Your Thrilling Case May Be Your Patient’s Worst Nightmare

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It’s been over 25 years, but I still remember my first clinical rotation as a third-year medical student: ob/gyn. It was so refreshing to finally take care of patients, to be in a hospital, and to see the things we learned in the classroom translated into clinical care. I’ll never forget a case from that first week: an expectant mother with Marfan syndrome with a risk of aortic rupture during delivery. The plan was for a scheduled cesarean section with cardiothoracic surgeons on standby. One of my medical student colleagues said, probably using their inner monologue voiced accidentally, “Oh, I hope we get to see something exciting!” The ob/gyn resident quickly retorted, “Well I certainly hope not! And you should think twice about hoping for something bad to happen just for your entertainment.” Ouch, she was correct.

Fast-forward 10 years later, and I’m an expectant mother, admitted to the hospital for induction of labor. After what felt like a billion hours, and only 4 cm of dilation on maximum doses of Pitocin, my doctor breaks the news that we are proceeding with a C-section. The medical student says excitedly, “Wow! This will be my first C-section!” Oh, the joys and the pains of a teaching hospital. The comment was fairly innocuous and did not change my confidence in the medical team because I understood how medical education works. But I can imagine someone else, in a time of vulnerability and emotional exhaustion, breaking down over the thought of an untrained medical student performing their surgery. And I cringe to think of what a Black woman well-aware of a history filled with gruesome surgical abuses — including “practicing” vesicovaginal fistulas without anesthesia and involuntary sterilizations — would think.

Practice Makes Perfect, Just Don’t Say It Out Loud

I learned another important lesson as a pediatric neurology fellow. We were planning a spinal tap on a child in the intensive care unit, and I was explaining the procedure to the residents, in earshot of the family. As I was walking away, as an afterthought I shouted, “Oh, and don’t forget to get an opening pressure, just for practice!” What I meant was that checking an opening pressure is a necessary skill that doesn’t add any risk to the sedated procedure, so it’s a good opportunity to get the technique down. Then the resident will be more proficient on future cases. The PICU attending took me to the side and explained how the family could have easily misinterpreted what I said and concluded we were using their child for “practice.” She was correct. Our words, regardless of their intent, matter.

Your Most Interesting Case Could Be the Worst Day of Someone’s Life

As medical students start clinical rotations and interns begin their journeys, remember every case is an actual person. Your most interesting case could be the worst day of someone else’s life. Your first-time intubation could be someone else’s last unassisted breath. The super-rare diagnosis, maybe only seen once in a lifetime, missed by several prior doctors, could be a death sentence for the patient.

This is true for attendings as well; the patients are not there for our education or our research or our publications. How we interact and view patient encounters sets the tone for medical teams. When we refer to patients by their conditions (“Hey, we need a consult on this COPD-er”) or room numbers (“Room 405 needs labs ordered”), we dehumanize them. A study analyzing the use of the term “sickler” to refer to people with sickle cell disease (SCD) was strongly associated with negative feelings toward people with SCD.

Stay Curious and Share Knowledge, Respectfully

It’s OK to be intellectually curious and to share wisdom and knowledge with colleagues. Exploration in medicine inspires great research and significant improvements in clinical care. But do so respectfully, honoring the patients and families who may have experienced great tragedies. Medical education is a byproduct of providing excellent care for patients, it’s not the primary goal.

Jennifer P. Rubin, MD, (she/her), is an attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, and an associate professor of pediatrics at the Northwestern University Feinberg School of Medicine.

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