Shocking Position

Doctoring Week 1 Over the past few weeks, I have spent a good deal of time analyzing exactly why I am nervous to enter medical school. In doing so, I revisited two poignant points in my life where I felt a similar blind apprehension. The first, I was in eight grade and was going down to Costa Rica with a summer program for three weeks to study tropical botany. It would mark the first time I would be truly out of contact from my family for an extended period of time. The trip marked a true coming of age for me—as I was learning about different tree types, I also gained a more intimate understanding of myself. For the first time, I felt my passions lead my questions, felt a confidence and calmness with my gained independence and felt a deep responsibility to my classmates and myself as we hiked through the jungle and faced numerous challenges together. Two years later, I faced a whole new set of challenges as I began running cross-country for my high school. I started running because I was bad at it. I wanted to push myself physically in a way I never had and, in the process, learned about both my physical limitations and my determinations. I also learned the value of a team—a group that provides motivation, honest feedback and constant support. More than anything, cross-country taught me how to push myself past my comfort zone in order to reach my goals. These rites of passage have taught me so much about myself—be it about my passions, my fears, my limitations and my potential. I take these small lessons from every step of my life and look to these experiences to give me strength as I enter the next four years. I now know that I am driven by passion, that I can be pushed past my comfort point, that I feel a great deal of personal responsibility and that I care deeply about working with other people to reach our common goals. Undoubtedly medical school will challenge me in ways I have never experienced but I hope these lessons will provide me with the strength and confidence to move on. As I start my next four years, I often reflect on my initial motives for applying to PLME. I was originally inspired to pursue medicine from reading Dr. Sacks’ books growing up. I loved the mystery of medicine as I viewed each case as a veritable ‘Who dunnit?’ of the body. I remember even then being acutely aware that, on the one hand, I wanted to diagnose bizarre, highly complex neurological disorders and on the other, I wanted to work closely with patients to help them to improve their lives—in my mind, medicine has always existed as a humanitarian/scientist duality. Ever since then, I have never seen myself pursuing anything else. Even after my first few days in medical school, I can tell the journey will not be easy. I have already begun to realize my new strengths and weaknesses in this new field. For instance, I can already see that, in class, one of my strengths as a learner is my tendency to synthesize as I learn. This means I take notes, ask questions and truly try to master a concept as it is being presented. Unfortunately, this tendency does have some drawbacks. I tend to fall behind when taking notes, missing important information as I focus on the previous concept. Overall, I know that I am embarking on a long journey, but it is one that I am truly looking forward to. I find medical school exciting because I know that I am finally pursuing a field that I have wanted for so long. The years of anticipation are finally coming to fruition and for me, there is nothing more exciting. My greatest fear in entering medical school is failing—just as pursuing your dream is invigorating, the thought of failure is devastating. That being said, I know I will face setbacks and I

realize that I must find ways to take care of myself both as a student and as a physician. I hope to find comfort in the humanity of medicine—I am working with people, not numbers or charts or figures. I hope this realization will keep me grounded and connected with my patients. In addition, I hope to set some time aside to pursue my own interests outside of medicine. I’m hoping that a few well-chosen hobbies will allow me to unwind after stressful days and to gain more perspective on my patients. In the end, I hope to be sustained by my family and friends. I have always looked to them for support and strength in everything I have pursued and I hope they can continue to help me as I enter this next phase of my life. Doctoring Week 3 Over the past few weeks, as our Doctoring checklist has grown longer and longer, I have learned to appreciate several things about taking a medical history. First, I have realized that how I look and how I feel are two completely separate entities. Each time I sit with a new standardized patient, I am working to suppress these intense feelings of nervousness as I find myself directing my body in a mechanical way. The first standardized patient I interviewed, I was literally reminding myself to breathe before asking each subsequent question. This separation between a professional exterior and my true feelings was even further amplified this week as we began taking sexual histories. I felt myself looking into my patient’s eyes, wondering how she would react and praying that she would not feel judged by my words. Taking a sexual history puts physicians in a shocking position of power—with just a few questions, we have the ability to completely alter our patients’ emotions, their comfort levels, and their overall perceptions of medicine. It is then ironic that, as we try and tread this fine line between authority and sympathy, between comfort and respect, we all cling desperately to our checklists. In a sense, I think this reflects something deeper about medical school as a whole: we are trained during these first two years to memorize before thinking. The sheer volume of information presented to us necessitates that we just sit and passively absorb. Then, by some magical process in a few years, we will learn to turn the switch from passive learning to active diagnosing. The beauty and struggle with doctoring is it is forcing us to think much earlier than any other class. My classmates and I focus so much on this checklist as if it is some barometer of success without looking at the bigger question—did we succeed as physicians? I suspect this question means different things for all of us but for me, it means My biggest fear when I interview standardized patients is their response to the question, “Did you feel comfortable during the interview?” To me, this is an indication of my ability to act as an effective and human relay between the worlds of disease and medicine and failure here . When we began taking sexual histories this week, I thought back to my last appointment with my physician to think about the language he chose when asking about my sexual history. Then I remembered, he didn’t ask a single question but instead chose to hand me a questionnaire at the beginning of the appointment and to then tap his pen against the table to fill the awkward silence as I nervously scribbled away answers and circled YES or NO. I remember one question in particular: “Have you had sex with a person who has had sex with someone of the same sex before 1985?” I sat there annoyed and confused, reminded of those infuriating aptitude tests from middle school with questions like, “If

train A leaves the platform at 9:15 and train B leaves at 9:20, what will John be eating at 9:30?” In retrospect, I now realize that the use of the questionnaire optimizes our society’s discomfort with openly discussing sex with each other. Just looking at popular culture, it is clear that we love the idea, the fantasy of sex, but bristle at the thought of discussing our own sex lives with anyone. Thinking of this provides me some comfort— it is natural for your patients to be a little uncomfortable when you ask about their sex lives so when they start wringing their hands and shifting in their seat, it isn’t necessarily because of my specific choice of words. That being said, it then places the obligation on me to be respectful while taking their sexual history and to reassure them that these pieces of information are important. The whole process reminds me on an article I read a few years back regarding the “medicalization” of addiction—a societal paradigm shift that allowed us to view addiction as a condition and not a moral failure. Our generation of physicians has a greater responsibility to our patients to place the topic of sex within a safe space where we can discuss it openly and honestly without the hindrance of social expectations. Only in this way can we begin to make an impact on safe sex practices as an important component of taking care of our patients as a whole. Taking sexual histories has been an enlightening experience. I know I am far from being an expert but I am excited and humbled by the opportunity to practice. I hope that as I continue in my medical training, I remember how honored I feel right now by the implicit trust my standardized patients place in me and how deeply responsible I feel to do everything in my power to provide them with the best care possible.