Seeing Color in Shades of Gray

Early in medical school I felt assured of the notion that all physicians are unified by a common code, a shared spirit for betterment and healing. Now that I am three-quarters of the way through my third year of medical school, I am quite certain that there can be many noticeable differences between specialties and the roles physicians assume. I was reminded of this when I was guiding two second year medical students through a differential based on their joint interview and exam of a patient: the two students, one planning to pursue a career centered on patient care and the other planning to pursue a field more distanced from patient interaction, displayed very different approaches to tackling the “simple” objective of diagnosing a patient in the clinic and determining a treatment. During the clinic session, the first student took all of the vital signs, conducted the majority of the interviews, and performed all of the physical exams. However, this student tended to hesitate when asked for an assessment of the patient’s condition. The second student interjected a few questions here and there and jumped to conclusions much more quickly, sometimes correctly and sometimes incorrectly (such as suggesting an NSAID for a painful joint in a patient who had a history of a bleeding peptic ulcer).

It would seem that style of approach and attitude play a significant role in steering a medical student toward one field or another: we mold ourselves to the archetypes we see in each field. Those who want to operate in the surgical suite practice the impenetrable confidence and cocky, competitive sportsmanship of surgeons. Those who seek to practice hospitalist medicine don the red badge of courage of Internal Medicine and its unwritten mantra, “We are the real doctors.” Those who see the brain as the king of all organs and consciousness as the meaning of life learn to find fascination in life’s current perplexing mysteries of the mind, however insignificant to everyone else. Those who find the heart to care for the sick of mind learn to harden their hearts to the jests of their colleagues and the curses of their sickest patients. Those who find they care the most for children denounce the self-inflicted suffering of modern adult life and fully embrace and idolize the preservation of innocence. Those who enjoy the fast pace of the Emergency Room floor the gas pedal and don’t turn back. And those who find comfort and poise in the Radiology reading room start investing in a good set of golf clubs (just kidding. Sort of).

However, in the end, our differences are merely caricatures of a more nuanced reality. I recently had a discussion with two friends about medical curricula, and they both argued for the need for flexibility in a physician’s character and manner. In their case, they argued for flexibility in scientific knowledge; instead, I would argue more for the need for flexibility in the ways we approach our patients, our colleagues, and our profession. The best physicians, those who patients, students, and colleagues alike speak of with awe and admiration, are those who surpass the usual boundaries and the commonplace stereotypes with ease and purpose. As I take on new roles and add more letters before and after my name, I hope that I do not forget to stay true to myself.

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1 comment
  1. John Roger Bell said:

    Just thought I’d share the Urologist’s perspective.
    The kidneys do an amazing amount of hard work unknown to the rest of the body and then deliver it’s labor of love to the bladder. The bladder in turn holds urine until such time as it feels its capacity being stretched, it then sends a signal to the brain telling you to pee.

    In summary, the brain is a simple organ that simply gets the message from the bladder that it’s time to go. The kidneys did all the hard work.

    😉

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