* * Anonymous Doc

Monday, August 3, 2009

Potential patients -- you should probably try to avoid getting sick at night or on the weekend.

I don't know why they think it's fine to have an intern, alone, taking care of an entire floor of patients, just because it's Sunday. Illness doesn't know it's the weekend! Something happens to you, and I'm the one in charge? Okay, so there's a second-year resident asleep two floors up, who I'm supposed to be able to ask-- but how much more does she know than I do? It's not that they expressly tell us not to page the attendings on the weekend, but that's what the culture seems to be. You do as much as you can handle, on your own, before you ask for help. Sure, that might be great for learning-- if I kill someone, I'm pretty sure I won't make the same mistake again!-- but it's terrible for patient care!

I guess it's not as if there's a lot I can do anyway in the middle of the night. No specialists, no diagnostic tests-- we can't run a CT scan outside of business hours-- it's a glorified babysitting service costing insurance companies thousands of dollars a day. Someone comes in on Friday night having a heart attack, he's not getting to the cath lab until Monday at the earliest. That's more than 48 hours he's just resting in the bed, with me in charge, asking him if he's sleeping okay. I had a patient last night kick me out of his room because he wanted to get some rest-- I was glad to go! It was midnight! I wanted to get some rest too! But I didn't want to be yelled at for not being thorough enough with my patient history.

A hospital in the middle of the night is an expensive waiting room, especially in the middle of the night on a Sunday. The nurses were reading books. Novels. Long novels. And I don't blame them-- no attending comes in, there's no hospitalist, there's nobody. If they call a code, it's me and I pray the second-year resident wakes up and brings some friends. And this is thought of as good medical care!

We had a smart-aleck elderly patient last night ask me how long I've been a doctor. I told him I'm a first-year resident. He said his grandson is a doctor so he "knows the deal." "So I'm like your first patient, right?" "Well, no, it's been more than a month since I started." "Oh, more than a month! Well then, I know I must be in great hands." Look, make me feel like a moron, that's fine-- but if you think it's better anywhere else, you're kidding yourself. Residents start the same time everywhere, and if it isn't me, it'll just be someone else exactly like me, who knows just as little. You want to forget about a teaching hospital and go to a community hospital instead? Fine with me-- instead of doctors, you'll be seeing newly-minted PAs and nurse practitioners, and your attending probably went to medical school in the West Indies. You can't win, sir. It's a Sunday night in August. Me and my month of practice-- I'm as good as it gets.


  1. Pretty bold statement to say that you with your "month of experience" is better than an NP or a PA.

  2. Bold is beautiful.

  3. Maybe in a steak sauce.