The First Day

4 Mar

The first day of a new medical school rotation is almost always the same. Often, I find myself sitting in the physician’s waiting room amongst the rest of the patients – sometimes making nervous small talk until I am called back to meet my preceptor(s).  Thoughts racing through my head like ‘what if we don’t get along?, what if they pimp me the entire time – will I know the answers?, what if I’m not good enough?’ After the initial pleasantries are made like where the bathroom is and who’s top dog in the clinic, it gets more awkward when we go to see our first patient and it happens to include a rectal exam on the same person you were just chatting with in the waiting room; talk about changing roles!

I end up following my preceptor around like a puppy dog most of the day, trying to answer every question correctly, present every case thoroughly, figuring out what my role is and continuing to make myself known and helpful – it’s usually full of small awkward moments like the preceptor forgetting my name while introducing me to the patient, or the nurse telling me it’s okay to interrupt the patient visit and I walk in during the pelvic exam – you’ll learn how the office flow works really quick to avoid this in the future!

It is always difficult to figure out little things like, can I stake claim to my own chair in the office or do I stand all day? Do I get lunch if my preceptor works through lunch? (always bring snacks!) Do I ask to do the procedure or do I just wait for the offer? Does your preceptor announce they’re going to the bathroom or do you learn the hard way by following them to the bathroom door? This is the kind of stuff that’s good to establish on the first day, figure out what your preceptor expects of you and remember that just when you think you know what’s expected, it’ll probably change!

Looking back over the last year of rotations, I initially had a lot of reservation about how I viewed my capabilities with patient care, based on my own confidence level.  I wasn’t sure how I felt about being the person people came to for medical advice for things that the most experience I had with was in a textbook blurb and a few exam questions…. And besides that, you have to do it in a way that makes sense to the patient! I remember being astonished at how much praise goes into a well child exam and how I never thought I could be excited enough about perfect happy babies to gain a parent’s trust.  Or how about the thought of ‘why would a parent ever think I would be someone that could give them advice about normal growth, development and anticipatory guidance – I don’t have any kids!’  and soon I was the most excited about telling a parent about how impressed I was about their happy growing baby and what milestones to watch for – what they say is true, practice DOES make perfect!

Patients will often act all kinds of funny and you have no control of the situation.  Some having no qualms about dropping their drawers in front of you or even with the door open to the exam room, some having kids running all over the halls and going through the trash can – I remember thinking about all the socially unacceptable behavior happening, that I felt powerless over, and what is my preceptor going to think of me?  Or how about when the patient with pelvic pain tells you that there’s no way she could be pregnant so you come up with an entire differential with pregnancy being a mere side note; and then when you go back in the room with your preceptor she tells him she’s been having unprotected sex for years. Good thing preceptors have all been the medical student before!

The take home message is that things change.  There are good and bad days – and maybe months – none will last forever and as soon as it’s getting good you have to start over. I was once told, by a very wise nurse, that the best people in medicine need a little bit of reservation and a little bit of guts.  Enough reservation to step back and analyze the situation before making thoughtless mistakes, but enough guts to jump in and make some split-second decisions before it’s too late.  Now is the time to find the balance!

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