So, you want to be a doctor. Fantastic (although if I had a nickel for every time I heard that, I wouldn't be taking out so many loans for med school). What does a doctor do? If you answered "Helps people" you are probably a freshman with good intentions but much naïveté. If you chose "Paperwork" or "Sitting at a computer" you probably have a little more experience. If you said "Inflict pain and interrupt frequently" you are probably a patient. Most people have a general idea of what physicians do, but they lack the important day-to-day details. Medicine is fairly romanticized thanks in large part to shows like ER, House, or Grey's Anatomy, and the many that came before it. Watching people put in orders, review charts, wait for labs, or conduct rounds does not make for very interesting TV (to the general public at least). Thus we arrive at our stereotypical freshman pre-med, gunning for med school without any conception of what physicians actually do. This is where shadowing comes in.
The ED is arranged like a giant horseshoe, the interior being the nurses' and physician's stations and the exterior being the patient rooms. I set my coffee down and put my snack in the mini-fridge (god help you if you fail to bring snacks). I greet Dr. S. and we begin the night. Dr. S. is very mild mannered and speaks calmly (ER docs tend to come from both ends of the spectrum, calm and manic). It is a typical night at the ER; abdominal pain is coming at us from every direction and shows no sign of letting up. Not too far into the shift, an elderly woman arrives by EMS. She was unconscious and had some dried blood on her head, suspicious for a fall. She was weakly responsive to pain, but no spontaneous movement or sounds. She got the usual 'ER Special' consisting of IVs, blood tests, and cardiac monitoring. She would almost certainly be admitted. Neurology would be consulted as soon as possible. Several hours later, her daughter came running out of the room, shouting for help; the patient was having a seizure. After a tense minute or two of not being able to locate any nurses or Dr. S. (he is the only physician on at this point), we stream into the room to assess the situation. The patient has stopped seizing at the moment, but is now not breathing. Her heart rate plummets. Quickly, a nurse starts to bag her, and Dr. S. makes the decision to intubate. Respiratory is paged, and a nurse prepares anti-convulsants. Finally, she's stabilized, and we all go back to work. No rest for the weary.
Shadowing is exactly as it sounds: the student follows the physician like a shadow, in order to observe. However, unlike a shadow, you will constantly be in the way, and you can/might be allowed to ask questions. Medical students are expected to ask questions, even if they end up being forced to answer their very own questions and ultimately being chastised for not knowing the answer (doesn't seem fair does it). It is extremely useful though, because you gain firsthand knowledge of how a typical day/shift goes. For example, I was shadowing an ER doc, and for the first 2-3 hours, we didn't see one patient. Labs were backed up and beds were full, so we just sat on our asses until it cleared out a bit. You do get to see procedures and patients (especially in surgery), but the little things are actually the most important. Adcoms want to see that you know what you're in for; the fairy-tale can be your motivation, but you better be prepared for the reality.
Around 5am or so, Dr. S. are seeing a patient about back pain when the intercom clicks on. "All help to triage stat!" the nurse shouts (first time I heard stat used in a serious context). Dr. S. is not phased, and continues to interview the patient. Seconds later, "Physician to triage!" Dr. S. sighs, apologizing to the patient, and we head down the hall to the waiting room (slowly I might add). Before we get there, two beds complete with patients come flying around the corner, pushed by a couple personnel. Both patients were stabbed at a party and had just walked in the front door. Minutes later, a third patient comes in and is wheeled back to an empty bed. The ED goes into lock-down, police are called, vitals and IVs are started, and ambulances are called to transfer the patients (the hospital is not a trauma facility). Shortly after our three stab victims arrive, a code blue goes out over the intercom. The physician covering the wards, Dr. P., is currently in the ED, and Dr. S. is not sure if she's even ACLS certified. Dr. S. and his scribe take off after her with the code box, and I am tasked with getting vitals from the patients. They all appear to be in discomfort, but one looks very pale and is shaking (effects of epinephrine). Dr. S. and his now disheveled looking scribe (CPR will do that to you) return, and the patients are transferred.
So, shadowing is important, an unwritten requirement of medical school. But how do you go about it? I was lucky; I got an internship through the university that handled the initial contact. For those less fortunate, I would suggest asking around the hospital if you volunteer at one. Academic medical centers are probably the best choice because they will be used to having medical students around. Ask your friends too. I came from a completely non-medical family, so I was at a bit of a disadvantage. Many of my friends had physician parents or grandparents, so they became a great source of knowledge. There are lots of guides pertaining to shadowing though, so just search SDN or Google for more in depth advice. You don't have to rack up hours and hours of shadowing, but spend one or two full shifts per specialty. It helps to get some variety as well, but even one experience is better than none. Don't forget to have fun, but make sure you reflect on your experiences too. If you really can't see yourself living that life, it might be time to switch paths. That's what shadowing is for. It wipes away some of the glamour, exposing the realism of clinical practice. It disenchants, leaving only the most dedicated behind to finish the journey to medical school.
