“Conceptual knowledge is not enough… you must have the conviction that comes from personal experience.” – quote from The Joy of Living, Yongey Mingyur Rinpoche
You learn medicine during the first year of PA school from a didactic approach: System after system, disease state after disease state, diagnostic tools, medical therapies, interventions, complications… so many words and pictures. Most of your time is spent in the classroom. In real life, medicine is not linear and in most instances, a disease of one system barges its way onto another system, often unwelcomed of course.
Last week was my first week of inpatient medicine at OHSU and I was overwhelmed. I felt like I had just learned basic Spanish and was thrown into the crowded streets of Spain, forced to find my way. I had learned most of the medicine during the first year and now I was being forced to apply what I learned in real life with a real patient who had real medical problems! Many of the patients are very ill and are “complicated.” I had a patient who had liver disease and chronic kidney disease, with hypertension and persisting tachycardia at risk for an infection.
At first, I felt ill… I was nervous to make assessments and plans and interpret data on things I had never seen before until now. It is tough to see the comprehensive effects of these illnesses when you focus so much on the details and when you learn disease generally by organ system. But that is what makes experience valuable because in time, it allows you to see patterns and algorithms.
This past week I realized I forgot that I’m a student. I’m here to learn and I’m here to take what I learned in first year and appreciate those things with a patient. Plus, I realized I am part of a medical team, where the attending and residents are much more knowledgeable and ultimately make the decisions regarding the patient. After this realization, I felt liberated: I have the freedom to look things up and share my assessment and plan in a safe teaching environment where I won’t be harming the patient. I can hone my skills as a future clinician under the guidance of a team.
The medical students have been so helpful on this rotation and my resident and attending encourage us to talk to the patient’s family, primary care provider, consult with specialties and order tests. I feel valuable to my team and in ways I do feel like I have some positive impact on a person’s life. Inpatient medicine is hard work and I’m glad for it. I didn’t choose medicine because I thought it was going to be easy. I chose it because I know the hard work will be rewarding.