A few years ago, I was sitting in clinic with a student that seemed quite anxious. I asked her what was up, and she said she was close to having to pick her specialty, and still hadn’t made up her mind. She said she was caught between ob/gyn and orthopedic surgery, and couldn’t decide.
“So which one do you like better?” I asked.
“That’s interesting, as they are two quite different fields.”
Also on my mind was that as an OB/GYN student, I thought she was average at best. In all honesty she seemed quite bright but not at all intersted in OB/GYN.
“So OB/GYN huh? I didn’t peg you for that. You don’t come across as loving it.”
“Yeah, but I do like it. And my mother thinks I should do it.”
“So what about ortho? Do you love that?”
“I like that. My dad thinks it would be great for me to be a surgeon, and that I would make a lot of money.”
At this point it occurred to me that of the six weeks I had worked with this woman, I had only seen her truly excited on one occassion, and that moment was when she was presenting cancer cases at our tumor board conference. She had prepared a tremendous amount of information about the cases she was presenting, and had seemed to be particularly focused on the pathology slides. She presented all kinds of information about the slides that other students would have just ignored. More that that, she was just beaming as she presented it.
“So… remember when you presented those slides at path conference? How did you feel then? It seemed like you were really into it.”
“I love that stuff. I love those slides, I really like looking at them and trying to figure out what it means about the patient’s disease.”
“OK…. so you want to do OB/GYN because your mom thinks it would be good, and orthopedics because your dad thinks that would be good and you would make a lot of money. The thing is this – you don’t really love those things, but you love looking at slides. What if I were to tell you that there is a job out there where you can look at slides like that all day, hang out with people who also love looking at slides, have great hours, never work at night, and get paid tons of money……..
Its called being a pathologist.
Ever think of doing that?”
Her eyes flew open, almost startled, like she had never really considered it.
She went into pathology and loved it. Her parents were pleased she found a job she liked, because in the end, like all parents, they just wanted her to be happy.
I have the pleasure of working with our resident GYN team for several weeks every few months, rounding on their patients and teaching each morning. One of the best parts of this is hearing our medical students present their cases.
Presenting patients is a skill that takes a great deal of time to master. Each student is taught the basic form of a medical presentation at an early ‘age’ – Subjective, Objective, Assessment, and Plan. Each of these bits can be broken down into many subareas, such a Past Medical History or Social History (part of the subjective usually), Chest Exam or Labs (parts of the objective), or individually listed problems (each parts of the assessment and plan.)
This sort of structure is both an aid to great presenting and a hinderance. It helps because it gives the presentation a structure that is easy to follow, and over the years of hearing such presentations the listener has created little boxes in their mind, and had developed the expectation that these boxes will be filled in a specific order. By following this structure, the student fills those boxes and thus creates a structured narrative that fits the listener’s expectations. This can be very functional and efficient. The downside is that if the student follows that structure too tightly, the presentation sounds stilted, like a person reading a spreadsheet. This creates a presentation that is technically correct, but lacks grace.