I love showing med students the ropes

A review of the satisfactions—and occasional frustrations—of providing on-the-job training in his office.

Why should physicians at a busy family practice teach medical students? Isn't medical school the place for aspiring doctors to learn medicine? Well, think about it. Where did you learn the most about practicing medicine?

The classroom is important, of course, but it also has limitations. Specialists who write textbooks and present lectures don't always see how illnesses present in beginning stages. The subtle early signs of depression, heart disease, and other serious illnesses that we see as primary care doctors may mimic nonurgent conditions. The sifting of the significant from the routine is a skill that's best developed during the typical multi-patient day at the office.

The rewards for taking students under your wing aren't financial, but they're real nonetheless. Students bring the enthusiasm of youth, a different perspective, and freshly learned facts that keep you on your toes. And we can make a difference not only in their lives but in the future of our profession, by helping them see nonacademic aspects of medicine, like:

We treat people, not just patients. During a routine physical, Sarah noticed that a patient's thyroid was enlarged. Tests showed that the woman had a benign goiter, but her thyroid was overactive and required treatment. We scheduled appointments with an endocrinologist, a surgeon, and a radiologist, each of whom would discuss a treatment option: medication, surgery, or radioactive iodine.

Sarah accompanied the woman to each of these appointments. Doing so helped sharpen her appreciation of the human—rather than the academic—aspects of illness.

There's always more to the story. Elena learned something new about her patient the old-fashioned way: by making a house call. She visited Charlotte, an elderly widow who, during her office visits, always seemed cheerful and relaxed. Elena's report revealed a very different Charlotte—a woman who spent hours alone in her apartment, waiting in vain for her children to call and pining over times gone by. The report now serves as a reminder that we sometimes know little of what our patients' lives are really like.

We don't practice in a vacuum. Some students make us wonder why we bother with our teaching program. Carter was such a student. An aspiring surgeon, he did nothing to hide the fact that he thought the four weeks he was forced to spend with our practice were irrelevant to his future plans.

"You want to be a surgeon," I said one day.

He nodded.

"And you think this has nothing to do with that?"

"Well, yes."

"And where to you think your patients are going to come from? Shouldn't you learn something about how referrals are generated?"

With that, I detected a flicker of interest that—perhaps this is wishful thinking on my part—continued to percolate for the rest of Carter's time at our practice.

Showing that you care is critical. That's something we tried to teach Ivor, who already had his ophthalmology practice planned. He even knew how much money he would make. He also knew that family practice was way off his radar screen—which was just as well, since his communication skills were rock bottom.

I managed to get his attention one day by imitating his chin-stroking, eyes-toward-the-ceiling clinical demeanor. Unfortunately, he never really got the message; he was only interested in a different sort of eye contact.

Some students, though, manage to touch us far more than we do them. Jeremy had sailed through his first year of medical school. Not long before he was to start his second year, his car was hit by a driver who had run a red light. After several weeks in a coma and almost a year in rehab, Jeremy was ready to resume his education.

When he came to our rotation he was undecided about his specialty. Ultimately he decided on the rehabilitation field, with which he had had so much personal experience. To his delight—and ours—he was accepted into the residency program at the hospital where he had been treated.

There was something special about Jeremy. He was gentle, altruistic, and genuine, and he had achieved against the odds. At his graduation he received a standing ovation. There wasn't a dry eye in the house.

John Egerton. I love showing med students the ropes.

Medical Economics

Jan. 9, 2004;81.