A Resident Should Get Student Discounts, Right?

A lot of emphasis is put on the team aspects of modern medicine and in some circles, this is viewed as a negative aspect, or more precisely, an encroachment on the (often) paternal and blanket authoritarian rule of law. Different environments have varying degrees of teamwork and each individual physician, in any given clinical scenario has a sizeable impact on the "temperature" of the room. Over time, with relationships built, and with a trust between people, people who work well with people will enjoy a healthy workplace community, in general.

As a medical student, there is not enough time to let time naturally build relationships and trust, and the astute and emotionally competent ones set out to get to know the people they will rely on to do their 'job' which is being a physician-in-training. Of course, by the time the support staff knows your name, it is time to go to the next rotation.

In politics, and popular culture at large one often hears about 'the movement of the goal posts,' which in this slickly packaged reference to our now non-intentional post-modern society of fluid truth and it  stands as the short-sighted idol to the evil of a progressive and self-critical society. In reference to the life of a medical student in their clinical years, it is much simpler with, usually, a more myopic gestalt, at least in day to day operation. Each physician I've worked with over the years has certain things they uniquely incorporate into their daily practice -- which stems from the interpretation and utilization of the collective experience, this is how training works. Sometimes it may be just a different way of questioning, or perhaps idiosyncrasies in bedside manner and communication, and of course all this when incorporated with the art of clinical practice it can be summarized as the exclusive approach to the art of medicine. Each hospital has their own culture, and within that setting the residents, attendings and of course, each Graduate Medical Education office has their own requirements and needs, too.

Medical students are often seeing things that we've seen many times over, for the first time. Knowledge is compartmentalized and a big-picture perspective is yet to grow. However, the third year students, who are all fresh off of taking the first round of board exams, have the largest working knowledge of esoteric and abstract facts and mechanisms. Stuff that I used to obsess over while studying for step/level I now seems like a fuzzy memory. It is good to remember the foundations of pathophysiology and I appreciate the students for this.

If life has taught me anything, and as a dedicated life-long learner, I enjoy trying to soak up lessons and experiences that are, at times, uncomfortable -- I can boil it down to two maxims, which are generally true some of the time, it is this:

1.  NO GOOD DEED GOES UNPUNISHED When doing the right thing, or when doing something nice or considerate for others, expect to pay a price. You can make a clear choice when acknowledging this as general law of the Universe

1. BETTER TO REMAIN SILENT AND THOUGHT A FOOL, THAN TO SPEAK UP AND REMOVE ALL DOUBT This is definitely true in medicine. In front of patients, support staff and colleagues, it is imperative that one chooses their words carefully and thoughtfully. In some ways it could be described as 'defensive speaking,' akin to 'defensive driving.'

Obviously I did not come up with these well-used cliches, but I do recognize their utility. And, as far as being a med student is concerned, the second one should rule one's conduct throughout the clinical training years. Knowing when to ask questions and perhaps, more importantly, the difference between asking a question versus having a question and making a note to look something up, or asking later is a skill that can make or break a rotation. 

I've not been in the military and nor do I have a lot of first, or even second hand knowledge of what being in the armed forces is like. However, medicine has a defined hierarchy and properly navigating the power structure demands adaptive behavior. Of course, when you are moving from one distinct environment to another on a regular basis just as med students do, it can take a toll on those who cannot adapt and who are not adept at "reading the room." Like all professional relationships, success doesn't necessarily come with all parties understanding the expectations of their role but I assure you that if even one party has an issue with understanding or failing to live up to the expectations set forth, failure is forthcoming. And that is the key -- expectations set forth. Often the most important expectations of a role are the ones that go unsaid. How unfair! Not only are the goal posts in motion, but you can't even see the goal posts! Once again, when humans are involved, communication is key.

So, as the interview season heats up for residency and the match process, I tip my hat to those catching the red-eye that they booked on their other credit card, the one that's not maxed out, just to get back to their rotation and catch hell for taking a couple of days off. Just know that you won't be wearing the Ice Cream Man coat forever.