The School of Medicine at our University of California Davis at Sacramento owes a good share of its formative years and development to the Physicians and Surgeons of Sacramento and El Dorado as well as other adjacent counties. Clinical appointments were readily given in return for teaching 50 to 100 hours per year. Having made attending rounds teaching students, interns and residents as a fellow, I continued the same routine for several months a year into practice. For the next decade or so, I donated my required hours teaching students in the weekly Chest Clinic. For the past decade I have participated in the Physical Diagnosis program by having second year students rotate in my office a day a week for two months every spring.

Although faculty benefit from teaching as much as student physicians benefit from the practice of obtaining histories and doing physical examinations, periodically the practicing physician must reassess the time invested and benefits obtained. Inevitably, one sees how much one gains by making this investment. Teaching and specifically the questions that students may ask forces professionals to look with new eyes at old practices.

As physicians get busy in practice, we may cut corners from our training experience. Occasionally items of personal history may be glossed over. Sometimes fundoscopy, prostatic or ovarian exams are not done. One need only to review charts to realize the brevity that is used. If we actually believed the frequently touted statement that "if it isn't written down, it wasn't done," many charts would scarcely document that a patient was examined. Doctors should see an aspiring future physician go through every step of a complete medical history and detailed physical examination if only to be reminded of the value of their own former habits.

This year our office had an interesting experience with two very bright students--one a female RN becoming a physician and the other a black male. It was with some amazement that I observed my student asking a 68 year old lady with advanced pulmonary disease and congestive heart failure about her sexual history. I was surprised at her skill in obtaining the sought after information. I was even more taken aback to find that my patient actually was having sexual liaisons between episodes of respiratory and congestive failure. I was not surprised that sex was unprotected. My students were. They even chided my patient to be more careful in the future. She told them not to worry. This detail, which we all practiced in our formative years is being re-emphasized because of the current lethal pandemic.

The first patient exam can be overwhelming for a student doctor. What doctors need to know seems never-ending. Mentoring is a way to give young student physicians a long-term view. It may also be a way for physicians with an overview to pass on the compassionate side of doctoring, which C. Everette Koop says is not taught in medical schools. Perhaps Dr. Koop should visit UCDavis. These medical students had sensitivity and compassion.

Students may be the teachers best stimulus for excellence. As Osler stated, patients are our best teachers. Patients examined by students in the presence of a faculty member may be a very rewarding teaching experience. The benefits go in three directions--to the patient, in the satisfaction that he/she contributed to a future doctor's training and the detailed examination re-assures him/her that a complete evaluation was made; to the student physician, for the learning experience and the sense of accomplishment; and to the faculty physician who was reminded again of the importance of his earlier didactic training.