One of the more rewarding parts of fourth year for me has been seeing my own plans form part of a patient’s plan of care. By this time in my fourth year, I have acquired enough knowledge and experience to directly impact patient care in a meaningful way. Its possible to do this as a third year student , no doubt, but it is just easier with a year of experience under my belt to recognize things that could or should be done and bring it to the attention of a resident or attending. Being a medical student means taking care of fewer patients than the residents, this often leaves time for a more intimate exploration of the patient’s chart which sometimes translates into a finding that impacts patient care. Also, being the first person to round on your patients in the mornings means that you are the first person to pick up an important finding or development.
A more recent an memorable example occurred on my general medicine sub-internship. I was helping to take care of a kidney transplant patient admitted for an acute decline in renal function. I rounded on this patient the first morning of his admission. When I saw the patient in the morning he reported development of chest pain with inspiration during the night. Knowing that the patient was acutely uremic by the numbers, I became concerned for uremic pericarditis. I did an extra-careful cardiac exam. I couldn’t believe my ears at first – I could hear something other than the first and second heart sounds – it wasn’t a murmur, it wasn’t an extra knock or gallop – it was something that I had never heard before in a patient – a friction rub. It was unmistakable – it was bad for the patient – but I was still excited. I rushed back to tell the resident. We rounded on my patient first that morning; the resident heard the rub too. An ECG was ordered and showed changes consistent with pericarditis. The patient went for dialysis catheter placement and had urgent dialysis for indication of uremic pericarditis. Later on the resident congratulated me: “Good catch.”
I didn’t need the congratulations of my team to feel good about it though, making a difference in this patient’s care was rewarding in its own right.