* * Anonymous Doc

Tuesday, August 3, 2010

Yesterday I started my new rotation-- no more overnights for a while.

My first month as a resident has been... okay. It is so much better to be the resident than the intern. I don't even think I completely realized it as the intern. It's not that you're that much less busy, but the fact that you're not at the bottom-- that you can delegate, that you can prioritize, that you're not being micro-managed, someone standing over you expecting a progress report every thirty seconds-- it makes it a lot easier to get through the day.

I think I've been a little bit spoiled this month, as far as the thing about being a resident that scares me the most-- being in charge, being ultimately responsible. Because in this rotation, I haven't been. There's been a fellow, there's been third-years on call for consultation, the attendings have been very involved. I've made decisions, but not really anything big, and there have been people to call with questions. I worry more about when I'm on the regular floor, and I'm really the one making the call a lot of the time. But by the time I'm on a regular floor month, I will have had more months of this, and I'll know better what I'm doing.

One of the nice things about being the resident is being able to set the tone for the team. As an intern, you have to adapt to your resident's style-- as a resident, the interns had to adapt to me. I'd like to think I was pretty easy to work with-- hopefully my peer evaluations will bear that out-- and that my "style" wasn't anything particularly bizarre or demanding-- but to not be beholden to someone else's idiosyncracies about how they wanted the notes written or what information they wanted in what order or which patients should get seen when-- was freeing, a little bit.

I think mostly what I learned is that I don't mind the teaching part of this, I don't mind being in charge of interns. I've written before about how we're not selected for our ability to manage people, we're not selected for our ability to teach, but those are really important parts of the job. And I didn't know what it would be like until I had to do it. And maybe it's because I had good interns this month, but that part of it has been fine-- and I think that's why I've had less to say on the blog this month. My hours have been long, the patient situations have been stressful and crazy, I've been sleep-deprived and exhausted-- but it's all been far better than the worst of intern year.

I say that now, but day #1 of month #2 is making me think I won't be so lucky the whole year... I've already been yelled at by an attending, a nurse... and a patient.

I can't understand how some patients think about hospitals and doctors. This isn't a hotel, and the things we need to do aren't really menu items from which you can pick or choose. "I'll have that test, but not the other one," is not a sensible thing for a patient to insist on. "You've already taken enough blood today," is not an acceptable patient response. We're not taking blood for our own vampire-like purposes. We're taking it because we need to check something that's going on inside of you, to hopefully make you better. When you refuse things, and make our job more difficult, you're only hurting yourself. Why do so many patients have such a hard time understanding that.

It's not just, "you've already taken enough blood today." It's, "I've already had an x-ray," and "I don't think that medication does anything," and "I should be getting more food," and "That's not where I want the IV," and "I'm supposed to take my pills in the morning, not in the afternoon," and "I don't need an MRI," and "you can come in here one more time, but then I'm closing the door."

I don't know how to convince the unconvinceable, and I don't have all day to try. If you don't think we're trying to help you, leave. Otherwise you're just making things worse.

End of rant.

3 comments:

  1. One of my friends was in the hospital a while back, very seriously ill. If you went to sit for a bit, it was amazing to see all the people come in, poke and prod, not say anything much (maybe hello), draw blood without saying why (I have to draw some blood), over and over again. I can imagine people get really tired of it, the constant interruptions, being treated like you're too stupid to say hello to, realizing that people have made mistakes in your care (oops, you weren't supposed to have that medicine anymore!). And I can imagine people get very defensive about it. That's not to say it's logical, but if someone's really feeling lousy, I can imagine they'd really want to say "just leave me alone for a while now."

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  2. If you are genuine, treat people fairly, teach what you know, and learn from them as well (even your underlings), you will enjoy the experience and be appreciated by those around you. I have found that to be true throughout my entire professional life. The folks that like to complain, on the other hand, are just something you have to learn to deal with the best you can. They will always be with you as well! Good post.

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  3. The Patient has a Side TooMarch 4, 2012 at 5:24 PM

    When you have five different people come and stick you multiple times each to get a vein for eight different (maybe, or the same, noone explains to the patient) in one afternoon... then yeah, haven't we already done this? I'm not a pincushion or a voodoo doll, I'm a person. One who has been jabbed with needles 27 times in three hours, and is running out of veins. How about a little coordination - let one (trained, please, pretty please?) nurse take all eight vials (hell take 10, incase you think of a few more tests to run!) or at least put one of those little port things in, because we both know you're going to want to repeat all those tests tomorrow.

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