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What I Do Not Tell The Medical Student
What I Do Not Tell The Medical Student
What I Do Not Tell The Medical Student
of test results to patients with implications immediate release of electronic health infor- tion to the patient with cancer. Oncologist
for clinical workflow. JAMA Netw Open mation. Am J Surg 2022;224:27-34. 2000;5:302-11.
2021;4(10):e2129553. 5. Baile WF, Buckman R, Lenzi R, Glober
4. Leonard LD, Himelhoch B, Huynh V, et G, Beale EA, Kudelka AP. SPIKES-A six-step DOI: 10.1056/NEJMp2312953
al. Patient and clinician perceptions of the protocol for delivering bad news: applica- Copyright © 2024 Massachusetts Medical Society.
Immediate Release of Test Results to Patients
I cannot bring myself to embody into the arms of her family. selves, the people behind the illu-
them. The knowledge is like the The patient went to college at sion? Would I bring him into a fold
face of Medusa, like the sun dur- Michigan State, where her dorm of people who could better support
ing a solar eclipse: I cannot look was shot up by a gunman last one another by collectively shoul-
directly at it without risking con- year. I do not tell the medical dering the weight of our shared
sequences. To fully bear the weight student that in my darkest mo- fears and vulnerabilities? Who
of such immense knowledge is ments, I have wondered if I have could better support the people we
still beyond my ability. ever done any child any favors by are supposed to be caring for by
I do not tell the medical stu- patching her up and sending her interrogating the realities and illu-
dent that I am still afraid to wield back out to struggle in this vio- sions of our own control and pow-
such power, and even more afraid lent world of heat and guns and er? Would he be better prepared for
of the damage that I will do when contagion that adults have created the grueling days of his training
wielding it poorly. for her to grow up in. I do not tell and career that are yet to come?
I remember another code dur- him that given sufficient time, Or perhaps I would crush an
ing my first year of attending- Death will win every battle. illusion that is necessary for us
hood — ventricular tachycardia I do not tell the medical stu- to continue doing this work, an
due to high-dose exogenous cate- dent what I often tell my fellows: illusion that sustains us by prom-
cholamines in a young woman that it gets easier, but it never gets ising, even untruthfully, that some-
with terrible septic shock. For easy. I spent so much of my train- day such fearless mastery will be
reasons I no longer recall, I ran ing expecting that once I was a ours. Perhaps our patients also, at
the code with help from only two senior fellow, once I was an at- least sometimes, need to believe
other sets of hands. The bedside tending, once I was an attending in this illusion.
nurse heroically did the jobs of with a few years of experience un- I don’t know. And the elevator
three people. My first-year attend- der my belt, I would no longer be doors are opening.
ing colleague, eyes as wide as afraid. The gnawing would ease, “Thank you,” I say, as he walks
mine over his mask, charged the the weight would lighten. When away. “I’m glad you enjoyed your
defibrillator. Although it felt to this comfort did not materialize, I time here.”
me like we fumbled through the wondered what was wrong with Disclosure forms provided by the author
resuscitation with too few staff me, why I was such an awkward are available at NEJM.org.
members and too little experi- failure, why I so often felt more
ence, we successfully constructed culpable than capable. From the Division of Pediatric Critical Care
Medicine, C.S. Mott Children’s Hospital,
the illusion. I know we did, be- I do not tell the medical student University of Michigan, Ann Arbor.
cause the young woman’s mother that I now recognize it as patholo-
later found my mother on social gy to be unafraid to lose a child. This article was published on March 16, 2024,
at NEJM.org.
media to tell her so: “Dr. Erica was What would happen if I did tell
in complete control.” We delivered the medical student? What if we DOI: 10.1056/NEJMp2313322
the patient largely unscathed back
Alzheimer’s Disease — Managing Stages of Dementia revealed, to each other and to our- Copyright © 2024 Massachusetts Medical Society.
What I Do Not Tell the Medical Student