Several patients cancelled or no-showed today, so I got a lot of reading done – half of a 42-page article on details of diabetes management. I would have gotten through more, except one patient came to review biopsy results on an “intradermal nevus,” and, having forgotten everything I learned in pathology on that subject, I had to get out a derm textbook to look it up, and got badly sidetracked by beautiful color photos of horrible skin diseases. (Intradermal nevus means a completely benign mole.)

Both of the ladies who were scheduled for pap smears cancelled, so the issue of whether that’s one thing I am allowed to do never came up. A baby did need shots, but the nurse manager calmly expressed her policy that, although MAs (medical assistants) are allowed to give the shots, they are not allowed to show medical students how to do them. So if I can ever get a patient needing shots and a non-busy nurse together in the same place, I can do shots. The chances of this happening, as you might guess, are close to nil. So I helped hold the baby down. Poor kid got four shots. A sarcastic voice in the back of my head is saying, it will just be too bad for all concerned if I thus manage to graduate without ever being supervised about giving shots. A more reasonable voice (probably in the front of my head!) is suggesting that nine weeks into the school year is not the time to begin panicking about never learning to do anything. But the topic of me and the PA and the nurse manager brings up the question of authority and hierarchy and women in medicine. My mother pointed this out.

Right now, I know way less than the PA and the nurse, but in less than two years I’ll have authority over them. So what on earth is the proper way to relate to them? Also bearing in mind that the whole doctor-nurse interaction is heavily molded by male-female stereotypes. That’s just the way things were, back when people figured out that doctors should wash their hands, and nurses should help keep things clean. Both popular culture and medical culture are steeped in the tradition of a female nurse obeying a male doctor. Now, it stands to reason that in order for things to work, the nurse needs to obey the doctor, even when the doctor happens to be a woman (or, less frequently, the nurse happens to be a man). But it’s understandably difficult for a 50-yr-old nurse with 25+ years of experience to be subordinate to a 25-yr-old (female) doctor with 0- years of experience. And what about right now, when I’m only a doctor-in-embryo? We won’t even go into the whole younger-prettier-competition-for-male-attention side to this rivalry.

So I’m considering this. My instinctive reaction to women who are older than me and know more than me is to act very tentative and submissive. This is not generally considered to be appropriate behavior for a third-year medical student, who, as I understand it, is supposed to act confident and semi-knowledgeable and like they are able to do handle as much responsibility as possible – and thus earn more responsibility. (At least that’s the way the other girls on this rotation act. The fact that they used to be EMTs may have something to do with it.) “He who will be chief among you, let him be the servant of all.” What does that mean in this office? Go run errands, get samples, give messages, look things up – I can do all that. But does it also mean not to ask questions when I think something is being missed? Or not to keep pushing to do procedures when it would make everyone’s life simpler if I would keep quiet? And WWJD doesn’t really help, either: he would just heal everyone without any trouble at all. 😉

Oh, and while we’re discussing ethical questions: that psychiatry stuff is coming back to haunt me. I’ve been reading Jay Adams’ Competent to Counsel, where he is decrying self-pity, and counselors who allow it, and victimization, and counselors who allow it, and laziness, and you-know-who. It strikes me that perhaps this means I shouldn’t nod and say “mm-hmm, I see,” and “that must be difficult for you,” and “things have been rough for you,” to patients who have no scientifically-documentable ailment (ie nothing but fibromyalgia and chronic fatigue), who are having anxiety attacks at the prospect of going back to work, or chronic headaches because they have to take care of three children, or who are laid out with pain at the prospect of pushing their mother’s wheelchair for a walk (I kid you not). Perhaps, strictly speaking, I ought not to contribute at all to their enablement by acting understanding about their difficult lives. But I really couldn’t handle another patient telling the doctor that I’m antagonistic and un-understanding. That would be too devastating. And all for nothing. It’s not like one third-year medical student telling them to buck up and get a life would really have any impact. So why risk my evaluation here for that? Just to tell the truth? (irony /off) Bother, bother, bother. I obviously have too much time on my hands. Hopefully tomorrow will be busy.