Dear Med Student:
I’m really trying to understand that you are scared because you are in pain. You came into my office to have your birth control method checked on. I gave my recommendation for your follow up care, which you questioned and rejected. Insisted my clinical judgement was somehow incorrect. I could feel myself getting flustered and frustrated, all of my insecurities and lack of self-assuredness leaking through my careful veneer of confidence.
You ask me question after question, complicated molecular details of the antibiotic that I want to prescribe to you that I cannot answer, because that’s not what my training focused on. You demand an ultrasound that is not clinically indicated because it will make you feel better. I acquiesce because I don’t want to fight you. I review that I don’t think its necessary, but will get the referral for you anyway.
You keep asking questions, can’t decide what you want, and even after we have decided on a plan you have more questions. I have five other patients that I must see, and I feel my day spiraling down hill before I can even finish my coffee. I’m under a lot of stress, Med Student. And you are monopolizing my time. I feel my empathy slipping away, my one bastion against the anger and burn-out many providers eventually feel.
I try to understand, I try to counsel you through it to the best of my ability, but when you insist on speaking with a doctor to get the answers I cannot provide you with, my confidence and sense of competence are shattered. Who is teaching you to treat nurses in this way, dear Med Student?
I know you have spent the past many years locked away, studying books and that your clinical knowledge is stunted because of the way medical schools train our doctors. You have just entered your first rotations, and I know you believe you have solid clinical judgement. I have been working full-time for almost a year and still doubt my knowledge and my skill.
Eventually, one of our consulting doctors speaks with you on the phone. She backs my recommendation and you decide to go ahead with it. I seethe in anger and feel like an idiot and feel justified all at the same time.
I am upset and flustered. But I must move on with my day. I walk into my next few appointments. Stumble over my words. Speak a little softer. Think about how young I must look to my patients, a child in dress-up.
I do something I have only done a handful of times in the past year, and that is close the office door and cry.
Dear Med Student, my wish for you is that you learn humility.
My wish for you is that you learn to treat other providers like human beings, even though through much of your training you are expected to be a learning and answering machine.
My wish for you is that you learn from nurses, and midwives, DOs and PAs and medical assistants. That you learn that we all do different jobs and have different skills, not simply that we are on a hierarchy with physicians at the top.
My wish for you is that you learn to be gentle with your health care providers, and that just because you study one area does not make you an expert in all of it. Learn to trust your providers, because we want what is best for you, and making them feel inadequate to care for you is no way to win an ally.
And while I do not wish you the same feelings that your visit erupted in me, I know you will soon experience them. Either at the hands of patients that do not understand your medical jargon or from attending physicians that will train you and sometimes haze you. You will experience it from classmates and residents, as your training programs foster competition rather than collaboration.
I know you will write off this visit, probably tell your medical school classmates about the NP that couldn’t answer your questions. You’ll make it into a hilarious story. Maybe you will even use this as evidence in your heart that nurse practitioners shouldn’t practice independently.
In some way I wish I could let you know that I will probably never forget you, and not in a positive way. I will never forget that feeling of inadequacy and shattered confidence. That this happened weeks ago and I still think about it every day.
My wish for you, Med Student is that you learn from the wise words of our dearly departed Maya Angelou, may she rest in power, that:
People will forget the words that you say, but they will never forget the way you made them feel.