To me, medicine seemed like the furthest thing from software engineering. It is about patient relationships, communication, and improving quality of life. Yet, somehow, I discovered a connection between algorithmic codes and the practice of medicine. The challenge of the third year of medical school is not only the long hours and new expectations; it is learning the codes and cues that make up the language of medicine. I spend every day trying to rewire my brain; creating algorithms that I can access on command. This may be a gross over-simplification, but let’s just run with it. In my new system, symptoms are no longer descriptions of a patient’s experience but a command input that enters my brain to trigger an output that stipulates the possible diagnoses, work-up, and treatment.
For example, a patient in the ER tells me he is having chest pain. Input: chest pain. Output: 5 most dangerous causes of chest pain: myocardial infarct, aortic dissection, pulmonary embolism, pneumothorax, Boerhaave’s syndrome
I tell people that “I am working” to simplify what I am really doing: creating a systematic thought process that I will hone over my career. Two years of lectures, excessive highlighting, and one USMLE national exam later, I have a lot of data with no organizational system. My brain feels like a file cabinet that needs to be alphabetized, cross-referenced, sorted based on pre-test probability, and then converted into electronic format. Needless to say, there is much work to be done. Every day a new piece of the puzzle falls into place. Immersed in internal medicine 6 days a week, I find comfort in one central theme of medical education: REPETITION. I have completed 6 weeks out of a minimum of 5 years of formal, supervised, on-the-job learning (2 years of medical school clerkships plus a minimum of 3 years of residency). The patient with chest pain I saw today will not be the last. From each new patient I will input a new line of code into my mental thought process and work to perfect the algorithms I have already created. As I advance in my training, I will assume progressively increased levels of responsibility with the underlying goal to treat and to learn.
See one, do one, teach one. It seems to be one of the prominent mottos of medical education; similar to the meaning of “sink or swim.” I never feel as comfortable as I present myself to be. Confidence is the security blanket that I use to hide from all the uncertainty that is peeking out from the closet. For example, just this morning, I finished interviewing a new admission in the Emergency Department and my attending turned to me: “Code status?” he said. Immediately my heart starting pounding, my palms got sweaty, and my eyes widened. But in the next second, I took one deep breath, turned my head back to the patient and looked her in the eyes. Then I recited the script that I had heard the resident say to a patient yesterday. “I need to ask you a question that we ask all the patients coming to the hospital. It is very unlikely that this will happen, but in the event that your heart stops beating or you can no longer breathe independently we need to know what measures you would like to have taken to preserve your life.” I had never said it to a patient before. This is a very loaded conversation that rightfully makes patients and their families uncomfortable and emotional. But the words came out like I was an old pro. Input: code status. Output: memorized script. Now on the other side of the first of many of these conversations I know that next time I will be even more comfortable and confident.
Right now, my role is to be a sponge. Each day I am challenged to learn as much as I can from the patients I work with. It is not uncommon for me to ask questions until they are exhausted to the point where they ask for a cup of water. But that is the privilege of being a student. When I know what I am doing I feel like a rock star. When I don’t know what I am doing, I hide behind the sentence “I am just a medical student.” On the morning of our first day as practicing third years, the director of the internal medicine clerkship told us, “If I were ever in the hospital, I would want medical students on my team.” We have the time to devote to our patients at their bedside, to read in-depth about every condition that is discussed, and to add value to patient’s quality of service. Each day is a work in progress. The challenge right now is honing my clinical skills via a step-by-step problem solving procedure, but I keep in mind that medicine is not just an algorithm. It is a commitment to self-improvement, self-reflection, and humility.