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Thirty seconds. - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
Thirty seconds.
Walked into my patient's room this morning. "I want to go home," she says. Then she gives me a Look. "Can I talk to you about something, just between you and me?" Of course you can.
She tells me that if Y, the resident who sees patients with me when S is on call, ever dresses her down for stating her wishes again, that she is going to throw him out a window. Apparently, he told her that she had no right to tell the doctors she wished they would just take her thyroid out if that was what they were going to do, accused her of being too emotional, and told her to just relax while she was in the hospital. I would take it with a grain of salt, but I know Y.

Today: He swept in, introduced himself and me before I could even see the patient around the door, and went through a whirlwind of question-answers, never pausing quite long enough for the patient to think. She has nausea and vomiting and diarrhea, has had for two weeks. That's all that matters to him, despite all his lectures to me about getting a good history and asking questions to sort out the differential.
Today: He interrupted another resident's morning report presentation to take up the topic of the anion gap and how vitally important it was to calculate the delta/delta gap in every patient with an anion gap. The patient in question had an anion gap of 13. Normal is 6-10 or 7-16, depending on which page of the bible Harrison's you read. Someone challenged him. He defended his work by pointing out that the delta/delta showed a hidden metabolic alkalosis. There was a whisper beside me. "Well, yeah, she was vomiting." Not so hidden. And again, a lecture on the urine anion gap. Y loves numbers and mnemonics and steps to go through to make sure you've covered every angle.
Somewhere along the line, he missed one: the bedside manner. He irritates me, abrogates the patient's voice, and sweeps through like some sort of mathematical tornado. He gets the right answer, but leaves everyone bristling. I do not ever want to be Y.

And so help me, if I ever have to have a medical student do what I did today, I may hang up my stethoscope and turn in my license in shame. After S left the room of a mid-seventies lady with chest pain, I looked at her. "They told you you're staying overnight, right?" She nods, with the shell-shocked look of the elderly and terrified and confused. "Do you understand what's going on?" She shakes her head. "Or why you're staying?" This is the second patient, O Best Beloved, for whom I have stopped at the bedside and taken thirty freaking seconds to explain why they are going to be admitted. The first was a lady who asked me, shyly, if she could ask a question. "Am I going to be staying here?" The second was today. Thirty seconds: "In women who have chest pain, especially over the age of 45, we worry about their hearts being the cause of it. Women often don't have the usual presentation for heart attacks. We want to keep you overnight, look at your blood for some markers of heart damage, and do a stress test - look at the way your heart uses blood - in the morning. If all that's normal, then you'll go home tomorrow. If something comes back not-normal, we'll call the heart doctors and have them talk to you. Okay?"
She nodded, managed a bit of a smile. "Okay." I looked into her eyes. "Any questions?" There was a pause, for thought, then she shook her head. "No. Thank you, doctor."

Thirty seconds.

now feeling:: frustrated frustrated

14 whispers echo . o O ( ... ) O o . whisper a word
Comments
lakos From: lakos Date: August 17th, 2004 12:49 am (UTC) (etched in stone)
*snugs* See? I know you'll be a good doctor.
From: silmaril Date: August 17th, 2004 02:23 am (UTC) (etched in stone)
"I do not ever want to be Y."

And since you're aware of this, you are not going to be.
From: sepuki Date: August 17th, 2004 03:43 am (UTC) (etched in stone)
Where are you going to be practising when you do get a residency? Because I plan on moving there.
mama0807 From: mama0807 Date: August 17th, 2004 04:41 am (UTC) (etched in stone)
I've seen the whirlwhind question-answer thing done on the ambulance, and it drives me up the wall.
reynardo From: reynardo Date: August 17th, 2004 05:02 am (UTC) (etched in stone)
I hate being talked down to or over by doctors. Railroaded. Condescended to. Patronised. Treated as if I am some sort of ignorant being with no feelings and no rights.

Thank you for being the sort of doctor I want to have treat me.

Isn't helping people why you want to be a doctor? Then you're doing a wonderful job.
amasashi From: amasashi Date: August 17th, 2004 05:09 am (UTC) (etched in stone)
I know exactly how you feel. Sometimes I feel as if the hospitals here are the breeding grounds for Doctor Ys. Ugh.
daghain From: daghain Date: August 17th, 2004 06:10 am (UTC) (etched in stone)
You surely know more about what goes into being a good doctor than I, but let me play asshole's advocate.

I've always believed that, like lawyers, doctors get paid the big bucks to be callous. Their work requires them to detach the disease or injury from the person who has it and make a decision quickly and efficiently based on objective criteria. In a certain light, the bedside manner Y is lacking is a luxury, like skill in teaching is for an academic. It's appreciated, and it makes you feel better about yourself at the end of the day, but what these people need foremost is healing and Y, in his way, isn't stinting himself on making sure they get it.

That said, if you can make the hard decisions _while_ grokking their pain, of course that's much better. It won't be easy, but I wish you luck.

Oh yeah, and I notice you've friended me. Right back atcha. What's the occasion? :)
ayradyss From: ayradyss Date: August 17th, 2004 11:58 am (UTC) (etched in stone)
I think you filled out one of my surveys a long time ago and I just now got around to noticing it :)

There is actually a fair amount of evidence that a good bedside manner decreases malpractice lawsuits, shortens hospital stays, and makes patients more likely to -get- the treatment and healing they need.
A good bedside manner can be the difference between your patient coming to you with vague RUQ pain on day 1 of appendicitis and your patient coming to you septic and in agony once the appendix has ruptured.

Not to mention Y gets just plain -bullheaded- about his diagnoses.
turnberryknkn From: turnberryknkn Date: August 17th, 2004 12:35 pm (UTC) (etched in stone)
A thought-provoking series of questions you touch on in your entry. Difficult questions.

waifofthenorth From: waifofthenorth Date: August 17th, 2004 04:17 pm (UTC) (etched in stone)
My oncologist don't really do that to me...everyone was very sure to make sure I knew what was going on...but my family doctor kinda did that last week, she just wouldn't listen, and she assumed that I knew stuff and that she knew stuff about me. Can I email you with questions?
ayradyss From: ayradyss Date: August 17th, 2004 04:29 pm (UTC) (etched in stone)
By all means, e-mail I can't promise I'll have the answers, but I can try. dr.nykki(at)gmail.com :)
From: dr_bobbie Date: August 17th, 2004 10:03 pm (UTC) (etched in stone)
I love you, sister. <333
tyomniye From: tyomniye Date: August 18th, 2004 04:55 am (UTC) (etched in stone)
Am I showing my age if I mention they had a Doogie Howser episode that dealt with this topic? Seems it hasn't gone away. Pressure is there to take care of as many people as quickly as possible and therefore they don't always get the treatment they need most. Sometimes the answer to their condition lies in the simplest questions... Anyway, a little tlc goes a long way. :)
ayradyss From: ayradyss Date: August 18th, 2004 10:11 am (UTC) (etched in stone)
I had the -biggest- crush on Doogie Howser :)
14 whispers echo . o O ( ... ) O o . whisper a word