* * Anonymous Doc

Monday, July 6, 2009

There's a second-year resident who sits in the nurse's station all day with her iPod on, absolutely fast asleep. She's not my resident, so I shouldn't really care, but it still seems ridiculous. I mean, a week ago she was an intern, so I guess now she feels like she can take it easy. But her intern is constantly trying to ask her questions, and she just shoos him away. If a patient gets harmed... whose fault is it going to be?

It's very quickly clear that the hierarchy at a place like this is clear and never compromised. Interns don't go directly to chief residents, residents take pains to avoid needing to call attendings, second-years deal with first-years, third-years deal with second years... everyone's at some level on the chain of command and there's no way to shortcut around it to just deal with the people you think are competent, or at least decent human beings. I don't think the strict hierarchy makes sense if best-quality patient care is the goal. Not that I have anything useful to say (yet), but at some point, if I see someone making a mistake, I shouldn't have to worry that I can't tell the chief resident he's about to harm the patient, just because I'm not supposed to be talking directly to him. I shouldn't have to hold my tongue and not ask the attending a question about the right meds for the patient just because my second-year thinks I should always go through him. Second-years don't know everything, third-years don't know everything, attendings don't even know everything. But we get thrown into this environment where the expectation is that whoever is one level above you knows everything you do plus everything you will ever need to know, and everyone's afraid to question that authority and think for themselves. I've already seen minor mistakes-- a patient discharged with the wrong prescription, and we had to call her and tell her not to fill it; a missed chemotherapy dosage because the handoff to the night float team was rushed; a patient discharged to clear a bed before everyone was really sure she was fit to leave. Nothing (hopefully) that led to any negative outcome for anyone, but it's still clear that mistakes happen-- and if I've seen these in less than a week, surely there are more happening over time, and throughout the system. There is unquestionably a lot of documentation-- and unquestionably almost everyone I've met has absolutely the best intentions, and frankly a pretty superb base of knowledge-- but we should be encouraged to speak when we see something going wrong, or else it's the patients who suffer.

I haven't talked to anyone outside the hospital for four days, except my parents. I get out too late to call most of my friends on the phone, and haven't been communicative enough on e-mail that I've had any substantive talks with anyone about what my life has been like since this started. I actually haven't yet figured out how anyone makes friends intern year. Every few weeks we're moved around to work with different people, and during the day it's too hectic to ever really have a conversation that isn't about ordering these labs or that scrip. Maybe once we start having some lectures, or some social activities, or clinic, it will be more apparent how to get to know people, but for now it feels like I've signed up for three very lonely years, going from home to the hospital back home to sleep and up again the next day. If I had a wife, she'd be feeling a little neglected at this point, I fear. Maybe not, maybe she would know I'm trying my best and there just aren't any options-- the day ends when they let me go, and it's not my fault if a new patient comes in right when I'm in line to sign out-- but I'd still feel bad. As is, I feel bad I'm wasting money on a cell phone plan, because I'm never going to use my minutes.

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