Hello, clerkship

One day you're a student, and the next, BOOM, you're a doctor.

No, not really. The thing is, I think I've been living in a happy bubble for the last three years, where the reality and gravity of my profession still hadn't sunk it. Things did a 180 for me yesterday when, after an extremely benign orientation at Psychiatry care of the chairman, a resident came into the room (where we were all lounging about waiting for the next thing to do) and said, "Alam niyo bang mayroong dalawang ICC na dapat naka-24 hour duty ngayon?" I felt like a headless chicken for the next few minutes. Apparently, because there are no clerks (who, if they're rotating in Neuropsychiatry, are assigned for duty in Neuro rather than Psych), WE--third year know-nothings--have been assigned to monitor patients and do 24-hour shifts, from 7 am to 7 am, AND we're still expected to show up for all of the classes from 8 am to 5pm.

I know my seniors will probably roll their eyes at this because they've gone on duty a gajillion times, and because monitoring a patient or making admitting notes is nothing to them, but wow, suddenly it was like I was a limbless person thrown into an ocean and expected to swim. In fact I'm still feeling a little bit at sea here. Up to this point we had only ever met patients who had already been evaluated before we got to them, so nothing we said or did could possibly have an impact on the management or outcome of the patients. We diagnosed things pretty much like people sitting at home watching HOUSE. We were just having fun. And it was really okay to make mistakes.

I'm also a little bit afraid. I saw the notes that an intern had made before me and I just couldn't believe my eyes. It was like he did this thoroughly horrible and careless examination of the patient, taking everything she said as gospel. You don't do that. You just don't. So instead of a schizophreniform or schizophrenic patient, his notes read more like the patient was just depressed, because he believed everything she said without realizing her lacking reliability or without consulting the two available relatives.

What if I missed something vital during MY evaluation of patients? My decisions will have such an impact on their lives. Eventually there will come a point when I won't have anyone to rely on but myself, and my (extremely bad) clinical judgment.

I know I used to complain that medicine takes so long. Now I think that maybe it shouldn't be five years but twenty, PLUS specialization.