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Knowing Your Limits as a Med Student
Anthony Rudine -- While speaking with a friend the other day, he informed me that his wife was ill. As a medical student, I hear this a lot, from friends, family, and of course patients. However, my friend also requested that I come over and take a look at his wife and examine her. This made me somewhat uncomfortable.
In the hospital, I examine patients all of the time, suggest lab tests to order, even perform some minor procedures. But the difference is that there is a safety factor there -- other doctors watching me and helping me.
I am unsure of the legal boundaries, in our litigious society, and was unsure what to do. What I did do was go over, examine her, tell her what I thought, that I was not a doctor and that she needed to see one. She went the next day. My diagnosis was the same diagnosis that the doctor gave to her the next day, I just don’t have the expertise yet to be sure.
It is very difficult as a medical student, when half of the population believes you to be a physician already, people at the hospital call you Doctor, etc, to not give advice when asked, to not overstep your boundaries.
I think there is a very thin line that exists here, and we must always be certain not to cross it. Either way, if I crossed a line or not, my friend was at least compelled to go to the physician, if nothing else.
I just cannot wait until I can prescribe the pills and make the diagnosis myself.
September 5, 2006 | Permalink
Comments
You´re right.
Posted by: Marco | Sep 6, 2006 11:42:44 PM
l have the same problem, especially when l'm working in ER. most of the times docs are near by, but sometimes he has to go(our docs make a house calls)and l'm left by myself in ER, with nurses. l have good knowledge in emergency medicine, but not so much in internal, pediatrics etc. so if it is something l do not know l just explain that l am a med student and that they should wait for a doc, and we all get along just fine. but l can prescribe some meds,in emergencies, but never mess with antibiotics.and for a house call, well my family members often ask me to examine them, but if l found it to be something serious or even not serious but requiring medications to treat it, l advise them to go to their doc's if nothing else to register it in their charts.
Posted by: ANTE | Sep 7, 2006 3:38:28 AM
this is quite similar to the condition in our india also.though i am doing post graduate in anaesthesiology i have faced the same condition so i think you are correct
Posted by: santoshbhaskar | Sep 8, 2006 10:35:20 AM
In a serious situation, an excellent escape mechanism is the use of lab tests!
After a detailed history and examination, you tell them that they need some lab tests for the definite diagnosis and this can be done in the ER after being seen by the ER doc!
Posted by: T M | Sep 12, 2006 11:01:36 AM
I remember reading somewhere, I think in my physical diagnosis text, that when patients ask you for medical advice the proper response is along the lines of "I am a medical student; this is a question you should ask your doctor". Now I'm in my third year and already I see a number of classmates dispensing perhaps a little too much medical advice...
Posted by: David | Sep 12, 2006 2:29:04 PM
Your friend probably was worried about his wife. He probably wasn't sure whether to take her to the doc or not. You are always better off saying "I am a med student and I prefer you to go to the ER or family physician." You can prescribe no meds, so the only thing your exam would be doing would be delaying them getting complete help at an er...Don't put yourself in a situation where you could be held liable for mis-information or legal trouble for overstepping your bounds.....
I doubt your friend would expect someone to ask him to overstep his bounds in a situation. He shouldn't ask you to.....
v
Posted by: vonna | Sep 13, 2006 8:09:07 AM
I handle that pretty much the same. It's interesting that you think that there will suddenly be a day when you are sure. Like the day you get your diploma or finish residency or whatever, you'll know how to be sure. I don't think that ever really happens...maybe we just trick ourselves into thinking that it does.
Posted by: Sara | Sep 13, 2006 11:41:05 AM
when it's non-emergent, don't tell them to go to the frickin Emergency Department!!! if possible, it's better they go to their primary care physician. the ED is already flooded with enough BS that should be seen in outpatient clinics.
Posted by: | Sep 13, 2006 11:51:45 AM
Unless you were in some other medical profession , and licensed prior to this situation it is probobly best to advice your friend to her primary care provider.
Unless it is an emergency on a weekend then a one stop doctors office, and lastly the use of an E.R. I would save the E.R. for muscle, bones, and larger cuts.
