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The Boston Globe

Opinion

nathaniel p. morris

Happy holidays, but I can’t help you yet

matthew daley for the boston globe

It’s the holiday season, the perennial time for gifts and cheer. As tradition goes, we return home to feast and watch parades on television, play in the snow, and celebrate the turn of a new year. But for medical students, there’s another tradition that’s met with a mix of great pride and fear — it’s the classic onslaught of questions from family and friends, probing for medical advice on their various health problems.

Usually, nothing major comes up — an aching tooth, a sore toe. But things can get awkward pretty quickly when it’s a weird rash or something that itches below the belt. It’s easy to act qualified and wise, as I spout out absurdly improbable diagnoses like systemic scleroderma and toxic epidermal necrolysis. After all, I’ve been in medical school for 16 months, and people think I know what I’m talking about. (I don’t.)

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Traveling for the festivities can take this guaranteed malpractice to new heights. Recently, I flew on three planes during which a flight attendant urgently called for a doctor on board. On two of the flights, diabetic passengers felt ill and just needed candy bars. But, on the third, someone had suffered what appeared to be a stroke. Lucky for me, when you fly out of Boston, almost everyone raises a hand after the call. Lucky for the sick passengers, they didn’t have to depend on a bumbling medical student and get diagnosed with leprosy or restless leg syndrome.

In this holiday tradition, circumstance is everything. When the health concern is minor and over dinner, requests for advice inflate medical students’ heads and allow us to show off. When professionals are nearby to help, as on those airplanes, we can sit back and pretend we would have known what to do. We get to believe we’re part of an exclusive club, where others look up to us and value our input. However, when the questions take a serious turn or people actually need our care, the masquerading swiftly comes to an end.

I’ve learned to always say, “If you’re having concerns, you should get checked out by a real physician who knows what he or she’s doing.” Maybe I’m feeding today’s medical-industrial complex with patients who don’t actually need care. Or, maybe, I’m trying to say, “I’m young and I don’t know. I’m sorry, but I just can’t help you yet.”

Medicine has some rather odd boundaries, in terms of the responsibilities and privileges of its physicians. Soon after you enter medical school, friends assume you to be a walking WebMD. One day, you’re a fourth-year student, powerless and paying unaffordable tuition. The next, you’re an intern, a full doctor who can hand out morphine prescriptions and declare someone to be officially dead. A similarly peculiar transition takes place a few years later: the harried (and sometimes hapless) resident suddenly becomes an esteemed attending physician earning far more pay.

Indeed, these transitions supposedly reflect quantum leaps in clinical knowledge and expertise. But a would-be doctor’s growth and maturity comes in smaller steps. Knowing the difference between Tylenol and Advil. Being able to discern the marks of fluid on a CT scan. Or simply having the confidence to walk into a patient’s room and stretch out your hand. See if you can guess which two I’m still having trouble with.

I wonder if I’ll realize when I’ve crossed that thin medical line, when I’ll finally feel comfortable in my ability to practice. Even the most experienced doctors shouldn’t diagnose at the dinner table, nor substitute quick opinions for proper health care. Still, as a physician-in-training, I think it’s these situations — away from the hospital and without a white coat — that most accentuate the role I’m poised to fulfill.

Perhaps, that’s what the holidays are for. To remind us of what people hope we can accomplish. And to let me demonstrate the dangers of free medical care.

Nathaniel P. Morris is a Harvard medical student.

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