Ask not “what” but more importantly “why”

Angie, Third Year Medical Student

As a medical student, you quickly realize what areas of medicine you better understand and other areas that you have no idea what is going on and would rather avoid like the plaque. For me, that plaque I like to avoid is cardiology, more specifically EKGs. Sure, I know that a ‘p’ wave corresponds with atrial depolarization and that “rabbit ears” indicate right bundle branch block. But put a strip in front of me, and my heart begins racing and I’m sure I develop sinus tachycardia (what the heck is that??).

I am currently more than halfway through my three week block of inpatient Internal Medicine at White Memorial Medical Center in Los Angeles. When I began, I was a bit skeptical to be at a non-academically affiliated hospital, albeit they have residents so it is still a teaching hospital. I didn’t expect too much teaching, and figured I would have to rely on my review book and review questions. Boy was I wrong! The very first day that I met my two residents and my attending, who was (surprise!) a cardiologist, they started setting expectations and began to question me on “the basics.” Whoops, too bad I didn’t even know how to replete potassium. My senior resident kindly let me leave early that first day (maybe I looked really overwhelmed), and I got back to my on-campus housing exhausted and anxious for the next day.

That very first week I was inundated with questions, looking up answers to those questions, and presenting my findings. My senior taught me how to replete electrolytes, and then asked me everyday exactly how much I would give to patients with low lytes. During rounds, my attending set the bar high for the residents especially as well as for me.  If he didn’t understand why a patient was still in-house when there was no acute medical problem to address, he asked me to look up the evidence. I made sure to know my patients well and to not miss a thing.  He said the very first day, “ask WHY, not what.”

But through the rigorous and often overwhelming academic aspects of this rotation (there is SO much medicine to learn!!), I have thoroughly been enjoying every moment of it. And I have to thank my intern, my senior, and the attending physician for all that I have gained in the past one and a half weeks. The attending clearly set the bar high and always gives feedback on how we could have better managed the patients (it’s always easier in retrospect he says), but he also sets a very good spirit of team work and acknowledges that he is most critical of himself, which is why he challenges us as well. He has taught me to practice evidence-based medicine, NOT anecdotal medicine.

My senior resident has a self-deprecating sense of humor and I’ve noticed that he picks up on everything. When he notices I look a bit stressed, he always acknowledges it concernedly to the point where I have tried to look as confidant and well-slept as possible (pretty much impossible). He always asks me questions, and if I don’t know it well, he’ll give me time to look it up and present it to him. Almost eerily, my senior can predict what questions my attending will ask me the next day, and I have made a better impression when I get pimped the 2nd time around. Apparently that’s how it’s supposed to work. He is a great teacher even during the crazy busy times, and I want to emulate his actions when I become a resident with a medical student shadowing me.

My intern is one of the hardest working interns I have worked with, and he gets the award for “Least likely to complain.” Even though I feel more tired than ever, I have chosen to adapt and continue pushing myself because I see that my intern often stays overnight to get work done and never seems to be dying.  My intern has taught me to stay calm, work hard, and do it without whining (although that might be hard for me…).

With all these important lessons I have been learning, I can’t help but now be grateful for getting a cardiologist for an attending, and being pushed beyond my comfort level to tackle something I once feared so much. I have a plan on how to tackle an EKG now. Even if it looks like just a squiggle of lines, I know that I have enough knowledge to figure out the basics of the EKG and go from there.  And sometimes, if the EKG looks really weird, it may be that it needs to be repeated! What’s more, I have been learning how to correlate the EKG findings clinically as well. What’s the point of knowing what an EKG says if you can’t answer the why ultimately help your patient?

Also, here is the link to an article in the New Yorker by the amazing Atul Gawande that I couldn’t put down. I wish I could say I’m so very well-read and that I found this all by myself, but actually my attending gave the article to us and said we need to read more (sad day when I am indirectly told I have become an uncultured-journal-articles-only-for-me kind of student).