An Exposure to Medicine
Reflecting on my experiences shadowing the doctors at the Huntington Hospital in the summer of 2018, my first real glimpse into the world of medicine.
Updated: Aug 26, 2018
This summer I had the opportunity to participate in Caltech's preceptorship program with the Huntington Hospital, a six-week long immersion experience designed to show students first-hand the many facets of medicine. While many of the other program participants were upperclassmen with additional shadowing experiences already under their belt, these six weeks spent were particularly special to me, as it was my first intensive encounter with so many subspecialties of medicine.
The Science of Medicine
One of the most common misconceptions held by many premed students is the fixation on the biological classes as the only real subject of importance during their undergraduate years. I've been able to see this mentality up close, profuse among so many members of the relatively small premed community at Caltech. Indeed many students in institutions nation-wide have the preconceived, yet erroneous, belief that solid understanding of human anatomy is all that is needed technically to become a good doctor. Yet, in hearing the conversations between doctors, I realized that this is far from the truth in almost all of the medical subspecialties I was able to witness.
I remember listening to one of the pulmonary intensivists educating the new interns about the calculations surrounding cardiac output, and how to make rapid estimations of patient condition that serve special utility at somewhere like the ICU, or intensive care unit. The cardiac output was proportionally to the central venous pressure and mean arterial pressure, and inversely related to systemic vascular resistance, terms that I could not fully appreciate initially because of my inchoate medical education. However, my understanding of the calculations being performed was elucidated when the pulmonary attending made a natural analogy to Ohm's Law, a relationship between the empirical measurements that characterize an electrical circuit taught in most introductory physics classes. An understanding of something as seemingly unrelated as physics and electromagnetism had helped me and the interns, visualize and internalize a complex cardiopulmonary notion.
Another example occurred as I was following one of the academic clinicians at the Doheny Eye Center of Ophthalmology, run by UCLA at the Huntington Hospital. This particular doctor was an expert in Socratic questioning to engage the residents and students in discussions involving patient care, and so for me, this was one of the most engaging moments of the entire shadowing experience. To understand how to diagnose optical nerve damage based on delayed pupillary light reflex, he explained the eye as a sort of 'black box' with only the optic nerve and pupil as the input and output; this black box model is a common problem of logic and reasoning encountered by electrical engineers. In another situation I was able to join the discussion in logically rationalizing why humans have an inverted retina, something that superficially seems as a counterintuitive evolutionary design to many because of the greater delay in eye response to external stimuli.
I have no doubt that a sound biological foundation is extremely important as a future clinician. But my experience in medicine has convinced me that it is most certainly not the only knowledge that is important; the value of individuals coming from different, 'untraditional' academic fields such as chemistry, physics, engineering, and the humanities cannot be understated; such heterogeneity is particularly important as the collaboration between healthcare providers continues to grow and improve.
The Art of Medicine
Through this preceptorship program, I was able to discover a new understanding of medicine, one that transcended the hard cover textbooks many of us are so familiar to: medicine is as much of a science as it is an art.
One of the more clear cut instances is during surgery. One of the surgeons I had the opportunity to shadow told me that in his 30+ years of practicing medicine, doing many of the same procedures day in and day out, he has still never seen two identical cases in two different patients. Furthermore, every Friday, the neurosurgery department held a morning session of grand rounds, where the neurosurgeons showed each other interesting patient cases from the week and discussed the procedures perform for each of the cases. During these sessions, one can always find debate between the doctors as they discuss their views on the best procedure for the patient. Indeed I have found that, in operating on patients, there is always a certain degree of stylistic choice and artistic improvisation involved in the procedure - the 'signature' of the surgeon on the metaphorical painting that is the patient. There is often no steadfast right way in helping the patient, something that describing medicine solely as a science fails to encapsulate.
I've found that the same is true for internal medicine physicians as well. In addition to catheter placements, intubations, and other medicinal procedures, art can even be found in determining which drugs and drug concentrations to give to patients. During my rotation with the pulmonary intensivists and general surgery residents, I witnessed how the residents and attending would sometimes disagree on the exact concentration of medicine to give to patients, or even whether or not to give medicine at all - opinions formed through different personal experiences and medical training. The same understanding of patient status can lead to very different treatment ideologies and pathways depending on the physician. Biopsy analysis and pathology slide preparation required the same level of care, experience, and physical dexterity expected of any other artisan. Something as complex and difficult as patient care cannot always be reduced to a hard-and-fast science.
The People of Medicine
"People don't care that you know until they know that you care." -Ian Ross, MD (Neurosurgery)
As the application process to medical school continues to foster an increasingly stressful undergraduate experience for many undergraduates at both Caltech and across the nation, I was reminded during these six weeks that fundamentally, medicine is a people-orientated service dedicated to helping the lives of others. Like any other business of service, we use the tools available to us - in our case the knowledge accrued over many years of medical training - to serve the community at large.
One of the most valuable things I took away from this experience is that the quality of patient cares not as much dependent upon how knowledgeable the doctor is about medicine, but rather the impression the doctor leaves on the patient. The ability to provide comfort to the patient that everything is going to be okay, even though the patient condition is deteriorating. The ability to sit down at eye level at the patient bedside and clasp their hand firmly, speaking to them calmly straight in the eye.
This is arguably the greatest, most euphoric feeling one can experience as a doctor, and what makes the many gruesome years through medical school and residency worth it. The chance to come out of a 5-hours long procedure and hug the family member after telling them that their father is going to be okay and will make a speedy recovery. The chance to directly make a difference in the lives of others. Not every procedure is going to be perfect, but it is these short moments of patient appreciation that makes medicine so rewarding and special. It seems that this sentiment is shared by many and what helps doctors get through the 80-hour work weeks and spending the weekend on call. It was a true privilege to witness this stirring, personal dynamic forged between patient and physician.
The Future of Medicine
The personal value of this six-week endeavor with Caltech and the Huntington Hospital cannot be understated. I was able to share this opportunity with six other Caltech students and recent graduates, and needless to say it was an impactful and memorable experience for all of us. To be able to witness almost all facets of medicine - from right at the patient bedside to up close standing over the operating table - has allowed me to garner a new perspective on what it means to be a doctor: its challenges and hardships, but also its incredibly fruitful rewards. I look forward to continuing to learn about medicine in the future.
Questions or comments may be sent to Michael Yao at myao at caltech dot edu.