I have seen people admitted for rediculous reasons, only because the patient demanded it.
Posted by: MR | Sep 13, 2006 2:21:15 PM
I also have faced the same problem several times ! Sometimes I feel very confident in telling these friends what I think they're suffering from and that they need to see a doctor etc. However, it has happened that after my friends had seen a doctor the diagnosis was a completely different one. Often enough I was also right which gave me even more confidence. But whenever I was wrong I felt really stupid and immature for having been so arrogant to think that I was already in the position to diagnose someone else without any real experience and without real examination or blood tests. Furthermore I still feel very odd when family members suddenly think of me as a doctor whereas most of the patients think I am a young nurse. And I feel kind of silly examining my own parents or friends because the relationships suddenly change in value, they get asymmetric.
I think this is just a learning process like all the other "emotional" skills. We have to get used to our role and we have to learn that our job is a 24-7 job, we are always doctors even in our spare time. And I think we should always try to remember the fact that some of us may be among the smartest ones in our class or that we may have good degrees. But that still doesn't mean that we're ready for the patients out there. And that we are - even if it's the end of med school - at the very beginning of a life-long-learning process.
I try to remember that everyday. But it's hard to walk on that fine line...between trying to establish a self-confidence that makes us credible when we are among all those experienced colleagues and patients who think we're still too young to be credible at all and trying to stay modest according to our knowledge and experience.
Posted by: Nathalie | Sep 13, 2006 2:36:52 PM
I'm surprised that anyone feels comfortable examining a friend, even if it was for suspected strep throat, whether you have a license or not. Kind of an invasion of privacy, that.
Personally, I'm with the folks who remind the friend that I'm a student, and they need to see a "real doc" to make sure there's nothing serious going on.
Posted by: andrea | Sep 13, 2006 3:59:18 PM
been in this kind of situation several times! and most of the times its my own parents who are the ones throwing questions like 'what's wrong with me?' or 'why is this so?' when they are not feeling well. i usually gave them my opinions, and in the end i told them i'm not really sure about that because i am still learning and they should go see someone more qualified. but the worst part is when they say 'what..u didn't learn this in med school??' ..how to react to that? anyone?
Posted by: AZAR | Sep 13, 2006 8:40:33 PM
i am a first year med student and my friend already called me up explaining the symptoms and asking what could possibly be wrong wtih her loved one. family and friends do expect us (student-doctors and doctors) to know a lot, be confident, and they look up to us for help. but i agree that even if one knows what the answer is, it is probably best to send people to see their doctor.
my father, an ER doc, too would never agree to treat anyone in the family, but always send us to see some other doctor.
Posted by: alice | Sep 13, 2006 9:44:56 PM
Even as a Paramedic, friends and family would often ask for a diagnosis of random symptoms, or suggestions of medicines to take. It is such a liability for anyone besides a doctor to make such calls- as to suggest medications for symptoms that may or may not be the root of the problem without further diagnostics. As inconvenient as they are for "normal people" that is what hospitals and clinics are there for.
Posted by: michael | Sep 13, 2006 11:13:31 PM
U guys are all right indeed. I feel the same here. In a developing country that I come from, some patients may even prevail on u to write meedications for them. They want to cut corners as they cannot afford the costs of seeing the "real doctors". There was this case of a boy whose parents approached me to come have a look at him. He appeared pale and hepatosplenomegalic. My diagnosis was typoid but because they boy exhibited some sort of hysteria, I adviced he goes GH fast. But another medstudent on the same street was getting to far in prescribbing something that nearly killed the boy. In the end I was vindicated for my lofty advice. True, the temptation is there, but in our kind of setting, there are ligious claims to make it stringent for those who are yet to finish medschool and qualify as real doctors
Posted by: Suleiman | Sep 14, 2006 5:04:57 AM
As a 2nd year student, people outside of my school ask me for medical advice once they learn i am studying medicine. The first thing I say, is that I am NOT a doctor and the person should seek professional medical attention. In basic science we learn the BASICS. So although i have learned quite a lot, i still don't feel its enough to go and diagnos someone. Besides i'm not allowed, and most of the times patients will need diagnostic lab tests to confirm, which i do not have, therefore I can not give any sort of accurate diagnosis anyways. So I just keep within my limits.
