I Am Your Medical Student

In my (K.K.) first clinical rotation, students were explicitly told to introduce themselves as “Student Doctor (last name).” The result: family members kept calling me “Doc.” Instead, I began to use some variation of “I am the medical student on your care team.” Neutral phrasing; not at all misleading and an improvement on “student doctor.” As the year progressed, I developed closer relationships with some patients more than others, depending on a number of factors, none of which seemed related to how I introduced myself. Miller and colleagues (1), in their Annals of Internal Medicine opinion piece, stress the value of viewing students as genuine clinical partners, particularly during the COVID-19 pandemic.

The first time I decided to introduce myself as “your medical student,” I felt very self-conscious, and I immediately resorted to my usual defense mechanism of dry humor. “I’ll be your medical student this evening,” I said to my patient and her mother, as if I was preparing to take their drink orders. This got a laugh. And I did bring them ginger ale.

Later that night, I went down to the emergency department to meet a patient who was being admitted to my team. I felt a little more confident: “I’ll be your medical student while you’re here in the hospital.” It was hard to read the patient’s face behind her mask, but I think she noticed and appreciated the phrasing. As I kept introducing myself to patients as “your medical student,” I felt a shift in how quickly they were willing to open up as well as how much responsibility and ownership I felt for their care. Some of this is attributable to the increased confidence that comes with time and experience as the clerkship year progresses. However, this 1-word change made a profound difference too. Every time I introduce myself this way, I am making a declaration that promises the patient everything implied in that possessive pronoun: I’m here for you, I’m the person you can talk to about any questions or concerns you may have, and I’m going to be checking on you frequently. Making all of those promises lends a sense of importance to the need to hold myself accountable for my patients. And I think patients appreciate it.

There is ample discussion in the medical literature on how medical students should identify themselves to patients. Many of these writings (2-4) focus on the ethics of providing clear, informed consent to patients that they are being seen by someone who is not a fully credentialed physician. One article by Marracino and Orr (5) examines some of the assumptions that may incline medical students toward using “doctor” in the introduction, such as thinking “student” is not a legitimate team member or that patients may refuse to allow a student to participate in their care.

Nurses, in contrast, rarely introduce themselves to patients as “the nurse” or “a nurse.” The greeting we are most accustomed to is, “My name is —, and I will be your nurse today.” This conveys a sense of commitment to that individual patient and his or her significance as a care team member.

We should encourage medical students to take a page out of the nurses' book. This helps build connection and empowers the student as a valued caregiver. Both patient and student stand to benefit. As student empowering as this may be, the rest of the care team has to support it or risk undermining the developing student–patient relationship. The issues of proper identification and informed consent are still relevant and deserve consideration, but too much focus on this aspect distracts from the student–patient relationship—a vital part of the student’s learning and development as well as the patient feeling heard and cared for. “I am your medical student” can be win-win.

References 

1. Miller DG, Pierson L, Doernberg S. The role of medical students during the COVID-19 pandemic [Editorial]. Ann Intern Med. 2020;173:145-146. [PMID: 32259194] doi:10.7326/M20-1281
2. Howell JD. Why medical students are 'medical students' [Editorial]. J Gen Intern Med. 1997;12:718-9. [PMID: 9383143]
3. Silver-Isenstadt A, Ubel PA. Medical student name tags: identification or obfuscation? J Gen Intern Med. 1997;12:669-71. [PMID: 9383134]
4. Jagsi R, Lehmann LS. The ethics of medical education. BMJ. 2004;329:332-4. [PMID: 15297341]
5. Marracino RK, Orr RD. Entitling the student doctor: defining the student's role in patient care. J Gen Intern Med. 1998;13:266-70. [PMID: 9565391]