By Natalie Cohen

It was my first day of anatomy class. Dressed in hand-me-down scrubs covered by a blue smock that still smelled of its packaging, I opened the laboratory double doors and began my long walk towards table one, with each step I passed by lab tables with white plastic sheets covering what I knew were dead bodies. Cadavers. I felt nervous, anxious, dreading when the cadaver would be revealed. I hadn’t seen a dead body before. Would I faint at the sight? Cry in front of colleagues I had only met the week before at orientation? I didn’t want to be there, I didn’t want to do it. What if I… liked it? What would that make me? As I stood at the side of my cadaver, initials RW, who died of lung cancer (the cause of death was posted alongside her initials on a sheet of paper on the door), I heard my anatomy professor call this lifeless body in front of me my “first patient.” “We treat these bodies in front of us like patients,” he said, “these are your first patients.”

I stood there, heart pounding, dreading the next four hours. This? This is my first patient? This is how I feel around patients?

As my time in the class went on over the next two months my anxiety subsided. Being around cadavers became normal. To a certain extent, however, that upset me even more. Why was I joking around while using a bone saw on my patient? Why did everyone in the class know about my patient’s abdominal aortic aneurysm? If she was my patient shouldn’t I keep that information private? Conflicting emotions cropped up each day I found myself next to RW.

There was one day of class, towards the end of the course, where I remembered watching some students stress about oral exams while others cried as the faces of our patients were revealed (faces usually remain concealed until we are ready to dissect the caput). I kept wondering why this experience in the lab was being compared to that of the clinical. I didn’t remember the cardiologist I shadowed ever feeling like this. I became curious, and began to research how calling cadavers patients came to be. It turns out this was a recent development (my textbook that had been around for decades only had begun the use of this word in the last few years) and, moreover, it was not a development being used by every medical school around the world.

As I furthered my research into the topic, using a concept I had learned through my medical anthropology training, the hidden curriculum, I began to write about why I thought this change, this lexical choice, was not an ethical way to promote empathy in first year students. I first presented this at the Annual Medical Student Ethics Conference at my medical school, and then developed it into a formal essay, now published in this journal.

The anatomy course is still such a universal experience to all medical students that is usually situated in the beginning of a student’s medical career; therefore, the way we teach this class is of particular importance, and this includes the way we talk about what we are dissecting. We must analyse these choices, as they can create parallels, habits, and expectations in students that can not only affect the way they view the course, but the way they view live patients. This paper provides that analysis.

Paper title: Is it Just Semantics? Medical Students and Their “First Patients”

Author: Natalie Cohen

Affiliations: Icahn School of Medicine at Mount Sinai

Competing interests: none