Posted by: Sharmilla | Sep 14, 2006 8:17:05 AM
well... at least be glad that you are not being treated like lowlife worst than plankton in the hospital which is the case here in Singapore.. occasionally we meet the nice chaps who treat the med students well, but most of the time, we feel like the family members and even some patients treat us more like parasites than anything else.
Posted by: Kai Jie | Sep 14, 2006 9:46:26 AM
I get this question all the time, but I think is a great opportunity to learn. I am honest and tell them that I am just a student and I could help them as far a I know. I have learn a lot just by listening and readying more about the problems. Remember we are studying and we learn also outside the classroom/hospital.
Posted by: Eddie R. | Sep 14, 2006 10:02:41 AM
As you said, there is a very thin line between what u can do but u r not alowed to, what u can legaly do as a a student and what u cannot resolve by yourself. I believe that even when u think that u MUST know exactly what to do in every case, u have to understand that can have doubts because u are not a doctor yet, and the knowledge u get with the current practice is as necesary(or more) as the one that comes from the books. We must learn to ask what we dont know and not to be afraid of that, we are people learning, and we can make mistakes allthought we hate to have them. We are not owners of the truth and we dont have all the answers. Every one around us can teach us a lot, and they`ll help to minimize our future, as people says in my country,"metidas de pata"!
Posted by: Laura | Sep 14, 2006 1:51:04 PM
It`is great that you express this feeling that like I think is very common in us. We have to learn, to trust in us and about our limits. Some day I read "practice medicine without books is like go to the sea having not boat, but practice medicine without patients is have the boat but do not have sea". I think we need use the time in the school to learn and eat books, then we will can go to practice this knowledge and our best effort to help people, but never forget that "practice make the master", really we need the experience. In your case, I have done the same. When someone make me a question our request my opinion, the better I can say, for now, is "please visit a Doctor"...and then I will go to study hard.
Posted by: Angelica | Sep 14, 2006 9:34:49 PM
As a medical student, you are learning medicine, but also learning to be a responsible individual. When people and patients have the impression that you are a doctor, it makes you feel good inside. However, misleading people is ethically and legally wrong. You have to step up to the plate, state you are a student and that you are learning so that some day you can help patients by yourself. Lies only benefit you short-term. Always tell people who and what you are....when you get on the hot seat, you won't have to provide other explanations.....
Posted by: Hetal | Sep 14, 2006 10:48:54 PM
your article was very close to what i am going thru and all the other comments helped guide me. thanks and keep writing.
Posted by: abhishek | Sep 15, 2006 3:13:40 AM
yep,exactly.here in the Philippines,even before when i started taking up physical therapy and had my further studies as a nurse(2nd degree),i always encounter such enigma in the hospitals where i worked with.Once you wear that white uniform and scrubs you've got there,people would look up to you and started asking for different medications,prescriptions etc. which would put you in a hot plate..i'm pretty sure that each pretensions would eventually pay you back later..better be honest and know where to draw your line.( wish me luck next year, I would be in my 1st year of medschool)
Posted by: MonF. | Sep 15, 2006 5:03:17 AM
Exactly right...
i just wanna say that i'm so glad,i see as a medical student you notice these boundaries.
wish you good luck during medical practice
Posted by: Sahand | Sep 15, 2006 7:01:03 AM
hi, this great i always do that whenever i asked.dont be shy to say:im a medical student
Posted by: | Sep 15, 2006 7:38:25 AM
I Often have similar Experiencers in the wards. This is when the patient asks what is the next treatment plann for her/him. Most of the time I know what the next pan is, but my limtations prevents me from communicating my ideas at that moment to the patient. I escape from the situation by Telling them " Senior doctor is to be consulted."
