Every week The Chronicle collects pre-medical students’ most pressing questions and poses them to professionals in the field of medicine. The Chronicle’s Patricia Spears sat down with Christian Horazeck, Trinity ‘09 and a third-year medical student, to discuss private practices, medical school curriculum and communicating with patients.
The Chronicle: Do you think that private practices will ever make a comeback?
Christian Horazeck: I think that really will depend on the field, honestly. Solo private practices are very much having a hard time sustaining themselves, but there is a move going to the multi-specialty, multi-provider practices that [essentially] combine the feeling of a clinic with the private practice setting—and those are still being successful.
TC: How often do you see medical students changing their mind about what kind of specialty they want to go into?
CH: That happens all the time. I personally went from internal medicine to anesthesia, and I’ve seen people jump from surgery to gynecology to dermatology, and back to surgery. You have residents switching fields. This is just very common [because] you like everything when you first see it and then you realize [that something else] feels even cooler.
TC: Has the curriculum in medical school changed to reflect the new emphasis on sociology and psychology in the MCAT?
CH: There’s definitely been a change—more and more medical schools are placing an emphasis on ethics. So you’ll have ethics courses, global health courses [and] sociological factors influencing medicine. Then there is this whole movement of getting humanistic aspects back into medicine and I think this really goes well with that change in the emphasis on the MCAT for sociology and psychology.
TC: What do you think is more important for a doctor—having great medical knowledge and skills or having great bedside manner?
CH: It’s hard to keep those two apart. I think in order to be a good doctor, you have to have both. Whether or not both of them have to be great, not necessarily. But honestly, you can have the best skills, [but] if you can’t provide it to a patient in a manner the patient accepts, you won’t be a good doctor. And it doesn’t really help the patient if you have the most wonderful bedside manner but cannot make up the lack of knowledge, so really you need both. Some fields, it’s better to have one or the other. [For example], surgeons don’t need much of a bedside manner, but even then it matters, and it definitely comes through. The more research we do, it really matters the way patients are thinking the doctor is behaving towards them.
TC: When students volunteer at the hospital, they sometimes feel like their conversations with patients seem contrived and insincere. Do medical students struggle with this problem?
CH: Definitely. I think in the beginning, every medical school has some sort of a course where you practice being with patients, and talking to them, which can feel very contrived. You’ll have standardized patients where it’s very weird to put yourself in that position, but even on the wards, you feel like you’re not really belonging there or that you’re asking the wrong questions. What you realize step by step is that patients really appreciate even the most seemingly contrived conversations, and at the same time, your conversations become more and more focused.
The other... problem is with the volunteer work, you don’t have the knowledge necessarily to interact with patients in the most meaningful manner. So the more you move along, from one year of medical school to the next, the more pertinent your conversations become, and the more meaningful they seem.
TC: Did your expectations going into medical school meet reality?
CH: Definitely. I went to medical school wanting to get three things accomplished. I wanted to have a lot of medical knowledge, I wanted to be able to be comfortable around patients and I wanted to be able to do well in procedures. And it might not seem that way while you’re doing it—sometimes in first and second year it felt like I was just treading water. But now looking back and comparing myself to lower-level medical students, it’s just extremely, extremely impressive how much we learn. I remember looking back at the first time I stood in front of a patient’s door and being all jittery about the fact that, ‘Oh my god, I have to talk to a person about their illness.’ And now I can walk into a resuscitation bay in the emergency department and get the most important information of a horribly injured patient within minutes, and it’s just such a change in confidence. It really is fantastic to realize how much you’ve gone through, and how much you’ve learned. It definitely met my expectations.