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When Does a Medical Student Overstep Her Boundaries?


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(Disclaimer: details of this story have been changed to protect the privacy of those involved.)

Six months into medical school, I learned the place I feel most like a doctor is not in class or in the hospital. It is at home, with my family.

Last month, I had the pleasure of visiting my family for a long holiday break. I was greeted with a barrage of innocuous medical questions. My father wanted to know about his arthritis medication. My aunt was more concerned about her headaches.

“You should ask your doctor,” I said each time, summoning my template response. I was not frustrated; questions like these I expected, and I knew how to handle.

A week later, my parents received a phone call. It was a close friend, saying he had been diagnosed with lung cancer.

My parents were devastated. I wanted to play the part of caring daughter, supporting a grief-stricken family. I had no interest in playing local medical expert. I wanted to offer comfort, not wisdom.

But the questions inevitably came. My mother came to my room that evening holding a pad filled with questions she scribbled down from the phone conversation. For the first time, I was forced to confront the boundaries of my role.

It is plainly wrong for a first-year medical student to offer any sort of advice. Yet as she progressed through her questions, it felt wrong, too, to plead blanket ignorance. Some of her questions seemed purely academic.

Did I advise on the course of treatment the friend was considering? No. Give a prognosis? Of course not.

But did I explain how someone who never smoked a cigarette in his life can still get lung cancer? And how cancer can be genetic, even if someone is the first in the family to get it? Yes and yes.

I paused at the phrasing of my mother’s next question. “Lung cancer is one of the bad ones. Right?”

***

I have heard several stories of cancer survivors who, years later, did not remember much of the beginning of their illness, but had it tattooed on their brain how long they were told they were going to live. For this reason, my clinical preceptors recommend steering clear of hard and fast numbers when talking to individuals. Rather, doctors should emphasize that each patient’s situation is unique.

The lesson I got from these stories is that when you are in the medical profession, your words matter. People have a special propensity for recalling anything that can be interpreted as a prognosis.

The same holds true for those just perceived to be in the medical profession. And, like it or not, a first-year medical student falls into this category.

What I realized from going home is that I can now state an objective medical fact – and have it interpreted as a personal diagnosis. I do not speak all that differently from how I spoke six months ago. Yet I am heard differently.

Talking about lung cancer, as an illness, is not the same as talking about our family friend’s lung cancer. But to my parents, it could be taken that way.

I do understand my mother’s motivation in asking. I ask my computer scientist friend when something goes wrong with my computer, and I feel fortunate that my friends have skills to impart to me informally. I would probably feel mildly offended if he waved his hands and said he was unqualified to say anything. But you know more than I do, I would probably say. Come on – tell me something.

Is medicine different? Certainly. It’s inherently about human life. But is it fundamentally, categorically different?

Just because I am in medical school, am I no longer allowed to state objective scientific facts, because they might be deciphered incorrectly? How much of someone else’s interpretation is my responsibility?

I chose my words carefully. “For some people, the symptoms of lung cancer can be subtle or mistaken for other respiratory problems, so it’s tough to catch early. The course of treatment depends on several factors, like the size of the tumor and whether it has spread,” I offered.

***

People ask questions for many reasons. They might be genuinely curious. Or, they might have a vested interest in the answer.

I spent my holiday break walking a moral tightrope between providing information and censoring myself for fear of misinterpretation. I was torn between wanting to educate and worrying I would somehow mislead. Between trying to help, while being cautious not to overstep my boundaries.

The simple solution to my dilemma is: say nothing. Say: “ask your doctor.” Say: “I’m sorry, but this is not my role.”
But, choose to say anything more, and you must always consider how it might be construed. What can be read between the lines. What can be taken out of context.

While I do not think it is feasible to hide behind a mask of invariable silence whenever the topic of medicine arises, I do think part of my new role is being more sensitive to gauging the asker’s motivations and adjusting my answers accordingly. Whether I feel like a doctor or not, I am aware that I am seen as speaking from a different position than I was a year ago.

I was careful to remind my parents that every patient’s situation is unique, that I am far, far from a physician, and that I am not involved in their friend’s care and therefore don’t know the details of his situation. Yet I still wonder if I spoke irresponsibly.

Sometimes, there is no bright line between information and advice.

It would be unfair to say that another’s misreading of my words is entirely on my shoulders. But I think I’d be just as reckless in blinding myself to the possibility.

Image: VIC CVUT at Wikimedia Commons

Ilana Yurkiewicz About the Author: Ilana Yurkiewicz is a third-year student at Harvard Medical School who graduated from Yale University with a B.S. in biology. She was a science reporter for The News & Observer in Raleigh, North Carolina via the AAAS Mass Media Fellowship and then went on to write for Science Progress in Washington, DC. She has an academic interest in bioethics, currently conducting ethics research at Harvard after previously interning at the Presidential Commission for the Study of Bioethical Issues. Follow on Twitter @ilanayurkiewicz.

The views expressed are those of the author and are not necessarily those of Scientific American.






Comments 2 Comments

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  1. 1. jgrosay 3:45 pm 01/20/2012

    This article is very adequate, and depicts a frequent problem for those having a connection with medical practice. One of the worse things that can be confronted by professionals is questions like: my relative XZ -or friend, or acquaintance, it doesn’t make any difference- seems having been diagnosed with ZZ. What can you tell about this ?. Going beyond of what can be found in open access sites can be some kind of a serious privacy violation; if you want knowing about the disease of somebody, you must address the question to the patient him or herself, that is in this way in control of the amount and deepness of information he/she releases about his/her illness, it’s hard to do but a good approach is “go to the books or to the web”, even when this may grant you animadversions, but this way, you can’t be blamed of violating any privacy. If not adjusting to this kind of rules, you can make considerable harm to the ill and those in connection with. Salut +

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  2. 2. notslic 5:04 pm 01/21/2012

    This is a problem that has festered in the legal profession, growing ugly with the increase in television advertising. Also the drug industry, with drug manufacturors advertising to influence individual patients rather than informed doctors.

    Now that I’m retired, I’ll give free legal advice to anyone that I can help. But I always start with “I’m no longer licensed to practice law” and I usually end with “You should get your own attorney if you want to pursue (or defend) a claim”.

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