Last time when I went home, a neighbour of mine lost her conciousness and her husbad came running for help. Though scared and unsure what will be the situation that is waiting for me, I ran to the spot. When I reached there, I saw a lady on bed. She was out of the unconciousness. It lookd like she was too tired and had just undergone an episode of convulsions. But I had my doubts. In fact, I was scared. What if I was wrong. So I kept quite and suggested they go to a Dr, Preferably a neuro. Later I was informed that she was put on anti epileptics. I was happy that I was wright but at the same time I was sad that I was not confident enough to tell out what I diagnosed. May be I thougt that I was just a student.
Posted by: Bithun Balan | Sep 15, 2006 8:51:17 AM
agree with you.
Posted by: pauling | Sep 15, 2006 9:06:01 AM
people do expect med students to know a lot. as a 2nd year year med student in the phil, what i tend to do is just explain them their condition - what is wrong and how the disease will progress (after an md already diagnosed the px of course) based from what i read. promoting a healthy lifestyle is the best we could do as of now.
Posted by: Asid | Sep 15, 2006 9:32:51 PM
hey,,,,,i v bn in ur shoes before but mine wasnt just once....i am a final yr student in UBTH,in benin city,Nigeria.immmediatly pple see u carrying d white coat around dey start calllin u doctor both in d hospital, and outside d hospital.the last episode is of neighbour,he keeps coming to give me diffrent complains of his wife and children i always try to telll him what i think d problem is and my daignosis ,but der is always dis fear dat i mite b wrong so i always tell h but dat he shld stilll go and see d doctor but he stilll keeps coming to telll me he doesnt knw why he went to spend his money in d hospital dat i am alraedy a doctor dat d doctor gave to him......i honestly cant wait to b sworn in in d next 6months as a doctor.
Posted by: joy | Sep 16, 2006 3:54:12 AM
well we always have that same situation where people would see us as one of the authorities in the medical field.getting a medical degree is just one step ahead most especially when you're already there as postgrad intern wherein you are trained to treat patients in your rotation.But as a medical student in that case, just be honest to them that you still have a lot to learn and all you know is just only this and that...and just limit yourself in your own opinion or the way you look at the disease. maybe one day they can comeback for a check up.after all "little knowledge is a dangerous thing.." .God bless };->
Posted by: andy | Sep 17, 2006 2:44:57 AM
I'm agree with you, we aren't doctors at least not yet perhaps we can make the right diagnosis, we can't prescribe as ones because we aren't allowed to.
All we need it's to wait, and give our support to all our patients, maybe we can't solve their problems we must comfort our patients or even our relates.
Posted by: Jessica | Sep 17, 2006 7:03:13 AM
yup, that kinda thing quite often happen to me too..And it just happened yesterday when my friend was sick and her mother wanted me to tell her what to take as medicine..Well3x, i did wish i could tell her what was wrong with her and suggest the medication. I did really hope i could beside i could not just let her sick without doing anything...But then, i suggest her to visit a doctor and i accompanied her there. thank god, she was just fine, nothing really a problem...Ok, that's all...(have a nice day everybody...do not litter ok?!;D
Posted by: fillian | Sep 17, 2006 8:44:43 PM
I have faced this situation several times too... and it is tough, because on one hand you wish you had the confidence to just say what you think, but on the other hand you know theres always a chance that you might be wrong... sometimes it makes me wonder when will i know that i have all the knowledge and skills to do this on my own?? i still have two more years to go, but many times when patients approach and call me Dr and i am clueless it just makes me think: what if i had been on my own?!
good luck to everyone and Greetings from El Salvador!!
Posted by: Patty_Valiente | Sep 18, 2006 1:08:09 PM
I'm a resident and still even prefer to refer people to a 'real' doctor. As an intern I am much more confident and do express to patients what I have learned about their condition and additionally give them my medical opinion; however, just last week a clinic transporter started telling me symptoms. I listened attentively and at the end said that it sounds like he should go see a doctor, his doctor. Unless you're the one going to follow up on everything -capably too, then you should always send them to their usual doctor.
An interesting perspective... (from a lawyer friend).
A doctor and a lawyer were talking when a person recognized the doctor and asked him if the limp he had was serious enough to go to the ER. The doctor could see he was not in a lot of distress and but replied that it looked pretty bad and he should go immediately to get it checked out, so the person left for the ER.
