Ah, July. The time of year when New Englanders start complaining about the heat after eight months of cursing the cold.
It’s also what may or may not be the worst time to go to a teaching hospital.
Now, we have interns in our office, but since it’s a legal environment, and since they spend all their time looking up cases we already know about and writing arguments we will never use in any brief we intend on filing with the court, there’s not a whole lot of damage they can do, beyond maybe jamming the printer a zillion times a day.
But hospitals are a different story. In mid-July, which marks the first week of rotations after the medical school academic year ends, you have med students becoming new interns, interns becoming new residents, and residents becoming new attendings.
There’s a soft spot in my heart (and maybe my head) for med students. Probably this is because one of my two best friends in the world is a doc. I call her Dr. Wenchface, for reasons which I will never explain to you, so don’t ask. We met in college (her freshman year, my sophomore) and I watched her grind her way through organic and inorganic chemistry and bio-med, while I read Jane Austen (for my English major) and watched China Beach (for my history minor). Back before there was email, Wench used to call me at night and we’d commiserate for hours – her about med school and me about law. (Just an aside: student doctors learn their craft on cadavers; student lawyers practice on poor people. Which one is scarier, do you think?)
So I’m always mindful of the rigorous and difficult training that doctors go through, and the part that I as a patient contribute to their becoming physicians. They have to learn this stuff somehow, and early, from taking a thorough and accurate medical history to doing a competent exam.
A medical student taking a history is relatively harmless, and it’s a skill they MUST learn early on. Personally, I never refuse when my doc asks me if I will let a med student (or intern, who has graduated from med school) observe an exam. If I’m not in pain, I’ll even let the student have a feel. Why? Because they have to learn it somehow, and almost every hospital in my city is a teaching hospital.
Last year, during a post-op follow up, Dr. Adorkable asked my permission to have a med student present. I said okay, shrugging. No biggie. He put his hands out for emphasis and insisted, “You don't have to; you can say no.” I looked at him and said, At this point in my life, I've had pretty much the population of Vermont looking all up in my youknowwhat. One more isn't going to kill me. Have a party. Invite your friends.
It was a few moments before he could collect himself enough to go and get the kid.
I find it educational, too, because I have to be very specific in describing my history and symptoms accurately, because if I’m vague or shorthand it, it will end up being taken down wrong.
Eleven years ago, pregnant with twins, which involved some fairly intensive medical intervention, I ended up in the emergency room at 8 weeks with severe pain. Since they couldn’t do anything with radiation (no xrays, no MRIs, no CT scans) without potentially harming the babies, they couldn’t rule in or rule out appendicitis or ovarian hyperstimulation (either of which could have been fatal). So in the course of bouncing from the doc’s office to the ultrasound factory to the ER, I had 18 different exams (and not the fun kind) over the course of 10 hours.
In the ER, a brand spanking new intern (as in “I graduated last week”) came to take my medical history. My timing couldn’t have been worse – it was July 10. He took my complicated history on the back of an envelope and I had to spell all of the specialized drugs I was on.
Finally, after endless consultations, they decided to admit me and wait and see if the sudden absence of pain meant my appendix had burst. I remember all the different residents and attendings standing at the foot of the gurney (OB, GYN, ER, MED-SURG) making the decision to admit me – and this baby faced intern waaay in the back of the crowd, peering over the shoulders of the grownups. Finally, the GYN attending sheepishly asked would I mind if the intern did one last exam, his first one? Sure, I said, to my husband’s dismay. I will never forget the look on that young man’s face; you’d think I’d granted him amnesty. He was very gentle, a little tentative, and very, very careful. Every one of the various attendings and residents thanked me as they left.
Of course it’s up to every individual patient, how comfortable she feels about participating in this kind of learning exercise, and it is her right to say no. Personally, I think to myself, who knows where that doc is now, eleven years later? Maybe he has as vivid a memory as I do, recalling that lady in the ER that July night during his first rotation as an actual MD, who let him do his first exam. Maybe he’s somebody’s awesome GYN right now.
I like to think so.
No comments:
Post a Comment