Shadowing Docs
A Dose of Reality for Med School Hopefuls
"What keeps the blood going in one direction?" Dr. Richard Lee stood in a Northwestern Memorial Hospital elevator and peppered two women with questions.
"Valves," replied Elizabeth Appelt, 20, barely audible over the chatter of two white-coated physicians nearby.
"And how many problems can we have with the valves?" Lee continued.
"Two," chimed Katherine Wang, 21.
"Right. They're either too tight or too leaky," Lee said, the ping of the opening doors punctuating his statement. "Really, this is basic plumbing. That's all we do."
Lee, a cardiac surgeon (and, apparently, fond of the gross understatement), was making rounds with an audience: two Northwestern University undergraduate students taking part in the Northwestern Physician Shadowing Program. He created the program several years ago after spearheading similar demonstrations during his days practicing at St. Louis University Hospital. Over 200 student shadowers have participated in Northwestern's program, following volunteer physicians from roughly 20 Northwestern Memorial Hospital specialties.
"We're introducing as many students to medicine as possible and allowing them to make a more informed decision that this is the right career for them," said Michael Yensel, the education coordinator for the Division of Cardiac Surgery and the program's co-creator and co-director. "They see what it's like to be a professional."
Television and movies have done medicine no favors in terms of depicting its reality. Is it all about renegade doctors, crises in the operating room, and constant Code Blues? Hardly. Instead, after receiving the patients' consent, Wang and Appelt watched Lee check up on patients in various stages of recovery in the Intensive Care Unit, consult with nurses, and offer advice and encouragement. He explained each patient's condition to the students, taking care to make the situation understandable but still clinically accurate. Some patients were upright and chatty, while others were barely conscious and in need of highly specialized care. The students fared well, not exhibiting any discomfort with the sensitive elements of the morning.
"I think it's about entering those situations with the right mindset," Appelt said of her poker face. "I thought it was really cool."
Lee said that the odd student blackout might happen once a year and he warns shadowers of that possibility before they make their rounds—should they find themselves getting woozy, just duck out of the room and find a seat.
"This is a great opportunity, but realize these patients are seriously ill," he said. Shadowing in the ICU is not typical, but Lee made sure his patients and their conditions were appropriate for the students to observe.
"It has definitely not turned me off of medicine, that's for sure," Wang said of the experience. "It's nice to see doctors interacting with patients without being that patient yourself."
Wang is a senior Anthropology major and Global Health minor from Lexington, Massachusetts. Becoming a physician didn't hold special appeal for her until the summer before her senior year of high school, when she participated in the National Student Leadership Conference in Washington, D.C., focusing on medicine and health care.
"I've always wanted to find some way to do my part in the world—how do I fit in the puzzle?" she said. "I feel like being a doctor fits my interests."
The precision and artistry of surgery is appealing, but so is the practicality of primary care. Books such as Tracy Kidder's "Mountains Beyond Mountains" drew her to the field.
It's especially important today for students to realize what they're getting into, Lee said, given how much the field has morphed in the last couple of decades.
"Every year it gets harder," he said. The technology is exploding, the advances in disease research require a wider breadth of knowledge, and the profession is simply not as lucrative as it used to be.
"Doctors need to be smarter, they need to be more dedicated, and they need to be more altruistic," Lee said.
Before beginning the program, shadowing students must show proof of immunization, submit to a background check, and attend an orientation covering safety, ethics, and protocol. Each shadowing assignment takes place in one day. The duration and circumstances depend entirely on the physician leading a student; it could last a couple of hours or a full shift. Fields range from cardiology to orthopedics to allergies.
While organizers have not tracked the number of students who wind up pursuing medical school as a result of a shadowing experience, Lee said it seems to be a successful entrée into the field.
"I would say a majority of students go on to apply," he said. "But the ones who decide not to apply—that's what we want, too."
Flanked by Wang and Appelt, Lee began this cool fall morning with a quick glance at some X-rays on a computer, making the day as much a teaching experience as it was an opportunity to observe. Wang took notes and Appelt watched (assignments are usually one-on-one), asking a few questions and answering some of Lee's. After some briefing about hospital etiquette, he led his charges down to the ICU. The assignment lasted about two hours, ending before Lee met with a patient to discuss the sensitive matter of surgery, an interface best conducted without a crowd.
"It was very worthwhile," Appelt said. "You really are going to know what you're getting into."
Wang and Appelt were privy to much: listening to intense discussions about treatments, wearing sterile gowns to enter the room of a liver transplant recipient, and watching spectral Doppler images of a damaged heart in the echocardiography laboratory. In one patient's room, a machine emitted a loud beep, causing Appelt to startle. Lee, conversing with a nurse, was unfazed. The morning was an eye-opener.
"I think it was actually after a few times of going into patients' rooms and thinking that this was something I could do," said Appelt, a Biomedical Engineering major from Park Ridge, Illinois. "I think I found out that it really is right for me."
"Do you mind if I show them your toes?" Lee politely addressed a bypass patient with some outward symptoms of vascular disease. The man gave a quick nod, Lee waved Wang and Appelt over, and they leaned in to get a closer look at his gangrenous toes, their unflinching expressions awash with fascination.
"Students face an uphill battle," Lee would say later, referring to the rigorous application process and the years of education and training. "But really, it is the best thing they could ever do with their lives."