The consulted doctor, who was somewhat annoyed by the person asking for an informal medical opinion, asked his lawyer friend how he handles people who ask him for advice. The friend replied that he just sends the person a bill in the mail for a consulting fee.
A few days go by and the doctor received a bill in the mail from his lawyer friend for "consulting services rendered".
Posted by: Dr. Phil | Sep 18, 2006 1:41:19 PM
Huh... tough comment...
well, even I have already graduated as adoctor, but still I'm a med student becuase one of my professor says this:"Medicine is a Never-ending Studies" ... :) So I think I have the right to make a comment too...
Well, as a medical doctor who working for NGO for Unreach Population, still I found some collegian who think they can tresspass their limit as a medical practitioner (or maybe they di'dn't realize it at all? I don't know...) by hiding it or transform it into things we called 'Practical' Clinical Skill (or Creativity)... but what I saw is just they are trying to make themselves sure that they 'actually' don't have limits. Well, we can generate practice across borders/country/policy, but still doesn't mean we don't have limit.
Afterall, on those area where the population is eagerly to achieve medical service that maybe they cannot have for long time, they think we (doctors) are god and goddess... well, it can really atrract someone profile into narcistic somehow... But in the end we can suffer if we cannot fulfill this idea, and the worst is: changing ourselves from our 'professionality' or even worst our 'profession'. {and so far I I know that's what always happen coz I've been there few times ago :( }.
Posted by: MikeGolan | Sep 19, 2006 3:47:47 AM
I understand your situation as it happens often with medical students of all years. What I was surprised to read however was your excitement to be able to "prescribe the pills". You should know that there is much more to being a Doctor than prescribing pills!!
Posted by: Darya | Sep 19, 2006 3:30:14 PM
Don’t be afraid . but i think that all medical students have these situations. When you will finish , maybe it’s psychologic problem . But you’ll have more confidence in you.
Posted by: faïssal | Sep 21, 2006 11:06:21 AM
I do have this problem also although we get the push to work as doctor I'm afraid sometimes that I let the patient dowen but with time we will handel this by our selves.
Posted by: soso | Sep 22, 2006 3:10:34 AM
This problem is the same everywhere, my non medical friends ask me for prescriptions. I think you did the right thing.
Posted by: Ijay | Sep 23, 2006 8:06:56 AM
I am a 78 year old third year med student, finishing what I started 45 years ago when I changed my life long profession to Engineering. When I appear in a white coat everyone calls me doc and I politely correct them, that I am a med student. When doing rounds in the phyc ward I corrected a patient that I was a med student he informed that I should either get out of school soon or trade places with him and maybe he could could finish sooner. I agreed with him and continued on my rounds.
Posted by: R. D, Holland | Sep 23, 2006 7:56:14 PM
i admit i hav also been guilty of suggesting treatment and making diagnosis without being out of med school... but mostly the query is from my family and friends. first i tell them that any treatment they take should come from a registered physician. many times i even turn away my family members and tell them to consult a physician.. but i do give them my opinion and emphasise that they confirm it with a DOCTOR. besides it gives me an opportunity to know whether the diagnosis in my mind was the CORRECT one.. also i read the comment posted by R.HOLLAND.. for a guy to go to med school at the age 0f 70yrs takes real GUTS AND CONFIDENCE. mr . holland whatever any one else tells u, u r an inspiration to everyone. to not give up and that it is NEVER TOO LATE to start learning........
Posted by: Boney Cherian | Sep 26, 2006 9:44:17 PM
Yeah... confusing a lot (sometimes)
thank God I am now a doctor.
But... here comes another problem ...
Posted by: Lany | Oct 3, 2006 2:49:00 AM
Its ok to feel scared...its alot of responsibility to give med advice or anything like that out of the safe zone...but even after graduation it will take years to get confortable in the skin of a doctor...
Ive never stopped doubting myself or asking for opinions even though im 99.9% sure...it comes with the territory but this is what we are here for and we must if not feel confident act it and do our best job always keeping up to date, reading, studing and learning and eventually our growing confidence will pervail...lol
Good luck
Posted by: Jean | Nov 18, 2006 10:53:12 PM
