The one thing that has been most amazing about the first weeks of medical school is the inherent capabilities that people now assume that the first year students have. I get it…we are more knowledgeable about medicine than an average person on the street and we look deceptively snazzy in our scrubs and white coats, but here’s the thing:
I don’t actually know much more about medicine than I did a month ago.
I have to carry my gross anatomy flashcards around with me everywhere and all I do is memorize, quiz myself, memorize, quiz myself. I can paint you a mental picture of your thigh, my friends, and rattle off the nerve innervations, but that’s about it. Don’t ask me about bleeding or pain or numbness, because I really don’t know. As the dean told us during our White Coat Ceremony,
“For the next three years, no matter what you learn, your mom is still going to know more about practicing medicine than you do.”
In one of my clinical classes, this is precisely why our facilitators (two physicians) teach us how to do clinical things like take patient histories and make superficial diagnoses. My first day with my preceptor, a pediatrician in Virginia, is on Tuesday, but I presume that she will also be teaching me the majority of my clinical skills once I get there. She would never leave me alone with patients and expect me to know what to do, right?
Enter the ophthalmology interest group that I joined.
On Wednesday night, several other medical students and I congregated on the 2nd floor of the ophthalmology department of the physicians group across the street from the hospital. White-coated ophthalmologists walked in and out of the crowd, still attending to their daily duties, while a few of the students helped carry equipment down to the training center.
The point of the meeting was to train us to help conduct glaucoma screenings throughout the city. We will get to learn basic clinical techniques from ophthalmologists and they get to have our free labor when doing humanitarian work in underserved areas.
The empty waiting room of the floor was quickly converted into a number of different “stations” with a physician and some sort of screening equipment at each. As small groups rotated through each station, the physician explained the use of the equipment, taught us how to use it, and then had us practice on each other.
At the first training station, a visual acuity machine was set up. The “patient” (student volunteer) was instructed to look into a desktop machine that showed various sized letters. Then, he or she had to recite them back to the “technician” (another medical student) to be recorded on their chart. Most of the tests involved similar machines, which everyone had seen at their doctor’s office before. It was all very straightforward and the machine does almost everything for you anyway.
Then, we were introduced to an instrument called a Tono-pen, which checks the pressure in your eyes.
The worst part of a physical exam at the eye doctor is always that annoying puff of air that gets shot at your eye. It tests the pressure in your eye and is important for diagnosing glaucoma. As much as it annoys me, it’s tolerable because it’s quick and usually finished before I can react. It’s nothing like say, having your eye actually touched. Repeatedly. By a sharp, pointy object.
The Tono-pen is more accurate than the air puff thing and it takes into account that different ethnicities have corneas of non-uniform thickness (something the air puff doesn’t do). It is also portable. The ophthalmologist teaching us claimed that the Tono-pen wasn’t really sharp, but I promise you, it is definitely pointy! So, after numbing the patients’ eyes with drops, the Tono-pen must be gently TAPPED on their cornea 3-4 times to register a pressure reading. You read that correctly. 3-4 times. In each eye. By a MEDICAL STUDENT.
The doctor warned us that we can give people a corneal abrasion if we are not gentle enough and that we are not allowed to have caffeine the days that we are volunteering because it will make our hands have a tremor. And let’s face it, no one wants a medical student with shaky hands tapping on their eye with a pointy object.
When I practiced using the Tono-pen (yes, we had to practice using this thing ON EACH OTHER), the poor second year student I was trying to test couldn’t even make it through the test on a single eye. You know why? Because it’s unnatural to have a POINTY, METAL THING TAPPED ON YOUR EYE THREE TO FOUR TIMES BY A MEDICAL STUDENT WHO MIGHT GIVE YOU A CORNEAL ABRASION.
That is, of course, precisely why I never volunteered to be a “patient” during this training session. I understand the significance of making contacts with the ophthalmologists, but no one wants to be the medical student who has to come back the next day after accidentally getting a corneal abrasion from playing with the Tono-pen.*
*I’m sure someone important would be angry that I just said we were “playing” with the Tono-pen, so no, we were not playing. I think we were all too scared to be comical anyway.