A Little Knowledge is a Dangerous Thing- in which I discuss Medical Student Syndrome

Dear Reader,

I am generally attempting to take the recent turn of events which resulted in my using a wheelchair with good humour. However, there are circumstances in which it is difficult to be cheerful and polite to people. What follows is an example of one such circumstance, and I hope it is of value to you when you next counsel a friend or, if you are in the helping professions, offer advice.

It relates to something which I will call “Medical Student Syndrome”; I am sure this is not a syndrome which affects medical students alone, but I am sure medical educators would give a number of examples illustrating the point I’m making!

I have a dear friend who also happens to be a medical student. I think she is amazing. She is a Mum, and does a great job with her lovely kids. She works really hard and has completed her education whilst having her kids. She is a kind person, who really feels called to helping others, and is literally putting her money where her mouth is by going back to college as a mature student to study medicine.

She called round to see me the other day. As is sometimes the way, she seemed more appalled by what has happened to me than I am. She behaved as if what has happened to me is tragic, and i hate the ‘tragic-crip’ narrative almost as much as the ‘super-crip’. Sometimes it’s hard for people to understand that although this is kind of new and shocking for them, I’ve been living this for nearly a year. I haven’t exactly made peace with it, but I don’t find my situation tragic. I have a lovely family, I have lots of support, I don’t feel ill so much as injured- I’m in pain but I don’t have flu. I try to be mindful in my daily life and squeeze joy out of the brief periods of activity and the time I get with my kids. Viewing my life as a tragedy disempowers me- assumes I’m not as capable as before. I may be tired, in pain, and not leaping around, but I’m still capable of everything that’s important and I wouldn’t give up my family for the world.

She looked appalled as I told her the result of my recent assessment. But the part which shocked me was when she said

“…but that’s wrong! I’ve just had a lecture in Physiotherapy and Occupational Therapy- and they were very clear that ‘if you don’t use it, you lose it’! you must get out and about!”

Now, where do I start.

  1. Attending a lecture on something does not make you an expert. It is hard for some very academic and bright people to understand that all their learning may not be sufficient to make a fully balanced and nuanced assessment of a case. That comes with years of learning, academically, or on the job, or with lived experience. It is easy, as a student, to see your latest studied condition everywhere- it is like internet self-diagnosis is for the general population.
  2. Other professions hold skills that are not taught as part of the Medical training. Some people believe that Doctors approach Gods with their learning, understanding and compassion. Some of these people will be your patients, and they will be sorely disappointed with you when they discover you are all too human. Some of these people become Doctors, and I dread to think what happens when they do, but I think that misunderstanding the benefits of the multi-disciplinary approach may be the least of them. When working as part of a treatment team, it may be the unqualified member of staff that the patient has opened up to… It may be the ward domestic that holds the key to understanding this individual. Shock horror, it may be the patient themselves who can inform you of their condition better than any mentor or textbook! Do not assume you are superior to other members of the team just because you are senior.
  3. Some professions actually hold better solutions for an individual than the medical establishment. We’re now approaching heresy, I know. Indulge me, kind medical student. In my case, unless I go for the surgical solution with the terrible long rehab and low chance of ultimate success, it is the PHYSIOTHERAPIST who is the treatment team lead. NOT the doctor.
  4. Without access to the case notes, best not to speculate. I love my friends. And people who know me would describe me as an open book. But what I have done with the health professionals involved that I make every effort to avoid with family and friends is tell them exactly where it hurts, how much it hurts, how long it hurts for, what the recovery period from the pain spikes is, and what that means for my daily activities, this is information I choose to share in the context of relationships that can effect change.
  5. As in Medicine, other professions have specialities with different approaches.My friend was taking the brief introduction to physiotherapy and occupational therapy in neuro-rehabilitation, and applying it to my musculo-skeletal condition. There are completely different approaches to take in this situation.
  6. Be my friend, or my doctor, but don’t try to be both. It is always good to be mindful of boundaries in relationships. If you’re my doctor, then I would be surprised if you invited me to your house socially (even if because of Transference I would quite like to be your friend). If, because of Counter-transference, you want to be my friend, then you should talk to a colleague about it and consider allowing someone else to provide my care. Similarly, if you’re my friend, I would be concerned if you felt you wished to review my medical treatment (even if I do occasionally show you unexpected lumps or bumps!) Give me advice to see my G.P., or even offer to take me there!

Dear Reader I bit my lip and didn’t correct her. I just shrugged my shoulders and we continued the conversation. I’m not worried, because I know she has lots more training ahead. In our NHS, she is likely to have to ask everybody she works with to help her at some point. But we have all met people who became doctors and are now arrogant and unable to see the perspective of the people they set out to treat, or the other people involved in their care. I sincerely hope she doesn’t turn out to be one.

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4 Comments

  1. Fish

     /  February 14, 2011

    The other side of this: Most of my friends-and-colleagues know me as “The Mental Health Bloke”, and seek me out for bits and pieces of advice occasionally.

    This isn’t always signposted – but I try to “signpost” it myself by saying something like “well, if I had my professional hat on….” – and if that gets a positive response elucidating from there, but otherwise holding back from imposing that role on people.

    Working out when to take which “role” in your r/ships is, I think, a matter of experience as much as learning. In an ideal world, your friend would welcome your feedback and take it on board in future. [Not that it’s an ideal world with friends most of the time….]

    Reply
  2. Yes….I agree Damini-

    I’ve often used my knowledge to help people become aware of stuff that’s out there in the way of services or things that are really a good idea to tell the G.P. I have even offered the failsafe “if I had my professional head on” myself on occasion! I think it’s fair to say that it’s wise always to be cautious that you may not have all the information, therefore remember fools rush in where angels fear to tread…

    Reply
    • Fish

       /  February 14, 2011

      I always do put in the relevant caveats etc.

      Actually, in my experience admitting one’s limitations *builds* trust – certainly helps build the enabling r/ship you need for MH work.
      And when people are clear about what’s your professional opinion and what’s your “instinct”, they actually start asking for your instinct a lot more….

      Reply
  3. You’re always great to talk to, from my (admittedly virtual) experience- and that’s something to be valued wherever it’s found!

    I think you’re right, and it would do Doctors no harm to occasionally preface a referral with “…Although I think it’s none of the sinister things I have to watch out for, I don’t know what that lump is. But I know a Dermatologist who is sure to know, and am referring you right now.”

    But I believe “instinct” often turns out to be a clinical judgement based on reasoning that we don’t “catch”, so we assume it’s come from instinct- I believe that usually when we break it down it turns out to be based on clues that spark off something in us. E.g. we may see a patient and just get the “hackles” that tell us he is about to explode- but this is actually a combination of subconscious awareness of his increased respiration rate, clenched fists, smell of alcohol and so on that we don’t put into words as fast as judgement is reached.

    Reply

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