Unrehearsed moments
Imagine you are a rock star performing in front of an audience. Sounds exciting, doesn't
it?
What if I told you that you were required to perform a song that you have neither
heard nor seen at a high-stakes event like Taylor Swift’s future wedding? Would you
still do it?
You might argue that a prodigy can effortlessly master any piece of music right away. But I am neither Mozart nor a prodigy in medicine.
The idea of performing a completely unfamiliar piece is unsettling. But these “unrehearsed moments” confronted me every day during my family medicine rotation as a 4th year clinicalclerk. Whether it is managing presentation I had never previously encountered or adapting to unexpected complications in what initially seemed a routine case, unrehearsed moments felt like performing an unfamiliar piece of music in front of a large audience, but the audience could be harmed if I played the wrong note.
At first, these unrehearsed moments were humbling, even embarrassing. I will never forget my first bimanual exam. As a male learner, I tried my best to mask my nervousness. Did I do a good job? Arguably not. I would be lying if I claimed to have felt the same fibroid that my preceptor felt. However, over time, I learned to respond to unrehearsed moments without a vasovagal reaction, even with a sense of appreciation.
Without being too cliché, these unrehearsed moments helped me build resilience, humility, and knowledge. Beyond these skills, the most significant lessons I learned from unrehearsed moments was the value of honesty. For me, honesty came from humility, which involved admitting my ignorance and acknowledging it to both my patients and my preceptors.
Admitting my ignorance with honesty was not easy from the get-go. At the beginning of my family medicine rotation, I worried that admitting my ignorance in front of patients would damage the trust and therapeutic alliance between us. However, a patient challenged this conception by inquiring about the differences between Naproxen and Celebrex in managing osteoarthritis. My pre-clerkship lectures definitely did not cover this. After being stumped, I admitted my ignorance to my patient—I felt embarrassed that I did not have an answer. Feeling unsatisfied, I left the room and took the time to conduct my research. After quickly reviewing the literature, I returned to the room and shared the information with the patient. To my surprise, the patient did not express any disappointment or frustration but rather genuine appreciation.
Medicine is never fully rehearsed, but I’ve learned the music lies in showing up honestly. By confronting ignorance with humility and honesty, I allowed myself to grow. Patients may also appreciate an honest “I don’t know,” as long as it is backed by “but I will investigate and let you know.” Because in the end, unrehearsed moments are not failures of the learner but rather the most valid form of learning.
Andy C.L Liu is a third-year medical student at the University of Toronto.
