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You guys must have read a lot of online articles and blog posts on how to prepare for medical school, how drilling it’s going to be or how rewarding the end journey is. Well, here’s something new for you: I will be sharing a few interesting encounters during my clinical year in medical school which have taught me important life lessons in surviving as a green medical student. These experiences are gold—they will remain with me throughout my journey as a student and hopefully when I make it as a doctor one day. Ask any doctors, and they will tell you their own memorable experiences even as far back as 40 years ago. So, here are mine for your kind perusal, which might hopefully give you an insight on how clinical year is like.
Lesson 1: English is not everything.
During my primary care rotation (means instead of being in the hospital, we were learning in a clinic setting), I was supposed to explain to an 80-year-old Chinese uncle on the effects of hypertensive medication on his liver. My lecturer doctor, an Indian, asked me to take over as the uncle could understand better if it was explained through Mandarin. After giving me a lengthy explanation to be translated to the uncle, with the liver being the limelight, my lecturer lowered his head to write the prescription on his prescription pad. I turned confidently to face my first patient of the day. Now it’s my time to shine. Then I paused. And my confidence swayed.
What is liver in Mandarin?
You see, I am a half banana who converses in Mandarin on everyday life topics, but definitely not medical jargons. I don’t talk about liver with my friends. Even if we did, we use the term “liver”.
Not knowing how to begin my explanation to the uncle, I turned towards my two groupmates cramped together in the small consultation room. First one: He is also a banana, almost on the same par as me in terms of our grasp in Mandarin. Ok pass. Second one: Although an Indian, she is educated in a Chinese school since young. Her Mandarin is definitely above all of us! Such is the beauty of diversity in Malaysia.
There was no room for whispering in the cramped space and it is rude to whisper in front of the patient. So, within earshot of everyone in the room, I decided to clear my doubts with my groupmate in Mandarin. “Hey, what’s the Mandarin term for ‘liver’?”. It was quite embarrassing, to keep the patient waiting, to be clueless of the term in my mother tongue and above everything else, it all happened under the scrutiny of my strict lecturer, who appeared not to be listening.
Before the answer popped into my groupmate’s mind, a stern voice from beside me answered: “Gan.” It was my lecturer. He was looking up from his prescription pad at me, and just as quick as he tilted his head, he lowered it again with his signature slight eye-roll with his lips pressed into a thin line.
We were flabbergasted. How did he know the answer to my question? No doubt, it must be from his decades of experience as a primary care doctor. But most importantly, how did he know what I was asking? Again, such is the beauty of the diversity in Malaysia.
Moral of the story is, equip yourself with some terms commonly used in the clinical setting in languages other than English. For example, names of organs, common infections (meningitis, dengue, pneumonia), seizure, hemorrhage, shortness of breath, hernia, placenta, uterus, miscarriage, etc. Truth is, English is rarely used in conversing with patients as Malay, and sometimes Mandarin, are more practical in government hospitals.
Lesson 2: Wear the skin of a doctor.
Let’s face it: Being a medical student in a sea of doctors, nurses, pharmacists, medical assistants and physiotherapists who are constantly checking on the patients in a particular ward of a teaching hospital is quite daunting. And we as medical students are required to take history from patients, in order for us to discuss the patient’s case with our lecturer and peers later. But how to approach them when faced with such adversities?
Patient’s history has been taken by another student who is not from your group. Usually in such a case, the patient is not willing to spend another 15 minutes with you repeating the same content all over again.
Some grumpy patients do not like to talk to students. They prefer only doctors.
You feel awkward approaching the patient. We are taught in medical school to firstly introduce ourselves to the patient with this famous opening line: “Hello, my name is Mei Hui. I am a third year medical student. Is it ok if I ask you a few questions regarding your condition?”. Personally, it feels very unnatural approaching the patient in such a way, as if gaining information is my priority rather than being concerned of the patient’s health. Hence, the hesitation in my approach.
These adversities could really be a pain in the bottom especially when we could not get the history of a very interesting and rare case, such as encephalitis, which will be an extensive topic of discussion with our lecturer. How to approach the patient?
A senior taught me this: Wear the skin of a doctor, just like how a sheep wears the skin of a wolf.
Remember, this doesn’t mean pretending to be a doctor by calling yourself one. Never lie to your patient. What it means is, wear the confidence and the familiarity of a doctor approaching a patient as if it’s your daily routine for the past 10 years. This is a great opening scene:
Situation 1: You see a patient with a rare condition. The patient appears unfriendly. You are determined to get the history. First, you walk confidently from a suitable distance towards the patient. Make eye contact and smile. If there is a file with a written record of the patient’s progress, glance through it. Know the patient’s name (e.g. Ali) and the presenting complaint (e.g. chest pain). Then approach the patient in a friendly but confident manner of a doctor doing his job: “Good morning Mr. Ali! How’s your chest pain now? Is it getting better?”
With such opening lines, the patient’s face will lighten up no matter how grumpy he looked in the beginning. Simply because you show that you care about him. After the patient updates you on his current condition, ask him a few other questions on his health and family. Then, ease into the conversation by introducing yourself as a medical student and gaining his consent to ask more personal questions regarding his condition. Usually by now, the patient would have warmed up to you and is ready to talk.
Situation 2: There is no file on the patient’s table as it is stored in the computer system of the hospital. Don’t worry. Approach the patient with the same confidence. Make eye contact and smile. “Hello madam! How are you today? Feeling any better?”
Truth is, most of the adversities arise from our head (which means adversity number 3). Patients are usually friendly and more than willing to have someone to talk to, especially when they are cooped up on their beds with nothing much to do other than sleeping their time away. Therefore, do not feel afraid or intimidated by your surroundings. Approach patients with sincerity, humility and a heart ready to learn. However, if this approach does not work, do not force your way into the patient’s privacy if he is not willing to talk. Respect our patients at all times.
Hopefully you have gained a glimpse of the clinical year of a medical school by now. If you are still far away from starting the clinical year, I hope these lessons remain with you until the time comes. Interested to know more? Stay tuned for Part II.
Glossary
Teaching hospital – A government hospital which allows medical students to practice and learn from the patients and the facilities available
History – A set of questions asked by the medical staff to know the details of the patient’s condition and other relevant information, such as the patient’s social lifestyle, family’s health, etc.
Ho Mei Hui, currently sailing the 4/5th part of her journey in attaining her MBBS degree in Newcastle University Medicine Malaysia. Barely surviving and always occupied with trying to keep her boat from capsizing in the middle of the ferocious sea, she regrets still not having learned how to swim. Single and available.