We went from cold and snowy Minnesota to warm and sandy Florida for one of Blade’s selective weeks. He signed up for a week of shadowing various physicians in the emergency room at the Mayo Clinic’s campus in Jacksonville, Florida. The following are a few of his Lessons from the ER in Medical School.
We tagged along and made a family trip out of it. The 70 to 80 degree weather, soft sandy beaches, and salty ocean air were a nice escape from the -10 to -20 degrees, snow covered lawns, and icy roads of Minnesota!
The ER visit for our daughter at 1 a.m. and the subsequent sick days just made it extra memorable. She spiked a fever of 105 degrees at one point. Thankfully the fever broke after two days, but that is all a story for another time.
Selectives at the Mayo Clinic
Many people have asked me since our trip, “Wow, how are you guys traveling already?!” “How is he rotating at different hospitals now?” “How come you get to go to Florida for medical school when you’re in Minnesota?” The Mayo Clinic Alix School of Medicine explains,
“As part of Year 1 and Year 2 curriculum, selectives are dedicated 1-2 week curriculum blocks that enable students to experience the self-directed approach behind the design of the medical curriculum, emphasizing personal responsibility for the learning experience.”
Students can set up a selective or participate in ones that have already been established. Students often travel to the other campuses within Mayo’s system to learn as part of their selective week.
The Mayo Clinic is a teaching hospital. The goal is to lead, transform, and heal.
“We focus on clinical training that redefines medical education. Our faculty members will know you by name and you’ll be surrounded by learning opportunities that you won’t find anywhere else. Our students don’t have to wait to make an impact in health care. They start here.”
We have both enjoyed the selective weeks that the Mayo implements. They are an integral part of the medical program. Not only does it give Blade an opportunity to shadow, explore different specialties, and expand his skill set, it also switches it up.
We get to see more of him (sometimes) during these selective weeks than we normally do during the six week blocks of classes. To read about one of his more intense selective weeks, check out Lessons from the OR in Medical School.
The Mayo Clinic at Jacksonville
Many are unaware that the Mayo Clinic actually has three campuses. The Minnesota campus, the Arizona campus, and the Florida campus.
According to the 2018-2019 U.S. News & World Report, Mayo Clinic’s Florida campus is ranked No. 1 in Florida and No. 1 in Jacksonville. Florida’s campus also is known for specializing in cancer, neurology, and neurosurgery, among others.
Because Blade is interested in emergency medicine, he was able to set up a selective where he could shadow three physicians in the ER while in Jacksonville. He learned different lessons from each physician because they all had different styles of teaching.
Lessons from the ER in Medical School
PHYSICIAN ONE
The first two days I spent shadowing physician one. We saw everything from scleroderma to bacterial infections to possible heart attacks.
The doctor I was shadowing pushed my thinking and diagnostic skills. He never gave me the answers, but rather expected logical reasoning from me. Every answer I gave was followed with the question, “Why?” Even when I didn’t know where to start, he would encourage me to start with something I did know.
My two main takeaways from physician one were to cast a wide net and to not take things personally.
Cast a Wide Net
Every new patient interaction started with a medical history and current symptoms conversation. Afterwards, we would exit the patient’s room and return to the physician work station.
Physician one would always ask me, “What do you think it is?” I would respond with “I think this because of this or that,” which was typically followed up with the question, “But what if the patient also had this symptom?”
Although my thoughts weren’t wrong, they were often too narrow. Partly because my medical exposure and my knowledge of
disease is a bit limited, but also in part due to me grabbing onto one symptom and connecting it to the most common diagnosis.
The nets I was casting were often too small to catch everything I would need to as a practicing physician. The attending really pushed my thinking to help me realize that going down a designated path too early may cause me to miss things that seem insignificant but are actually important.
A lot of issues look like the same thing initially. Chest pain doesn’t just mean heart attack. Every symptom or test run could change the diagnoses.
Don’t Take Things Personally
A patient came in covered with hives and was not happy. They had been super itchy for days and were noticeably agitated. They were making it difficult to get IVs in and mouthed off to us and the nurses consistently. This patient really was difficult to work with.
I asked, “How do you deal with someone like that?” He responded with a question.
“Think about getting one bug bite and how much that annoys you. How would you feel if you had a hundred of them with no relief?”
Awful. And here was this patient, covered in itchy hives without any relief or healing. Of course they’re going to be impatient.
He reminded me that suffering brings out the worst in people. It doesn’t reflect on you as a physician, it reflects on the human element of suffering.
In the ER, you are going to run into people who are upset and hurting. So don’t take things personal when a patient is mean.
PHYSICIAN TWO
I shadowed physician two day three of the selective week. We saw typical ER cases like lacerations, abscesses, possible heart attacks, and infections.
However, this particular day I didn’t just observe or assist I did — let me explain.
The doctor had a “learn by doing” mentality. So, I actually ended up doing quite a bit on my own. I performed my first suture on a patient who was awake. I lanced an abscess. And I even started the differentials (or interviews) of patients on my own.
