Trust Issues

As my time in residency passes I grow increasingly weary that the goals & foundation of graduate medical education will only be a forethought in the corporate pursuit of healthcare profits. The worst part of my day on the medicine service is Case Management rounds. Reason being that I stand there justifying to people who aren’t physicians just why a patient of mines is either leaving or not. It’s usually during this time I'm reminded that a patient I'm caring for doesn’t have insurance, hasn’t been here long enough or that a person I am taking care of has been deemed to be in the hospital for longer than expected. Just to give some background on my thought process I am doing residency at a smaller community program which just happens to be owned by one of the largest hospital corporations in the nation. Our medicine months are divided by either working with the hospital’s own hospitalists group versus working with our associate program director who happens to still be old school in his ways regarding doing both inpatient & outpatient care. The teaching philosophies are almost night & day. When working with our hospitalists group many more of our “interesting” cases are regulated to be worked up on an outpatient basis which is always funny to me since I am sure that it never ends up being worked up versus when we are with our other attending he actually prefers that everything that can be done in the hospital be done because he understands the lack of outpatient care is likely the reason why they are here in the first place. The cost of patient care is of premium focus on our hospitalist service which I think sometimes cripples our management because were really not allowed to educate ourselves in patient diagnostic care.

Even now discussion regarding a patient cap on our residents has become a drawn out  issue but I am certain its not because the hospital is concerned that we would learn less from patient care (medical education perspective) but really because the hospital would have to foot the bill in hiring another hospitalists or physician extender to make up for the overload(corporate perspective). I come from the mindset that an intern having to deal with 12-15 patients is NOT a good idea because they only learn what to do for the patients but not really why.

Again I come from a small community program so maybe the dynamics are different at a bigger hospital or even a educational institution but its hard for me to believe that hospitals are only focused on the dollar bill at small hospitals but not larger ones. My attending jokes all the time that they aren’t making doctors like they used to & I am inclined to believe that this is one of the biggest reasons why.

Feel free to give feedback especially if you happen to be at a bigger institution. 

Review: Gastroenterology Month

I painfully got finished with Gastroenterology(GI) last month & lets just say I couldn’t wait to get back on the wards. Let me first start by saying that I don’t think the cases were bad or even boring for that matter but I learned very quickly that GI was a specialty that I wouldn’t consider even if the fellowship position was given to me. I used to think that Cardiology picked up a lot of bullshit consults just because the person had a heart but GI definitely tops the cake. If a person became nauseous during the hospital stay GI was summoned. We had a few unfortunate cases during the month, one patient had diarrhea for over 6 months before getting it checked & it turned out to be colon cancer which had spread to the liver & another patient which a severe case of alcoholic hepatitis who was as yellow as the sun(no exaggeration). But for the most part plenty of cases where I didn’t need the expert opinion of my attending to solve the problem.

One of my main reasons for my dislike for GI is that fact that you never really leave the resident lifestyle. I have said from the beginning that once I leave residency I don’t want to go into practice knowing that any second I could be called for an emergency that will cause me to get out my bed at 3am. One day in particular I was told to come in a little later than usual because my attending had procedures to do at another hospital but lo and behold a STAT GI bleed consult from the ER caused me to speed into work early. To make matters worst I had to deal with an attending who base line voice level was yelling & he had no problem making a scene yelling at a nurse, myself or a patient whenever he was in the mood. All in all I commend anyone who wants to do GI but I can assure you that this is one resident you will not have to compete with.

The night before..

A few years ago (2/13/11 to be exact) I sat up in my room knowing that the next 24hrs would drastically change my life. It was the day before match and all I could think of was did I make the right choice in choosing to go the osteopathic route instead of the allopathic match. I didn’t sleep a wink & my motivation to go to the clinic was zero. I’m sure many 4th yr students are in the same boat & I just wish them the best today.

Review: Infectious Disease Month

Just finished my consultant month in Infectious Disease(ID) & it was great to get away from the wards for a bit. Plenty of interesting cases including cryptococcal meningitis & a post influenza staph pneumonia which resulted in severe rhabdomyolysis(Both cases will be future case presentations). Being in the hospital setting you form a mental picture of what HIV patients look like because we tend to see the noncompliant ones but seeing them in the office setting helped me truly appreciate that HIV is becoming a chronic disorder & no longer a death sentence as it used to be. Had one patient even joke that it was easier to be an HIV patient than a diabetic because she hated the needles. I enjoyed the month, loved the outpatient aspect of it & the fact that you don’t get called in the middle of the night for STAT consults. Definitely in the discussion for possible fellowships.

This month Ill be doing Gastroenterology(GI), wish me luck because long hours are ahead of me.  

Priorities

As I began night call a couple of weeks ago, we were paged by the ER to do an admission for a lady having seizures. I arrived to the room to find the patient sedated at the time of my exam accompanied with her husband & son–n-law. I didn’t notice at first that I as I walked in the room neither of them acknowledged me but as I tried to get some history about what happened prior to the patient suffering a seizure I quickly realized that all eyes were affixed to the tv behind me. “Unfortunately” I had began to ask questions as the Baltimore Ravens were driving down for what would be the game winning field goal. In disbelief I made it a point to reposition my self so the husband couldn’t see the tv without moving  over & lo & behold that is exactly what he did. It got to the point where he became visibly frustrated with my questions & stated that he had nothing else to offer.

Now for the short time I have been a doctor this easily ranks #1 as someone not having their priorities in order.