Category Archives: medicine

Reflections on 3rd year of medical school

I did it.  I finished 3rd year of medical school.  Overall, it was one of the most enjoyable years of my education.

The 3rd year of medical school is the first time many medical students feel like they are a “physician” because, for many, it is the first time a student is assigned a patient.  This does not mean that you, as the medical student, are solely responsible for the individual.  There are a number of checks and balances to ensure patient safety.  But your team of residents, fellows, and staff does expect you to treat the individual you have been assigned as “your patient.”   The medical student is expected to know the patient’s history, test results, and current treatments.  Furthermore, most teams expect the medical student to have these bits of information about the patient on the tip of his or her tongue, ready to spout a needed piece of knowledge when asked.  This is a big change.  The medical student’s role changes from passive to active. Furthermore, the medical student is often asked to make recommendations regarding the care of the patient.  The team may agree or disagree, but the medical student’s opinion is expected.

The 3rd year of medical school is also where I understood the importance of being able to say, “I don’t know.”  A surgeon asked me a question at the beginning of third year to which I responded, “I think…”  The surgeon immediately cut me off and said, “do not think…KNOW.”  He was not being arrogant; he was reminding me about one of the critical aspects of patient care.  If someone asks you a lab value, test result, or a drug dose, the answer should never start with, “I think…”  If you are not sure, then say, “I do not know and will look that up.”  (This is why you quickly learn to have important patient facts written down and with you at all times.)

Learning how to say, “I do not know” if one of the most valuable lessons of medical school.  Actually, it is one of the most valuable lessons anyone can learn.  “Not knowing” is continually reinforced as a “bad thing” and there are certainly things that any medical student must know.  Worse than “not knowing”, however, is pretending that you do know.  This is how people get hurt.

Tools for the Wards

I am DONE with inpatient rotations for 3rd year (there is much rejoicing!)  Throughout the year, people asked me about some of the unique items that I carry around in my coat to help me out on the wards.  Here is what they are and were I got them.

  1. The White Coat clipboard – My classmate Dan Chan gets credit for introducing me to this foldable clipboard.  I am still wondering what I did before I had this thing.
  2. The best pen ever – Again, Dan Chan gets credit for introducing me to my favorite pen.
  3. Rayovac LED penlight – You can spend A LOT of money on penlights at medical stores that are of poor quality.  Instead, go to your local hardware store and pick up this beauty of a light.  Bright, well-built, and cheap – this pen light has been indispensable on countless occasions.
  4. Moleskine – You need something to write notes in…might as well use what Hemingway used.  Seriously, Moleskine makes the best notebooks/sketchbooks.

Notable article from the NEJM: Chlorhexidine–Alcohol versus Povidone–Iodine for Surgical-Site Antisepsis

Surgical site infection is a BIG deal.  These infections increase surgical mortality, post-surgical complications, length of hospital stay, readmission rate, and healthcare cost.  Post surgical infection rate is something tracked by individual surgeons, hospitals, and the government.   Interventions that have proven to reduce the rate of surgical site infection, such as antibiotic prophylaxis, are also tracked.  Thus, a new article published in The New England Journal of Medicine comparing the 2 major surgical site preparation agents, chlorhexidine-alcohol versus povidone-iodine, is notable.  In short, the authors’ suggest that chlorhexidine-alcohol surgical site preparations are associated with lower surgical site infections compared to povidone-iodine surgical site preparations for clean-contaminated surgical sites.

The article can be found on the NEJM website.