There were a lot of things that I didn’t understand when I first went to medical school. One of the things that’s become increasingly evident over the past two years is just how many people are involved in the care of a single patient. Healthcare, as it turns out, is a team game. Just to give a quick example of this, here’s some of what it takes to care for a single patient in the hospital:
1-3+ nurses who oversee their direct day-to-day care. This changes depending on the day of the week, time of day, and who is on what shift. If something big is needed, other nurses from that same floor help out.
A patient care technician, who assists the nurses and (I believe) helps with cleaning and other duties.
Janitors who clean the room.
A respiratory therapist if they are having immediate breathing difficulties or recovering from a disease that makes it hard to breathe.
A social worker who helps out with the financial burden of medical care (in our super-awesome bankruptcy causing system of healthcare in this country).
A physical therapist who helps with rehabilitating and strengthening their muscles.
Down the road, an occupational therapist that will help them back to their daily living activities.
A chaplain who helps with spiritual and emotional support.
An attending physician or team of physicians managing them and their illness.
A fellow or resident(s) who learn from the attending physicians and take care of the patient while the attending is away.
An intern (the first year after graduating medical school) learning the ropes and helping with patient care.
A 4th year medical student, who has a little bit of an experience.
And finally, a 3rd year medical student who has no idea what they’re doing (that’s me, folks).
That, my friends, is a lot of people, and is far from the whole spectrum of the people involved in patient care (others are charge nurses, administrators, ultrasound or radiology technicians, etc.). Providing excellent patient care is a massive effort from all these people, and it has to be coordinated: moving as a single unit efficiently, directly, and correctly. It’s like running: the arms, legs, lungs, heart, abdominal muscles, eyes, ears, and every single part of the body must be focused on putting one foot in front of the other. If a single part is out of sync, like a foot that is not flexing early enough, it makes running incredibly difficult.
My education, as a MD student, is learning to be the leader, the thinker, the guidance of the healthcare team. My incredibly long educational process is designed to mold me for that crucial role. There is a reason why we spend 4 years of undergrad, 4 years of medical school, 3-7+ years of residency and maybe 1-3 years of fellowship in training: the role of a physician is a difficult one, so we must be extensively prepared. If there’s one thing that I’ve learned as far as what makes a good leader, it’s this: you must know the people you are leading. Being acutely aware of what makes them tick, where they come from, how they think, and understanding their role is critical in creating and managing a cohesive unit.
In order to work with other physicians, nurse practitioners, physician assistants, nurses, occupational therapists, physical therapists, social workers, respiratory therapists, patient care technicians, and the many other members of the healthcare team, I have to understand what their job is, and more importantly, the background and training they bring into that role. During medical school, I’m doing my best to figure out how everyone in healthcare is trained and the experience they bring in order to really, truly understand them.
Just to paint this picture for you and give a better understanding of my role, here is my perception of medical student education: we are trained to understand the human body from the very smallest level (i.e. small molecules and cells) to the very largest (organ systems and the entire body working together). In that way, we strive to fully and deeply understand the human body, so we can develop a global understanding of each and every process. Our education is not necessarily 100% rooted in pure practicality. We learn the biochemical processes behind every process in the body, at a level of detail that is not always immediately applicable to what is going on with that patient. This is the source of some frustration among medical students, and I think that’s partially because we fail to see the big picture. I’ve been among that unhappy group many times. We get frustrated as to why we are learning and memorizing the particular chromosome a genetic defect is on, or the metabolic intermediates in the pathways of generating energy from sugar, or the exact signals that cause platelets to aggregate and form a plug to stop bleeding.
These are the small steps, the things that other members of the healthcare team don’t necessarily learn. I can say with almost 99.9% certainty that nursing students didn’t have to memorize the coagulation cascade or how the GPIB receptor, von Willebrand factor, GPIIB/IIIA receptor, ADP, TXA2, and fibrinogen work together form a platelet plug. To be clear, this isn’t me disparaging nursing students or nurses in any way, it is simply being aware of the differences in our education and how we think. Does knowing all of these things make a gigantic difference in how we care for a patient who has a myocardial infarction (heart attack)? Not in the slightest. Does it contribute to the overall understanding of the process going on in this patient and how to think globally about the problem? Absolutely.
That’s where I fit into healthcare: I am the seeker of “why?” with the knowledge of “how?”. Throughout these years (and the rest of my life, really), I am going to seek to work with and understand how other healthcare professionals understand our own little world. For our first two years of school, my class was paired with nursing students during their 3rd and 4th years. My nursing student (now practicing nurse, shout-out to her!) was absolutely amazing, and instrumental in opening me up to how to understand other members of my future team. We had many a conversation on different medical topics and how we each understood them, and it was eye-opening. I vividly remember our conversation on how bisphosphonates work, which are drugs that are used in osteoporosis to prevent bones from becoming weaker. We could see where her knowledge ended and mine continued, how I, as a medical student, went all the way to that cellular level.
To bring in a funny story about practicality of my education, my roommate (another medical student) has a girlfriend who was a nursing student at our institution and is now a practicing nurse. When she was in her 3rd/4th year of nursing school and first started working with the medical students, she talked about how clueless they were as to very practical things about healthcare. She kind of made fun of them for being clueless about such a thing as taking blood pressure and wondered what they were even learning (Disclaimer: She is awesome and wasn’t being malicious here, I would have done the same thing in her shoes. 1st years are indeed clueless). At the time, I was accepted into medical school, and this actually scared me into being afraid of nursing students making fun of me for knowing nothing. And it’s true, our first two years (especially the first year) delve so deep into things that aren’t immediately practical, but build an essential knowledge base upon which we can exponentially learn. We can tie down concepts to this vast, solid base, which allows us to learn and absorb vast amounts of information. And as I became a 1st year medical student, I felt so stupid around the nursing students. We knew nothing. However, by the end of my second year, the strides I made were massive. It was a slow start, but accelerated rapidly.
On to the story that inspired me to write this post. Last night, I was with one of my good friends who I was a resident assistant with back in college. His fiancée (fun fact, the female form of that is fiancée, a man is a fiancé) is an occupational therapy (OT) student and his brother is a physician assistant (PA) student. While I spent some time talking with his brother about his education and how it worked, I want to focus on the OT side of things. There were 2 other OT students there besides his fiancée. I’m going to be frank: I didn’t really know what occupational therapy was before last night. So, I thought I’d ask. This was my opportunity to really understand what it was and how they could be helpful with my future patients. And yes, I’m a nerd, because this was happening at midnight on a Saturday night. Wild and crazy, my life is.
After asking, “So…what exactly is OT?”, one of the OT students there asked what field I was from and why I was asking. I replied that I am a freshly minted (with 1 day under my belt, wooo!) third year medical student. To that, she rolled her eyes and replied, “Oh, I had hoped you wouldn’t say that. How do you not know?” My knee-jerk reaction, at least internally, wasn’t pretty. Who the hell was she to expect me to know something that I literally, until that moment, hadn’t cared about? The past 2 years of my life were spent memorizing the types of leukemia, how they develop, and their cell lineage, the symptoms of multiple myeloma, the various ion transporters in the kidney, and the list goes on and on. Medical students live under a rock for two years, digesting massive amounts of information, and emerge after STEP1 to the new world of clinical medicine. But, after that brief flare of anger, I realized that she really didn’t understand what my education was like, and why exactly I wouldn’t know what OT was. I had 1 day of being in the hospitals to my name, I have a massive amount to learn. I explained how my education worked, what I was learning the past two years, and how we don’t necessarily interact with or get a big sense of other medical professionals in our first two years (besides nursing, in my case). ]
This brief misunderstanding between us passed, and we had a 30 minute discussion between the four of us about what exactly occupational therapy is. The long story short is that they are involved in helping patients accomplish tasks of daily living and help alleviate daily problems caused by a disease. For example, they help someone with posture and standing after a hip replacement, or helping a patient use their new wheelchair, or helping them with hand strength so they can type again at their job. It was a very valuable discussion and a way in which I could build on my understanding of my team. It opened the door to learning about when and how to utilize OT in caring for my patients when I’m a practicing physician. We don’t get that kind of direct training in medical school (at least initially) about OT’s or PT’s or any other medical professionals.
So please, other healthcare professionals and students, be gentle on us as medical students and even on practicing physicians. When we ask questions, inform us, guide us, let us know what you can do for us and what we can do for you; more importantly, let us know what you can do for our patients. Some of us might not even be fully aware of your capabilities, so take the initiative to let us know. We love to learn and want to learn. I want to know my team, I want to know you. Even if you don’t directly work with a particular person, as these OT students will likely never work directly with me because it’s a big world, talk to them and inform them anyway.
I hope that this has helped illustrate how I, as a future physician, see the world of medicine and the things that I bring to the table. And if you’re another healthcare professional, I hope this has helped you understand us a little better. We’re all on the same team in this crazy world. I want to lead effectively and passionately, to inspire those that I work with, to understand them, to know them. I want to teach them but also learn from them, be decisive and strong but also humble. And above all, I want to give the best care to those that put their trust and lives in our hands.
Sorry for any earlier spelling and grammar mistakes, I finally went back and proofread this.