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.
skip to main |
skip to sidebar
Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
Posts
Followers
About Me
The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
No comments:
Post a Comment