Decision Making

One of the hardest things as a medical student is to commit to a plan. We are often asked to "put our money down" and decide on a diagnosis or a test or a treatment. Of course, this is an educational exercise; residents and attendings use this opportunity to discuss why our decision was correct or incorrect. But it feels scary, as if we were actually deciding on a course of action for a patient. As a student, we feel like we don't know enough, so we hedge. "Well," I say, "if we think she has a community acquired pneumonia, we'd start these antibiotics. But if it's just a flare of asthma, her inhaler will do." But that's simply skirting the question - the attending wants to know based on my clinical judgment whether the patient has an infection or not. This is the transition from a third year medical student or clerk, recording information, to becoming a doctor, interpreting that information and acting on it. This year, I've been trying much harder to take a clinical stance with each patient. I am often wrong, but then it becomes a learning opportunity. I've realized in the coming years as a resident, I will have to develop more independence in decision making. It's a scary step, but I think I am ready for it.