The other side

Medical student Filip Simunovic decided to spend his summer holidays working as a porter in a German hospital and explains how working on “the other side” was an enlightening and rewarding experience

When thinking about the most useful way to spend a free summer, I had a few ideas in mind. Firstly, that I was not able, as a first year medical student lacking in knowledge and skills, to participate in a clinical clerkship. For similar reasons I was not prepared to plunge into a research environment. Secondly, I wanted to improve my German by living in a German speaking country. Thirdly, taking into account the World Health Organization’s guidelines on medical education¹; the recommendations of the World Federation for Medical Education²; and those of the Association of American Medical Colleges,³ which name knowledge, skills, and attitude the three most desirable qualities of a doctor, I presumed it would be beneficial to work on my attitude. I decided to find a position that would empower me, with full access to a hospital, and give me the opportunity to experience hospital life from a different perspective. So I applied for a month’s work as a porter at Heidelberg University Hospital.

Getting my bearings

My port of call was the University Hospital for Internal Diseases. The southern part of the hospital is divided into two sections, each comprising eight wards for inpatients and two intensive care units. The wards are named in honour of the professors who excelled in their respective fields of internal medicine. For instance, the Von Dusch ward receives patients with immunological disorders, with people dressed up in green robes, masks, and gloves, and for diabetic patients, there is the Curshman ward. The examination facilities are in the northern side of the complex, and patients move through connecting bridges.

What do porters do?

In brief, a porter picks up patients in their rooms and delivers them safely to examination rooms and vice versa. Some patients can walk by themselves, but most have to be transported either on a wheelchair or on their beds. It sounds like a simple enough job, as long as you know your way around. But jobs are seldom free of complications—for example, the patient’s files are misplaced, no nurse is there to unplug a monitor or an intravenous line, or no wheelchair is available. One patient refused to go because he was there the day before or no one told him he was scheduled for rectoscopy. These are all facts of life in a porter’s daily routine.

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Heidlberg castle and the Neckar River, Germany

The other side

I felt as though I had crossed to the other side. Medical students in my country are regarded as little doctors, achieving greater status as they progress with their studies. The ideas and experiences related to hospital life that medical students get are limited by the student’s “doctor to be” status, and they miss out on some aspects of the other side—the real world of patients.

By working as a porter, I got a chance to see things from an opposite, more patient centred perspective. I saw pain, misery, confusion, and helplessness. I gave moral support for people sentenced to endoscopies and heart catheterisations, and I had to play it cool with frustrated patients who had been waiting for half an hour or more. I realised how much it means for a patient not having to wait when I stayed with them during the procedures, after which I would take them back straight away. One patient even offered me a20 (£14; $24), but I think he was heavily sedated. I witnessed their fears before a procedure and their feelings afterwards, and I was their ally in chasing after the doctors and nurses.

Most patients were friendly and eager to give me a detailed account of their illness, often mistaking me for a doctor. I would talk with them, take a look at their files, and make a serious face of someone who understands something. Some were less pleasant, looking down on me because of my position and my German accent. I never took offence at such attitude—it was interesting to observe how differently people react to being sick and dependent.

By being an everyday spectator of the doctor-patient relationship, I became aware of the importance of developing a proper attitude. If a doctor doesn’t radiate self confidence, she or he can’t expect the patients to be relaxed and trusting. One time I waited an hour for a patient who was scheduled for an insertion of a central venous catheter. When the doctor arrived, he took another hour for the procedure (time which the anaesthetics ceased functioning), and received suggestions all the time from five observing colleagues. After that we had to wait for the x rays, and, by the time I took him back to his waiting parents, almost three hours had elapsed. By now, it was hard to expect the man to be smiling and cooperative. I became aware of how complicated it is to achieve a proper balance between availability and authority, without being pompous or insecure.

My concept of a doctor’s role and position in a hospital became clearer. You might be standing on the top of the hierarchy, but you still need to be constantly aware that proper hospital functioning depends on a number of other people, starting with the porters. What can a doctor do if the patient is not there at the scheduled time? Can they adjust the treatment to the new findings if they don’t receive them because the person bringing the laboratory results falls asleep? I realised the importance of every single cog in the hospital’s machinery. The hospital’s smooth functioning was possible due to a friendly atmosphere, in which everyone is, and feels, important. I found this rewarding and constructive.

Medical students should follow my example and try to see patients from a different perspective: perhaps it should be mandatory. We expect our chosen careers to be perfect, but experiences such as mine force us to compare our dreams with reality. The illusions instilled by watching television series, were swept aside.

Also, working in another role in a hospital ends up shaping our interests. I was leaning slightly toward surgery, but now I am more interested in internal medicine. The magic of eight-hour operations gave way to more delicate diagnostic methods of cardiology, angiology, or nephrology. It took me just a few hours with a junior surgical intern to realise what kind of dirty and demanding work he was doing. And it took another hour with a heart surgeon in an operating theatre to realise how boring an operation can be.

Working abroad as a porter is probably the best thing a first year medical student can do with his or her summer. You get paid, start speaking in a new language, and get to meet nice girls.

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To do this job, you need to beef up a bit as well!

1. World Health Organization. Division of development of human resources for health: developing the protocols for changes in medical education. Geneva: WHO, 1995.
2. World Federation for Medical Education. Basic medical education: WFME global standards and quality improvement. Copenhagen: WFME, 2001.
3. Association of American Medical Colleges. Learning objectives for medical student education. guidelines for medical schools. Washington, DC: AAMC, 1995.