The two main takeaways from this particular physician were to step outside your comfort zone and try then work to perfect.
Step Outside Your Comfort Zone
You have to be willing to step outside your comfort zone. A physician is a problem solver. People come to you because they don’t know what is wrong and want you to fix them.
Doing my first differentials I was a little nervous. A differential more or less is when a doctor goes over everything that could be wrong, justifies the diagnosis, and then thinks about what to order to confirm and treat the diagnosis.
In my medical school infancy, I had done this maybe ten times with simulated patients that acted a certain way to help me solidify concepts. This wasn’t a simulation. The problem could literally be ANYTHING.
I didn’t want to screw up. These were real patients with real stories and real families. But, here I was, doing my first real workups, which required that I do my best and step outside of what I had previously experienced.
Rest be assured, I reported directly to the attending, who did his own workup right after me. However, I still felt the weight of other people’s problems as I talked to them. In order to function in this role, I had to push my boundaries and put to use my education.
Try then Work to Perfect
This same evening I was able to do something that I hadn’t done before—my first suturing on an individual who was awake. I had previously closed on a patient after an operation (hear more about that from Lessons from the OR in Medical School), but this was a whole new ball game.
An individual came in with a deep gash to their leg. After looking at it, the attending asked if I had done sutures before. I replied that I had in surgery and on a practice pad.
The physician nodded approvingly, handed me the suture kit, and said, “Don’t screw up.” Talk about jumping in the deep end.
The patient was unhappy to be there and at one point told me they wanted to leave and proceeded to try and get up to go. Luckily, the patient’s family was there and talked some sense into the individual.
The issue with a tramatic injury is that the flesh doesn’t always line up just right. A surgical incision is clean cut and usually straight as an arrow, making closing up much easier. This patient’s injury was not straight, and in some areas the skin had torn away, making it jagged.
I did my best and had the attending check my work before the patient was released. The physician offered a suggestion in one area, which I corrected by adding a new suture.
Ultimately, I learned you have to be willing to try new skills and then work to perfect that skill. Being my first time in an emergency setting, I feel like I did well closing up the wound, but I would be lying if I said it was perfect.
PHYSICIAN THREE
My last day of shadowing I observed physician three. This was the busiest of all the days. The ER was so packed that patients were on beds in the hallways.
I mostly observed this particular doctor and the patients he worked with. However, I probably learned the most valuable lessons.
Go the Extra Mile
This attending physician would often stop, pause, and share with me a simple, yet important lesson and then go straight back to work.
At one point, an individual came in with symptoms of possible shock with a really low blood pressure. This patient was known for illicit drug abuse and alcoholism. We busied ourselves stabilizing the patient, and after all was said and done, we decided to keep them for a little observation before discharge.
The patient asked for some food as they hadn’t eaten all day. To my surprise, the doctor left right then and there to get a sandwich and drink for the patient from the break-room.
In the break-room, the physician asked me if I thought the patient would like a blue or orange Gatorade more, to which I responded blue.
He grabbed a blue Gatorade then said something that really caused me to think.
“Every person that walks in the door expects a correct diagnosis and correct treatment. What makes you a fantastic physician is doing everything beyond those things.”
Here was this physician, busy as can be, juggling multiple things all at the same time. Among the craziness, he had the decency to not only get a sandwich, but care enough to pick a drink they most likely would enjoy. It really didn’t take too much longer to do so, but in meant the world to the patient.
I must confess, when we brought the blue Gatorade, the patient actually asked if they had orange. So, off I hurried to the break-room to make the switch.
Eliminate the Totem Pole Mentality
Another simple but profound lesson was learned as we cleaned our stethoscopes after seeing a patient. The attending pulled out a wipe that happened to be the last one to clean his stethoscope. He grabbed the empty canister and made for the recycling bin.
A nurse noticed the doctor doing so and said, “You don’t need to pick up garbage. It’s not your job. Let me get it.”
As tactfully as ever, he responded,
“Its not your job either. I can do it.”
After disposing the canister, he looked at me and said,
“The people that have the totem pole mentality think that the people below them should take care of the rudimentary jobs, like picking up garbage. But, when you get rid of that mindset, everyone is on the same playing field.”
I saw in practice what a teamwork mindset did for this physician. The nurses that worked with him loved him. They weren’t afraid to approach him, nor were they timid in acting when he was in the room.
You want people to want to work with you and feel comfortable interacting with you, especially in medicine. Medicine is a teamwork field.
When everyone is appreciated, people don’t feel insignificant. Rather they feel important and needed. Which is exactly what they are.
Gratitude
After a week of shadowing, I learned many lessons from the ER. Reflecting on these experiences only makes me feel blessed. I feel an immense amount of gratitude to be part of such an amazing medical program and have the opportunity to shadow and learn from some of the world’s best physicians.
This is a collaborative post written by Blade and Kristi Hargiss.
