Notes from a Medical Student:

The Doctor's Knock

I've often thought that the doctor's knock, that tap-tap-tap on the door immediately before entering the exam room, was always a great metaphor for the remaining graces and manners of office medicine. In a way, a knock on the door is usually equated, at least in my mind, as a request: "May I come into your home?" or "Will you be so kind as to let me in?" Interestingly it almost implies the invasion of one's abode by another for a philanthropic, benign cause. Yet in this day and age, where privacy is quickly becoming public domain, it still stands as a testament to a level of courtesy and respect that stands firm at the center of being a physician. This is not without irony however, because the knock-knock usually is immediately followed by a turn of the knob because, well at least in my mind, I can't hear anyone through these thick doors.

The reason I mention this little metaphor is that I've come to a realization over the past month in Family Medicine that the end is nearer than I think. I move with a little more confidence now and feel more relaxed when I counsel on giving up those Ultralights or trying for that extra thirty minutes on the treadmill each week. I feel more confident because the explanations and choices that I have to give are starting to flow out of me. I don't find myself reaching into the recesses of my mind trying to remember what antibiotic is first-line for Streptococcal pharyngitis, or what a reasonable asthma regimen might be. So with this confidence comes the questions about what the future entails and asking myself should I let the world shape me or should I shape the world. I remember almost half a year ago that I was shutting my eyes tightly trying to remember an 'on the spot' question, whereas now I knee-jerk the response and expect the next two to three questions as follow-up. The mantra has been knowledge before speed. So I thank my time here in Family Medicine for allowing me to slow down and truly ponder what are the choices I can give, what are the red flags I'm looking for, what canI do to develop more of a rapport. In a sense that is what this entire month in Family Medicine has been for me…a lesson in rapport.

Tap-tap…knob turns…door opens, and there sitting in a small chair is the patient. His face brightens up when he looks up at the attending physician I'm following. "How are you doing?" Simple words, but they will result in all the information you might need to help. I watch as the two, the patient and the physician, shake hands and sit down. They chat…asking how's this and that. If you would remove the white coat and gown from this picture you couldn't tell that this was a conversation between physician and patient. The attending physician leans over to me and says, "I've seen Mr. H for…oh what has it been now?" "Ten years," says Mr. H. I smile and realize that I know very few friends whom I've kept in contact with longer than ten years.

I think of all the yearly physical exams, the heartburn and sick kids, getting them through cancer and off cigarettes…this conglomeration of attempts to help mold a person's life in some manner to increase both quality and quantity. It dawns on me then that a physician's job is more akin to that of a blacksmith. Today, the patient simply has a physical. The visit ends and they both go their ways, happy to see each other. I don't believe rapport can get much better than that.

Not to say that all relationships are that friendly. I've noticed over the past month that these long time relationships often take on the form of other long term relationships: the younger and older brother, the father and son, the squabbling old married couple that never agree. But through it all, the good news and bad, the function is often the same: to remind the patient that they are as much a part of this congregation of homo sapiens today as they were on the day they were born. As for myself, with this new confidence and lesson in rapport, I move closer and closer to the end of third year and the beginning of my final year of medical school. At this point it seems so far away…and yet in a way not far enough.