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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Friday, September 14, 2007

Short White Coat: We learned that for a reason?

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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I'm back from a summerís hiatus from medical school -- the last weíll get until graduation. With the recent start of a second year crammed with endless classroom hours and totebags of take-home work, as well as the vaguely looming threat of next springís Board Exams, training has shifted into high gear.

Last spring, I wrote about learning how to talk to patients, how to use empathic words to connect with them and accumulate facts about their medical histories. In our second-year version of Patient Doctor class -- in which we'll actually touch and probe our guileless test patients -- we discovered this week that we need to know why we're asking each question. It's called taking an "informed history," and it requires steering the interview toward a shifting target diagnosis. If asking about a headache complaint, we must suspect migraine, tumor, or hemorrhage (among other options) and ask questions that will parse out the true cause.

Inherent in this new expectation, and in the courseload we have already undertaken in second year, is the notion that we should apply our cumulative knowledge from the past year or so. A fair demand, yes, especially since weíll be treating patients as third-year students in a matter of months. But I canít help but think I have a lot of learning -- and re-learning -- to do before I can call myself informed.

Our professors reassure us that this fear of ill-preparedness is normal at any stage of our processive march to full doctorhood. But with a year of school under my belt, I've already acquired the uneasy feeling that Iíve learned these things before, that I should know to ask if the pain always is in the same place, or if it has affected the patient's vision. No more wallowing in the ignorant bliss of first year.

Posted by Ishani Ganguli at 01:10 PM
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