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Amid all the whining about exams and stress and studying, I want to share with you one of my favorite things about medical school. I am sure I’ll come up with a few more in time (I am expecting awesome things from the simulation center, for example), but right now the highlight of every week is our class patient interview.

If you’re not familiar, a tried and true habit of medical schools since ye-olde-days is to get find patients with the disease you are studying and bring them in front of the class to talk about their condition. I suspect that in said ye-olde-days they also demonstrated their ailment or had to deal with some undignified poking and prodding by the presenting physician. In our class, thus far, they have simply sat in the front of the room with a clip-on microphone and answered questions by their physician or, in a few cases, a specialist in the field who may not have met them yet.

I have a few selfish reasons why I love patient interviews. First of all, it isn’t material we’re tested on. Yes, the disease of interest is related to what we are studying, but there is no expectation that we will take notes, and the interview is not recorded, for confidentiality reasons. We’re not even allowed to have our computers open during the interview, which is a big deal in a curriculum where everything is online. The only expectation is that we show up on time, we dress professionally and we wear our white coats. Some people do take hand-written notes, but I am happy enough for the chance just to listen for a change.

Besides the low-stress environment, a patient interview offers so much to learn. First of all is the variation. Lectures strive to teach you typical cases, but seldom do I expect a patient to walk into my practice with every single hallmark sign of a disease. It’s kind of fun to watch the physician try to lead the patient down a particular path (and when did you start to experience X symptom?) only to have the patient go off in an entirely different direction.

We also get the chance to see how a disease affects day-to-day life. Most of the lecture pathologies come with a cause, a list of symptoms, and perhaps a few lines about what the patient might say if they wandered into your office looking for a diagnosis. Patient interviews follow a narrative. They fill in the blanks between doctor’s visits and express frustrations I might not expect.

Also? I love any excuse to wear my white coat. I know it’s terribly dorky of me, and I’m usually uncomfortable in my nice clothes before I even get to school (last time we were all caught in a rainstorm that somewhat (haha) dampened the professional spirit), but dressing up for patient interviews makes me feel like I’m really in medical school. Like I’m actually going to be a doctor someday. That thought still catches me by surprise sometimes.

I do, however, wonder what it looks like from the patient’s perspective. I understand the need to dress professionally–how awkward would it be to talk about your health problems in front of 150 kids slouching around in T-shirts and sneakers–but I wonder if the white coats don’t make it a bit more intimidating than it needs to be. A friend of mine who has been the subject of such interviews said that everyone looked like clones. I suppose you have to be a brave soul to agree to the patient interview in the first place. I also wonder if it isn’t a bit pretentious for us first years, who know nothing much of merit, to be sitting around wearing these symbols of knowledge, as though we had something to offer this individual other than gratitude. Regardless, I am glad they are required, because if left to my own devices, I would never quite feel my white coat was an appropriate wardrobe addition.

White coats notwithstanding, I hope the interviewed patients have a positive experience as the subjects of our scrutiny. When the floor is turned over to the students for questions, at least one individual usually voices thanks for the opportunity. I hope the patients know how genuinely it is meant. We future physicians like to pretend that we’re something special, but in the end we are nothing without the trust of the sick. I have not yet earned that trust, and it feels very special that, despite that, there are those out there willing to put themselves out there for our education.

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What do you call the dude who comes in last in his medical school class?

Answer: Doctor!

I was told this joke when I was preparing for postbac. It’s funny, right? Because no one wants their doctor to be that guy. We all hope we’re getting treated by a genius who never misses a needle stick and can diagnose you as soon as you walk in the door. We don’t want to think about our doctors missing questions on exams or struggling to understand the basic concepts of disease.

I think that’s part of the reason I get a funny look when I tell people that medical schools are pass/fail for the most part. (The first two years, anyway.) No one wants to think about their doctor as someone who just barely scraped by with a 70; we’d at least like to think of them striving for that A.

source: Yoga Retreats.

There are good reasons for the pass/fail system, though. By and large we medical students are competitive bunch, and that particular quality is only reinforced though extreme curves and weed-out classes in pre-med. That kind of competition has an ugly side. There is a pretty significant difference between a doctor who made it to the top of her class because she is intelligent and hardworking, versus one who made it by being vicious. (Although, I won’t lie, it makes for great television.)

Beyond that, most of the medical schools I seriously considered attending seemed to take the attitude that, by virtue of being accepted into their program, we had proven ourselves. We all had the capacity to become physicians, and there was no need to put us through the wringer just for the sake of establishing our right to be there. Once you’ve made it to medical school, you’re clearly a smart, driven person. Now it’s just a matter of making sure you’re a smart, driven person who knows how to practice medicine.

Of course. there are degrees of excellence, so in case you’re worried that all doctors are considered equal, keep in mind that the second two years of medical school are graded, and students must pass  two numerically graded board exams before they can be considered for residency. There is another board exam after the first year of residency, and regular board certifications throughout a doctor’s career.

And, if I might just add, having just clawed my way through my first real medical school examination, passing medical school is nothing to sneeze at. It isn’t the same thing as passing high school or a college course. These tests are designed to challenge us, we who fought our way to the top of the undergrad heap.

So to the dude who came in last in his medical school class? I will most certainly call you Doctor. I know very well that you earned it.