For the first time, I stood facing a patient’s waiting room door alone, unaccompanied by my preceptor. A tingle of nervousness began to creep in as I faced the wooden semi-soundproof slats. Every fiber of my hand seemed conscious, and my fingers became aware of the tickle of the ambient draft. I remembered the routine a professor of mine had said: wash your hands, breathe, knock, and wait. I heard the muffled assent from the other side of the door and tachycardically went in.

Fingers still grasping the door’s metal handle, I delivered the opening three sentences I had practiced persistently while pacing around my apartment. “Hello, I’m Harry Doernberg, a medical student. I work with Dr. F. Is it ok if I sit down and ask you a couple of questions?” I moved quickly to the chair in two steps, now I sat facing the patient. We chatted. My brain clumsily tried to recreate the pages of the medical interview I had memorized, but each heartbeat’s voluble vibration seemed to interfere. I remembered enough to offer “So what brings you in today?” “Just a regular six-month check-up.” I struggled to think of what to respond with. Every neuron was firing simultaneously, though no two seemed to connect. The internal calmness slowly attained with detailed interview practice fell away, replaced instead by muscles that slowly tensed like a rope twisted at both ends. After regaining enough inner composure to elicit a full history, I finally left the room to retrieve my preceptor.

János Starker, famed cellist and pedagogue, was fond of telling his students that it was fine to be nervous because it showed that they cared. This mantra often responded to students’ expressions of performance anxiety. Though most musicians are experienced performers, playing in front of others often remains stressful, so much so that many take beta-blockers at some point in their careers. Years of auditions and competitions create the expectation of tacit judgment from the audience—a worry that ears are aware of and judging every mistake. In the highly competitive world of music, even in collaborative environments, the perceptible feeling of public evaluation can cause anxiety. Often, this concern of public judgment is, in part, what musicians are concerned about. Fit into Starker’s adage, many young musicians care how others will perceive them—a mindset that underlies the stage fright of performance.

When I used to perform, I would also feel that same nervousness. It was easy to worry about the personal consequences of a poor performance, catastrophizing that others would not want to collaborate or that I would lose an audition. Tension would sometimes invade my playing, causing a Schubert sonata to sound like it was being piped through the neck of a stretched balloon. Music’s freedom of self-expression could become stunted by self-doubt. János Starker, my own teacher’s teacher, would have probably pointed out that I cared, maybe too much, about other’s opinions.

In the few moments between when I left the examination room and finding my preceptor, one question lingered—why had I felt the same nervousness now in medicine as I had in music?

This patient interview seemed, in some way, a performance too. Like an audition, I had opened a door to be greeted by an unknown person sitting across a table. Practice, rehearsal, and comments from my peers and professors had sharpened a new skill, and I was presently putting that education to the test.

Yet, unlike a public performance, I hadn’t been concerned about how my audience assessed my abilities. My tension didn’t stem from the worry that the patient was going to complain to my preceptor, and no one was peering through the one-way glass of an OSCE examination with a ranking sheet. In contrast to how a poor musical performance would negatively affect me, I was unscathed by imperfections in my interview. Whatever happened in that examination room, I would walk out the same as I had come in.

I wondered how that patient would come out of that room. They had arrived at the outpatient clinic for medical care. Had my preceptor not come in afterwards to give an expert interview, they would have left not knowing if an important part of their story had been missed. The care that they were entitled to hinged almost entirely on my own ability to elicit, recognize, and treat symptoms and disease. The patient was the one who would bear the repercussions of my inexperience.

While he was alive, Starker admitted to being a nervous wreck backstage. He was once asked to explain his nerves in the context of his axiom–what was it that he cared about to make him so anxious? It was not that he questioned his ability to play in the minutes before a concert, he said. The opinion of others and his own self-perception was unimportant. Rather, what weighed heavily in the performance was its responsibility—to oneself, to the audience, and to music. While his pre-concert nervousness remained the same throughout his life, the years of concertizing had changed its underlying basis—from cares about internal impacts to external ones. Now, it was the weight of responsibility, his care for art, which induced his nerves.

At the door of the examination room, I began to experience a similar responsibility. Like Starker, concerns about the personal effects of the performance had not precipitated my nervousness, as had been the case on the musical stage. The interview’s outcome had little effect on me. Rather, the cause was my tactile understanding of the responsibility to the patient, the worry that I would be unable to provide good care, and the fear that my inexperience would do harm. In Starker’s terms, I had internalized the care of the patient as my own, each interview a concert to a greater end.