Friday, December 28, 2007


Practicing in a teaching hospital has its privileges. The latest technology is readily available. There is always a willing, even eager helper. As a general rule there is a collegial relationship between the attending staff (physicians who teach the residents) resulting in the liberal use of the "curb side consult", several physicians offering thoughts on the diagnosis and treatment of difficult cases. This results in a high level of competent care for the patients.

There are also a few drawbacks. One is the constant testing. My kids frequently remark that they will be glad when they are no longer tested. School, I know, seems like a journey from one exam to another, but life is a series of tests too. One of the draw backs of constantly working in a training setting is that every patient encounter, is a proctored examination. Let me illustrate.

As a second year resident it became my job to supervise one of the interns who was so book smart it was frightening. Adam would answer questions with direct quotes from textbooks. I suspect that his memory was photographic. Like most interns Adam lacked judgement.

One Saturday when we were on the labor and delivery unit together, I sent Adam back to the delivery room with one of our most arrogant attendings. There were two ways to preform every procedure, Dr. Jones' way and the wrong way. This appeared to be a routine laboring patient about to delivery her second baby. Adam had been on the obstetrical service only a week but I thought surely he has seen Dr. Jones do another delivery. Besides, all he had to do was help drape the patient, pass instruments to the attending physician and look attentive.

Once the baby's anterior shoulder was out, Dr. Jones always requested the nurse to push 10 units of pitocin in the IV line. Instead of questioning this practice prior to the delivery, it was after the fact when Adam said, "Gee, Dr. Jones, I thought you weren't suppose to do that because you might trap an undiagnosed twin?" Please try to understand that this occurred more than twenty five years ago when there was no such thing as routine sonography.

"Dr. Parker," Dr. Jones replied to Adam, "Any obstetrician worth his salt would know if there were twins by now!" As he was speaking Dr. Jones placed his hand on the patients abdomen and palpated the large mass that was indeed, the second twin.

A few expletives, some nitrous oxide, and minutes later holding a healthy second twin we had all learned something. The process for stopping a very strong contraction and delivering a second twin by breech extraction was etched in my memory. Adam was beginning to process the need for questioning in a less accusing manner before someone above him took action. And Dr. Jones. Well, in the next two and a half years, I never saw him push pitocin prior to the delivery of the placenta again.
TestingSocialTwist Tell-a-Friend

No comments: