Thoughts and insights from medical students
Smart Doctor, Good Doctor & Iatrogenesis
It’s quite a common practice to observe some competition amongst medical students and even doctors. This competition can be a healthy – if everybody benefits from it in the sense that knowledge is shared. At the end of this one gets to graduate with excellent grades (smart doctor) and then enters the real world. The good thing is that, we can assume that the better your grades are, the more knowledgeable you are and hence you’d be a better doctor.
In the real world however, the patients are not interested in the grades that doctors obtained in med school, and the hardly ask. He comes in with his problem and depending on how it was solved, he leaves with an impression of his doctor- good, normal or bad (or any other scores in-between).
We can see here that we have different expectations in med school and in the real world, although at the end of it all, it the patient has to be our priority. At the end of it, it should be the patients who can grade us better. Our score sheet (success-failure rate), awards, bank accounts, etc. are indicators, but every single patient’s evaluation of a doctor is very important.
Here, my point of view as a medical student is mixed with my point of view as a patient, that of my friends and family and the patients I’ve seen a student.
Many a times, a patient is given a summary of his condition in a language he speaks by his attending physician. He can probably repeat the same words he was told if asked to. If you went further to ask him to explain what those words mean, you’d be surprised at their response. I did this little exercise during my first clinical year. Obviously he’s not a doctor so it’s ok for him not to understand the pathophysiology etc. of him disease. But one of the most important things we expect from our patients is the COOPERATION. How can I cooperate if I don’t understand what you, my doctor, are talking about? Many patients were unable to ask for clarification because they didn’t want to be thought of as dumb or tagged as “know-it-all”. So the poor thing goes home with very little knowledge about why he had just being to the hospital. There goes a smart doctor adding another victory to his score sheet yet on the patients grading sheet, he’s just a doctor.
I also found out that many patients who cooperate with their doctors do so for fear of one thing or the other, usually death. On my rotation in internal medicine, I got to know, for instance, that some diabetics didn’t eat sugar because they thought they would just die instantly if they ate a teaspoon full of sugar. Some hypertensive patients behaved the same with table salt. Yet still, other hypertensive patients stop taking their medication because “they don’t feel ill!” In a good proportion of all these patients, they do what they do because they don’t know, because they weren’t spoken to in their language by their doctors.
In my next rotation, I’ll keep record of this experiment and then we’ll get a better picture of what our patients know about their conditions, sometime after they have been told about it. If you can, please do the same.