The ED is arranged like a giant horseshoe, the interior being the nurses' and physician's stations and the exterior being the patient rooms. I set my coffee down and put my snack in the mini-fridge (god help you if you fail to bring snacks). I greet Dr. S. and we begin the night. Dr. S. is very mild mannered and speaks calmly (ER docs tend to come from both ends of the spectrum, calm and manic). It is a typical night at the ER; abdominal pain is coming at us from every direction and shows no sign of letting up. Not too far into the shift, an elderly woman arrives by EMS. She was unconscious and had some dried blood on her head, suspicious for a fall. She was weakly responsive to pain, but no spontaneous movement or sounds. She got the usual 'ER Special' consisting of IVs, blood tests, and cardiac monitoring. She would almost certainly be admitted. Neurology would be consulted as soon as possible. Several hours later, her daughter came running out of the room, shouting for help; the patient was having a seizure. After a tense minute or two of not being able to locate any nurses or Dr. S. (he is the only physician on at this point), we stream into the room to assess the situation. The patient has stopped seizing at the moment, but is now not breathing. Her heart rate plummets. Quickly, a nurse starts to bag her, and Dr. S. makes the decision to intubate. Respiratory is paged, and a nurse prepares anti-convulsants. Finally, she's stabilized, and we all go back to work. No rest for the weary.
Shadowing is exactly as it sounds: the student follows the physician like a shadow, in order to observe. However, unlike a shadow, you will constantly be in the way, and you can/might be allowed to ask questions. Medical students are expected to ask questions, even if they end up being forced to answer their very own questions and ultimately being chastised for not knowing the answer (doesn't seem fair does it). It is extremely useful though, because you gain firsthand knowledge of how a typical day/shift goes. For example, I was shadowing an ER doc, and for the first 2-3 hours, we didn't see one patient. Labs were backed up and beds were full, so we just sat on our asses until it cleared out a bit. You do get to see procedures and patients (especially in surgery), but the little things are actually the most important. Adcoms want to see that you know what you're in for; the fairy-tale can be your motivation, but you better be prepared for the reality.
Around 5am or so, Dr. S. are seeing a patient about back pain when the intercom clicks on. "All help to triage stat!" the nurse shouts (first time I heard stat used in a serious context). Dr. S. is not phased, and continues to interview the patient. Seconds later, "Physician to triage!" Dr. S. sighs, apologizing to the patient, and we head down the hall to the waiting room (slowly I might add). Before we get there, two beds complete with patients come flying around the corner, pushed by a couple personnel. Both patients were stabbed at a party and had just walked in the front door. Minutes later, a third patient comes in and is wheeled back to an empty bed. The ED goes into lock-down, police are called, vitals and IVs are started, and ambulances are called to transfer the patients (the hospital is not a trauma facility). Shortly after our three stab victims arrive, a code blue goes out over the intercom. The physician covering the wards, Dr. P., is currently in the ED, and Dr. S. is not sure if she's even ACLS certified. Dr. S. and his scribe take off after her with the code box, and I am tasked with getting vitals from the patients. They all appear to be in discomfort, but one looks very pale and is shaking (effects of epinephrine). Dr. S. and his now disheveled looking scribe (CPR will do that to you) return, and the patients are transferred.
So, shadowing is important, an unwritten requirement of medical school. But how do you go about it? I was lucky; I got an internship through the university that handled the initial contact. For those less fortunate, I would suggest asking around the hospital if you volunteer at one. Academic medical centers are probably the best choice because they will be used to having medical students around. Ask your friends too. I came from a completely non-medical family, so I was at a bit of a disadvantage. Many of my friends had physician parents or grandparents, so they became a great source of knowledge. There are lots of guides pertaining to shadowing though, so just search SDN or Google for more in depth advice. You don't have to rack up hours and hours of shadowing, but spend one or two full shifts per specialty. It helps to get some variety as well, but even one experience is better than none. Don't forget to have fun, but make sure you reflect on your experiences too. If you really can't see yourself living that life, it might be time to switch paths. That's what shadowing is for. It wipes away some of the glamour, exposing the realism of clinical practice. It disenchants, leaving only the most dedicated behind to finish the journey to medical school.
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