“You’ll feel a pinch where I’m putting the numbing medication,” the intern says as she pulls the skin on our patient’s neck taut. The attending watches attentively; this is the intern’s first time placing a central line. I stand off to the side — my left hand gently squeezing the patient’s hand under the sterile drape, my right hand holding the ultrasound probe’s tail, making sure it doesn’t contaminate the sterile field. The patient moans, constantly moving. Instinct tells me this will be a difficult central line to place for an experienced attending, let alone a naïve intern. The intern tries multiple times, unsuccessfully, to advance the needle into the vein. Minutes tick by on the clock. I sense her nervousness. With encouragement and guidance from our attending, she finally reaches her target and aspirates some blood. She sighs with relief, brushing her hand against her forehead.
I freeze. Did she just touch her face? An uneasy feeling creeps up from my stomach. As someone entering a surgical specialty, I feel acutely observant about maintaining a sterile field. I watch her hand float down towards the patient.
“STOP!” I belt out. “You touched your face! You’re not sterile!” Startled, the intern steps back. My attending looks at me, surprised. “Are you sure?” the attending asks apprehensively. My heart races. I nod, and the attending gives the intern instructions to re-gown and glove.
Was I absolutely certain she touched her face? Yes, I am 90% confident. But as always, there’s an element of doubt. Regardless, I’ve been taught that hands anywhere near the face are red flags in the “sterile world”. Weeks later, I still repeatedly questioned myself… should I have spoken up? There are traditional roles for individuals in medicine, including students. We do what we are told — call offices for medical records, gather vital signs, etc. We never tell someone what to do (unless it’s a classmate from a year below us). We’re not experienced enough.
Was I wrong to break that unspoken hierarchy?
No, absolutely not.
My patient and his safety trump anything else. But this experience drove me to reflect about the traditional place and role of a medical student.
When younger classmates about to enter their clinical years ask for advice, the same question always surfaces: What are medical students supposed to do during clerkships? The answer usually contains similar elements: be on time, ask thoughtful questions, know your patients, and help the residents but don’t annoy them. Except this “classic” advice doesn’t translate easily to actions.
As I write this piece, I’m completing my medical school training and moving on towards residency. I hope it will encourage my colleagues entering their clinical years to challenge the status quo of “just a medical student”. Being a medical student is a luxury and a privilege; you are, to some extent, responsible for your patients, but by no means are you their sole healthcare provider. And unlike the residents and attendings, your commitments revolve around learning; you don’t have other responsibilities to juggle. You can choose where to focus your energy. My wisdom is simple: Create opportunities to do more for your patients.
Again, this advice doesn’t spell out actionable steps for students. Instead, I share these anecdotes to help my future colleagues grasp what a broader definition of “medical student” can entail and to challenge yourselves to reshape the medical student’s conventional role.
While on my emergency medicine rotation, many of my uninsured patients actually qualified for healthcare benefits. Several didn’t have access to a computer to apply for these benefits, and if they did have access, it was a challenge to successfully navigate the complex websites. The medical team would often turf this concern to social work, but we all knew the social workers were too few and had too many responsibilities. I saw a solution — during my shift’s “downtime,” I would bring out my laptop, sit with patients, and help them apply. Technically, I wasn’t learning “clinical medicine” (diagnoses and treatment), but this role gave me valuable firsthand insight to this significant barrier in healthcare. Importantly, it made me feel useful. Me, “only a medical student,” advocating for my patients and changing the way they access healthcare substantially. Best of all, this newfound “superpower” only took a few moments of my day.
As the doctor’s office I worked in for my primary care rotation transitioned to electronic records, I witnessed the staff’s struggles. For example, at the end of each day, the medical assistant would have to scan every patient’s EKG, import the files into the EMR, file each individual EKG, one-by-one, into the correct patient’s chart, and finally, timestamp it for the correct date. It was taxing, time consuming (not to mention irritating), and frankly time she could have spent with patients or prepping for the next day. I knew this system had to change. I worked with the IT department and helped create a program that would automatically transmit the patient’s EKG directly from the machine into the patient’s electronic chart and file it into the correct date. When the trial run for this program was successful, the attitude of the entire office shifted from strained to hopeful. In a few days, I was able to help the entire office (and therefore, the office’s patients) run more smoothly. This experience reminded me that a solid medical foundation is not the only component to providing excellent medical care; you need innovative approaches to create a system with a supportive culture and good workflow.
As you start your clinical education, do follow that classic advice (it’s common sense to be prepared and show up early). But, also champion your patient. Here are some more tangible ways for you to do just that:
- Draw diagrams for your patients so they comprehend what a “colostomy” is and how it will change their daily care.
- Show families and patients YouTube videos about intubation and chest compressions so they actually understand code status.
- Spend 20 minutes of your lunch break reading to the patient whose family hasn’t been able to visit. Or watch a TV show with that patient after sign out.
- Review your patient’s medication list and speak up when you’re worried about a mediation interaction or a potential safety risk.
- Set up the translator on the phone before your team rounds to make sure the patient and family understands the next steps in care (or make sure to clarify any questions after rounds!).
- Make a list of PRN medications available to your patient and why they might want them (i.e. Feeling nauseous? Zofran!).
- Save the national suicide hotline number into a patient’s cell phone if you have concerns.
- Triple check the expiration date on vaccines before they are given.
- File an anonymous patient safety report at the hospital if you witness something happen to your patient that makes you feel uneasy (it’s better than remaining silent, especially if you aren’t comfortable reporting the incident to your clerkship director, Dean of students, attending, etc.).
- Write on a piece of paper the names of the patient’s healthcare team: i.e. heart doctor, lung doctor, resident, intern, etc.
- Follow your patient for his or her bronchoscopy procedure, ask to watch the procedure, and then help orient him or her after it (this will also help you explain procedures to your other patients!).
This list is certainly not exhaustive, but I hope it gives you ideas to act on. Do the things that make the healthcare system a better place for patients, and I promise you, you’ll learn more than you think in the process.
Sara Rahman is currently a student at the Frank H. Netter MD School of Medicine at Quinnipiac University. She’s excited to start her OB GYN residency at The George Washington University in Washington D.C., and given the nation’s current events, she is ready to serve as an agent of change to minimize healthcare disparities and put the ideals of women’s health into practice.