Short White Coat Syndrome

Being a third year medical student is awkward. There's the short, stubby little white coat (which I refuse to wear; it's heinous); there's the fact that I look like I'm a 12 year old trapped in a 6'5'' frame; and then there's the constant, honest struggle that all of us face between providing care and knowing our limitations. This year is all about learning, and part of that learning is doing things for the first time. Sometimes this means asking the right questions or discovering a new physical exam finding, but often it means counseling a patient on different ways of quitting smoking, or even giving a patient his or her diagnosis. But from the patients' perspective, who are we to care for them? Who are we to tell them they have dementia? Two years of Anatomy and Physiology, Biochemistry and Pathophysiology certainly don't qualify us to give advice. But we have to learn sometime.

Even something as simple as introducing oneself I find extremely complicated. I have tried a number of approaches, each with varying degrees of success. I've walked in with, "Hi, my name's Robert. I'm a medical student working with Dr. So-and-so." Casual, honest, and to the point. However, I've also discovered that I get less information from a patient with this approach. Often an attending will ask the exact same question to a patient, and he or she will give a more detailed (or even completely different) response. Patients are much less willing to discuss issues such as mental and sexual health when I'm "just a medical student."

On the other hand, I've tried to enter with, "Hi, my name's Robert. I'm working with Dr. So-and-so. What brings you into the office today?" I have found with this approach, I often get a better story for the patient. I am more likely to address real issues, and often patients are more forthcoming. But did I lie? Although I didn't introduce myself as a medical student, there it is plain and simple on my ID badge (see for yourself!). But often patients now think I am a doctor. They know I'm not the doctor in charge (not their doctor), but they think I'm a physician nonetheless.

What is even more intriguing to me is that sometimes it doesn't even matter how I introduce myself. I can tell them I'm a "medical student," and then the patient will leave the room saying, "Thank you, Doctor!" Or a patient may be on the phone when I knock, and they will tell whoever it is on the phone that they have to go because "the doctor is here." I affirm that I am just a medical student, and that seems to make not one iota of a difference.

Thank you, Doctor.

Explaining what a "medical student" is, is oddly difficult. Correcting a patient, telling him or her that you are not a physician is actually very time consuming, and has irritated a number of patients I've met. Numerous times at the beginning of the year I would spend several minutes with some people describing what my role was within the health care team. This was either very complicated to some, or I'm just a flat out poor communicator. Most patients really didn't understand it, which honestly is a testament to the complexity of our health care system. You aren't a doctor but you still provide care? You can't write prescriptions but you can enter medical records? You can counsel me about my health but can't sign off on it? It does seem a bit odd.

I guess the reason I'm spending so much time on this is twofold, 1) Is not introducing yourself as a "medical student" a lie of omission, and 2) Do the benefits outweigh the risks?

My initial reaction to Question #1 is "yes." Question #2, I'm not sure. I think it's tricky because I have noticed such a distinct difference between the two approaches (keep in mind I would never say that I am a doctor, and when asked, I always give an honest response). Patients are more willing to answer my questions, allow me to perform other aspects of the physical exam, and much more likely to listen when I counsel them on their plan of care. Family Medicine is a great example: I am expected at the end of each visit to wrap up the encounter with the patient. This means I tell them what the plan will be, including what medications we need to change, what referrals we need to make, what tests we will order, etc. Learning how to do these things well is so critical to our education.

On the other hand, I'm not a doctor.

Ultimately, I've decided to err on the side of caution. I guess there will be plenty of years ahead of me when I am a doctor and still in training. Or maybe I'm just over-thinking this whole dilemma. Maybe it's different for third years at large teacher hospitals where their role is more defined. Simpler. I'm not sure. That's why I think this year is somewhat "awkward." What am I?

Next time maybe I'll just say, "I'm not doctor, but I do play one on TV."