White Coat

Today, our third day in medical school, we have now run through the logistics of being here and already ceremoniously received our white coats, and have proceeded to explore the patient-doctor dynamic. In one encounter, the physician and I visited an old man who had just come out of his second round of chemotherapy with harsh side effects that rendered him hospitalized. He most strongly desired to go home, now unwilling to go through more rounds of treatment. Despite his discomfort, he gives us a huge toothless smile, a smile that so filled me up with happiness that I couldn't help laughing out loud. After a few moments of genial remarks all around, his wife asked the doctor what his options were and the "real facts and figures". The doctor tells them that if the patient were to simply go home, he would be looking at 6-8 more months to live. If he went through another round of chemo, he would "only" have 15% chance of the negative effects again and "better than even odds" of complete cure.

What struck a chord in me was what the physician said after we left the room. "They told me they wanted just the facts," he said, "but patients do not ever really just want the facts--they want you to tell them what they should think about the facts. And even if you wanted to give just the facts, there is no way to do so without coloring it in some way." He could have given the exact same "facts" as "If you go through chemotherapy again, there is a 1 in 8 chance that you will be stuck back on this hospital bed" in which case the patient would be compelled to avoid the treatment and go home. The truth may be facts and figures, but they can be made to fit any scenario.

He warned me that patients are always reading signals, and that we are constantly sending them. Say I had gone in, and been really sympathetic: "Oh hi mister. Gee you look a bit tired today. I hope the next round of chemo doesn't take too much more out of you." My opinion medically as an essentially pseudodoctor would not have mattered, but even such a simple comment would reinforce the patient's own feeling that maybe he should forgo treatment to avoid the negative side effects.

While I've often heard stories of medical students are mistakenly held up as doctors in the eyes of patients, I had not thought much about the implicit signals are always being sent despite their knowing that we are only medical students. The medical encounters and interactions today were not way outside the realm of my experience, but I did feel a new dawning of awareness that comes with the white coat. I felt proud that the patients had mainly positive things to say about their care at MGH and even traveled for miles just to be treated there. They commended us for being students at Harvard Med and wished us successful careers. Our past few days have been filled with accolades and welcomes by the many prominent deans and faculty, yet only today do I feel that I truly should be here. I am finally believing that one day I might be needed because I have been told so by the most important people of all, the patients.