Over the last two decades, I have spent a great deal of time working with and teaching medical students. Extraordinary sponges of knowledge, these eager scholars emerge from the dark cave of incessant testing and classwork (dominating their first two years of medical school) only to be bleary and blinded by the deep complexity of the patients in their charge. Sated with knowledge, but bereft of experience, they find themselves going down abstruse rabbit holes of inquiry, entertaining inconceivably long lists of diagnoses, and performing the most contortionist of exam maneuvers. After emerging from the patient’s room (usually fifteen minutes later than desirable), students find themselves dazed yet delighted. They are finally practicing medicine.
What unfolds next is a torrent of semi-organized information offered with pressured speech and intermittent eye contact while hands fumble through countless papers of chicken-scratched notes. As we begin to entertain the crux of the visit—what is the matter and what should we do about it—their eyes turn glassy with a faraway look. Drawing from the recesses of neurally-stored knowledge, they offer a tangled web of possibility and impossibility. Somehow they are no longer in the room with me, but lost in the book-stacks of memory. Stuttering, stammering, and blushing, they finish—uncertain with how they did, but glad it is finally over.
That is when I look at them and ask, “Tell me, what do you really think is going on?”