.

The patients’ complaints about their coughs may be concocted, but the concerns of the students are genuine. And though sympathy and the warmth of a fellow human’s touch require no extra training or special degree, these qualities are no less valuable than a prescription.

But as I've observed over the years, this part of us slowly erodes away by the grind of training. Sure, we become incrementally more versed in medicine but we also grow proportionately more distant. We have a competing agenda now — to solve the diagnostic puzzle at hand as quickly as we can and move onto the next one. We walk into the exam rooms with the swagger of someone who knows just enough to think we know it all but not enough to realize how little we actually know.

I became painfully aware of this change towards the end of my third year when a new patient came in with a cough. In the eyes of this new version of myself, a cough is merely that: a minor inconvenience that will likely self-resolve in a few days like the countless other patients who also came in with coughs. Why even bother coming to the clinic in the first place?

And so, my gestures were coarser. My gaze a little more distracted. The cadence of my speech a bit more rushed. Reassurance and patience were secondary to efficiency. Whatever gains we made in medical knowledge seem to have been neutralized by our loss in human compassion. Blame it on burn out or a busy clinic schedule or even the arrogance of knowledge. But there is no excuse for this ugly transformation.

The final year of medical school will be a grueling list of tasks: the few remaining clinical rotations, board exams, applications, residency interviews. But I implore all of us who are edging closer to the precipice of becoming a doctor to watch our first patient encounters no matter how awkward or uncomfortable.

And when we invariably find ourselves cringing at their younger selves and turning our heads away from the screen, take heed of who we once were and humility in whom we have become. And for the sake of those we will care for, remember that above all we were taught that underneath each white coat or a pair of scrubs is a decent human being.

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

Steven Zhang is a fourth-year medical student at Stanford. When he’s not cramming for his next exam, you can find him on a run around campus or exploring a new hiking trail. 

Photo by Cparks

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