On Hurting Patients

As the other students in my class, I came to medical school because ultimately I want to help people. However, I didn't fully realize that with the intention of helping people, you sometimes I have to hurt them (ex: vaccines, drawing labs, IV medications, sometimes even physical exam maneuvers).

We had a young women come into clinic the other day because she has tenosynovitis. One of the treatments for tenosynovitis is a steroid injection into you wrist, underneath the tendon sheath. I went into the room, introduced myself to the patient and her family within the room (husband and 2 small children), and explained to them about the procedure. I was working with a resident that day.  As the resident is preparing the injection, she tells me "I'll do the first one and you'll do the second."

Medical school is about learning and that includes procedures, but I had never given a steroid shot before, especially not into the wrist where there are about 20 other things in that small space. This was also the first time the resident was doing this particular procedure. I didn't say anything and just tried to get into the mindset to do it. The resident puts the needle into the patients left arm and starts injecting. The patient flinches and starts crying. The resident finishes, looks at me, and asks, "you want to do the next one?" I am conflicted. I don't want to look like a bad/afraid/uninterested medical student, but I am not comfortable with this procedure and the patient in front of me is crying out of pain. I say, "I'm not really comfortable doing that." The resident gives me a look and does the injection. As we walk out of the room, she tells me that I'm doing the next steroid shot even if I'm scared. I tried to explain to her it was more to do with the patient crying in front of me and unfamiliarity with the procedure than fear. 

The experience made me realize how much I DON'T like doing procedures outpatient. Even though I am a procedurally geared person, I like surgeries because the patient is anesthetized. They can't feel you cutting through their skin; they don't FEEL. I have found outpatient procedures really difficult, especially joint/steroid injections. It's hard to want to try something for the first time when it includes inflicting pain on a patient.