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The little things: Scope@10,000

Looking back on her medical training, Jessica Gold realizes it was the little things - like watching a resident console a scared patient - that mattered.

It is almost funny, the things that stick out from medical training, when I start to reminisce. Of course, there are the big things, like moving on to clinical rotations for the first time, graduations and the Second Year Show (a Yale School of Medicine tradition, when students lovingly poke fun of the faculty). There are the not-so-great things, like the hierarchy, sexism, burnout and inherent challenges of medical training. There are the people, particularly the friends that helped me out of my loneliness and the mentors who guided me in way more than medicine. 

But, there are also the more subtle things.

The patient who first called me "doctor"; the nurse who saw me crying and came over to see if I was doing alright; the attending physician who bought me a cup of coffee. Those moments pass quickly in a sea of consults and pages, before you have a chance to appreciate them. Yet, looking back on it now, it really was the little things that made all the difference in my training. 

My third year of medical school, I had never seen a patient receive bad news before.

I was on my medicine rotation and knew what my patient's tests meant: cancer. As I looked at the images, I began desperately searching for the words I was taught to "correctly" deliver bad news. I knew there was an acronym to guide the conversation, but I could not remember what the letters meant. I went over and over it in my head thinking somehow the script would save me. If we told her "the right way," maybe it would hurt less. I had no concept of what that really meant or how the acronym worked in actual conversation.

I walked into the room with the resident and he began to speak. As if the patient already knew what he was going to say, she began to cry.

In that moment, the resident stopped talking and looked around the room. In a corner far from her bed, he found a box of tissues. He handed one tissue to her and put the box within her reach. I watched in awe as her breathing, which was once heavy and tense, relaxed. It was as if he said, "I see your pain and I am here for you," simply by getting her a tissue. It was much better than any acronym I could have spouted out.  

In education, the phrase "hidden curriculum" is so often thrown around that we forget what it really means. In medicine, it describes the concept that on the wards, students learn from example. Often the term carries a negative connotation -- as students pick up on power dynamics, pressure to conform to a certain "doctor mold" and doctors' lack of empathy.

Yet, students can also learn the good, as well as the bad. Those moments can truly shape who you become as a physician. I know this because, they did for me. 

Before that resident showed me, I had never thought about what a simple gesture could mean for a patient. Caught up in the words I was taught and the boundaries that were modeled, I was stuck in the minutiae. Always just trying to "fix" things. I forgot to be human first.  

From that moment forward, I made it second nature to have tissues accessible and always modeled similar behavior as a resident to medical students. I went out of my way in educational sessions to model this when patients started to cry.

And I became so interested in understanding my patients' feelings, that I even became a psychiatrist. Perhaps I have my resident to thank for that.

Jessica Gold, MD, is an assistant professor in psychiatry at Washington University in St. Louis. A former psychiatry resident at Stanford, she is a corresponding member of the Pegasus Physician Writers.  You can find her at @drjessigold on twitter or at drjessigold.com, where you can find some of her pieces for Self, In Style and Glamour.

This piece is part of Scope@10,000, a series of original narrative essays from writers, physicians and thinkers in honor of Stanford Medicine's Scope blog publishing 10,000 posts.

Photo by Julian Paolo Dayag

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