* * Anonymous Doc

Saturday, November 14, 2009

Today was my last day of this rotation-- on Monday I switch hospitals, though the work will be much the same. Standard patient floors, six days a week. I was hoping I'd get out early today since it was my last day (so no new admissions), but I had to write my final notes for the next intern to know what's going on.

So many transitions from doctor to doctor, so many handoffs, so much potential for disaster.

One of my med students sent me a text thanking me for helping him out and being a good role model. I thought that was nice.

A couple of months ago, I thought, oh, it'll be great not to be the intern, it'll be great to be the second-year or the third-year, so I can delegate all the scut work to the intern. Now I'm realizing that even though we have to do a lot of the scut work, we also get to leave when we're done and don't have to stick around to supervise. There hasn't been a single day this month that I've left after my resident. My hours have been bad, but hers have been terrible. And she has the responsibility of not making mistakes, too. At least I have someone to check with. She has no one. It's all on her. Something goes wrong, it's on her. I don't want to be the resident, I really don't.

There was a piece in the New York Times yesterday about primary care, and how no one wants to go into it, the pay is low, the respect is low, the rewards are low.... I thought the piece sold primary care kinda short. In private practice, it's not as if the hours have to be any different from specialists-- you're setting office hours-- and if you think you're dealing with the same problems over and over again in primary care, well, how many problems is a dermatologist really dealing with? How many different problems is a cardiologist dealing with? Yes, the pay is lower-- hopefully reforms will change that-- but there's also the reward of getting to know your patients over time and being the person they think of as "doctor." I can't imagine being an anesthesiologist, never knowing your patients, sitting alone in the corner of the room manipulating machines, and only having anything to do when something has gone terribly wrong. I'll take primary care over that, I really will.

1 comment:

  1. Anon,

    You have it all wrong. In primary care you see and deal with everything. It is not boring, far from it and that is really a major crux of the problem. Remember the primary in primary care, I see the patient for just about everything before a specialist sees him. I decide if I want to handle the condition or send the patient to the specialist, whether it be dermatology, cardiology, radiology...

    It is the legal and economical framework which forces me to send the patient to the specialist. If anything goes wrong and there is a lawsuit, I am defensless for the lawyer's attack of, "Why did you try to handle the problem instead of sending the patient to see someone who has studied that particular problem in more detail?" (ie why didn't you send to the specialist?).

    And the other major problem, if it is a problem that I can handle without a procedure, I can spend 10 minutes or 30 minutes working out the correct solution but in the end I am going to get compensated for the 10 minutes (insurance rules). With overhead being 80%, there really is not much room to take on many of these cases.