Dr. B Gets an F
Flashback to a year ago: I'm a first-year medical student--a fledgling, a novice--trying to integrate countless facts into a coherent understanding of how the human body works. Professors slam me with two months' worth of information inside of two weeks' time. They tell us that this is a necessary process, one that all doctors must go through: we must first learn the science of medicine before we can master the art of healing.
My life revolves around tests, labs, deadlines, long hours in the library and very close relationships with the baristas at Starbucks.
In the midst of this chaos, I developed a crippling ankle condition that transformed me into a concerned patient for the first time in my life. The pain started as a dull ache that I experienced only during exercise. Then it gradually worsened, to the point where I could barely walk to school the day after I'd played a basketball game. A golf-ball-sized bulge stuck out from my right ankle, and my two months of medical education suggested no remedies.
It was at this point--worried, looking for answers and desperate to get back to normal--that I decided to see someone.
Dr. B, the orthopedist I consulted, had attended a prestigious medical school and had gone on to complete an illustrious residency program and a fellowship specializing in the foot and ankle. I waited thirty minutes in the exam room before he walked in, flanked by a second-year resident wearing a long white coat. Dr. B himself wore a gray sports jacket and tie. His hair was slicked back, and he radiated authority.
After introducing himself, he glanced at my x-rays and MRI and started examining my ankles.
"You see this," he said to his resident. "I can fit my two fingers underneath his left foot, but none under his right. This patient has been running his arch into the ground." Glancing back at me, he told me to walk in a straight line.
As I walked, he said to the resident, "Yup, look at that. He's pronating way too much on his right side. Something's off with the mechanics there."
He went on talking to the resident, never addressing his comments to me, and using medical terms that I didn't understand.
Finally, scribbling in my chart, he said, "Sit down."
I sat, feeling confused.
"All right," he said, "I'm going to order you some rehab, and I want you to get a pair of orthotics. Rest your ankle, and come back and see me in five months."
He handed me the chart, stood up and turned to leave.
"When you say 'rest my ankle,' what does that mean exactly?" I asked his back. "I was hoping to play basketball in a few weeks, and I want to run a 5K a couple of months from now."
Turning back and grinning wryly, he said, "I wouldn't do any running until you see me again. The way your ankle looks, I'm more concerned with your walking normally at age thirty-five than running in a 5K next month. Any other questions?"
He seemed annoyed at being delayed. For my part, I felt panicky. What had seemed like a small problem now seemed like much, much more.
"Is surgery an option?" I asked.
He paused, then said it was risky and probably not the best idea.
My mind was racing. I couldn't bear the thought of giving up physical activity--one of the few pleasures in my life of stress and studying. But I asked no more questions, for fear of irritating him further.
Dr. B turned again, opened the door and walked out.
My visit to Dr. B was the worst encounter I'd ever had with a physician. I'd gone in seeking answers, guidance and direction. I came out feeling scared, confused and worried that I would never be the same on my feet again.
I didn't make a follow-up appointment .
I did start physical therapy, as he'd recommended, and I made an appointment with a podiatrist recommended by a friend.
The physical therapist was wonderful. And he was incredulous when I told him of Dr. B's concerns about my ability to walk later in life.
"A doctor told you that?" he said. "I've seen people with worse problems than yours recover 100 percent. And you're young! With rehab and stretching, we can have you running and playing basketball again. I'm confident of that."
I left the session with a plan for my recovery, and feeling a lot more hopeful.
Then I saw the podiatrist, Dr. Stevenson. Podiatrists attend podiatry school instead of medical school and are trained in the diagnosis and treatment of foot and ankle conditions. When I repeated Dr. B's words to him, he looked at me and said, "You know, I've seen hundreds of people with problems worse than yours, and you know how many I've told they would never run again?"
"Zero," he said, making a circle with his right hand.
After having me walk in several straight lines, he studied my feet and ankles for a long time. He showed me an anatomical model and explained what was going on: My arch had started to collapse and apply extra pressure on an already injured posterior tibialis tendon. With rest and the help of an orthotic device, the tendon could heal--and I could return to running and playing sports. He then sat down and answered all of my questions; I had plenty. I left feeling much more optimistic about my condition.
Being a patient and seeing three different professionals gave me valuable insights into the doctor-patient relationship. Although Dr. B had attended prestigious schools and on paper had more qualifications than the physical therapist or podiatrist, his lack of compassion and poor communication skills made him a far inferior clinician.
I promised myself at that point, while still a beginning medical student, that I'd never practice medicine like Dr. B. I want to be a caring physician who not only makes the correct diagnosis but also facilitates the healing process by listening to, reassuring and working with patients.
In my first year of medical school, when the focus had been on memorizing medical and anatomical facts, my own anatomy managed to teach me a pointed clinical lesson without any cramming at all.
A year later, many of the facts I stuffed into my head are lost to me, but that lesson has stayed. It had better--if I'm to be the kind of doctor that I myself would want to go to.
About the Author:
Gregory Shumer is a second-year medical student at Georgetown University School of Medicine. After graduating from the University of Michigan with a degree in Biology and Asian Studies, Gregory spent a year teaching English to middle-school students in rural Japan. He started writing essays, poems and short stories in high school and now continues to enjoy writing as a medical student.