Our medical students want to draw blood. They announced it at a recent curriculum committee meeting. We faculty had been droning on about grades and giving feedback and whether lectures are a thing of the past. Then it was the students’ turn to speak, and they hijacked the meeting, filling the room with their energy and their eagerness to master this simple skill.
Already we teach them simulated blood drawing. They extract red water from ropey veins in isolated plastic arms. But the students want more than that. They want to get real blood from real people, and they propose to practice on each other, which is how I learned to draw blood as a medical student 30 years ago. As the students outlined their plans, I sat remembering my own experience.
We were in the midst of learning how to examine people. We’d dropped a couple hundred dollars on tools: a blood pressure cuff, a stethoscope, an otoscope for the ear, an ophthalmoscope for staring deep into the eye. Then we practiced for weeks using our tools on each other and the occasional volunteer patient.
Examining people turned out to be more difficult than I’d expected. I strained to identify the thuds and clicks of heart valves. The subtle breath sounds of the lungs were like whispers from a distant room. I began to feel like an imposter – not a person who would become a doctor, but a person in a white coat who was currently impersonating one.
Then one day, our instructor brought in tubes and tourniquets, needles and alcohol wipes. The next thing we knew, we were drawing blood from each other.
I still remember how amazing it was. I couldn’t hear a heart murmur to save my life, but drawing blood wasn’t that mysterious. You tightened the tourniquet on your partner’s arm, found a plump juicy vein and stuck a needle in it. Bang. The blood filled the tube. I got my partner’s blood on the first stick.
“Shoot, score,” I remember thinking. “Maybe I actually WILL become a doctor.”
For the next couple of years of medical school, we students drew blood regularly with our senior residents as coaches. We learned to choose the right tube for the different blood tests, the right needle for different-sized patients. When the hospital was short on tourniquets, we learned to improvise with latex gloves.
Though there were phlebotomists – hospital employees paid to draw blood – they didn’t work nights or weekends. Even during the day, they didn’t draw blood in emergencies. And so we students honed our blood-drawing skills. Eventually, with the right needle, we could get blood from a stone.
I don’t know whether student blood drawing was ever part of a formal curriculum. Maybe it was just convenient. We were, after all, economical phlebotomists – we drew a lot of blood and paid a lot of tuition to do it.
Regardless of the thought behind it, drawing blood was a boon to us. Becoming a doctor was daunting. Our residents and professors were adept and knowledgeable, confident in their abilities to diagnose and treat patients. We were anxious, unsure about whether we could become them.
Mastering the blood draw gave us heart – it was a sign that we could succeed, that we might master other skills. And phlebotomy had fringe benefits that went beyond the wielding of needles. We learned how to sit with patients, to chat with them and distract them as we stuck needles into their arms. We learned to comfort patients, to apologize to them. If we listened, we learned a lot from them about the experience of being a patient.
Medicine and medical education have changed since my days of blood drawing. Resident work hours are regulated now. Doctors in training are no longer expected to transport patients and place every IV. They draw blood infrequently. With less time in which to learn, our trainees are directed to more high-yield educational activities. Hospitals have responded by hiring IV teams and transporters and round-the-clock phlebotomists.
All this is good. Residents are no longer indentured servants. I applaud it. There’s an unanticipated downstream effect, though, which is that teaching medical students to draw blood from real patients with real arms has largely fallen off the educational radar screen.
Our students are smart and intuitive, though, and in some visceral way, they’ve identified the loss of phlebotomy as a gap in their education. They recognize that drawing blood is a potent symbol of what they hope to become. Their goal is to be people who are intimate with blood: people who draw blood and touch blood and examine blood under microscopes. They want to be fearless in the face of blood, to save lives by giving blood or by stopping the loss of blood. Drawing blood is step one in their vision of this process.
Our ultimate job as medical faculty is to teach the students to be doctors. Part of doing that is enabling students to be inspired by their own skills, just as I was inspired by their renewed efforts to learn those skills.