7-11-11 Monday  + 8 months

Couldn’t help responding to good friend Dr. Rick Davidson’s comments about today’s medical residents and the way it used to be when we served as house staff together at Vanderbilt.

  We rotated thru 4 hospitals to give us a breath of experience: Vanderbilt University Hospital (generally more complicated, esoteric, and mysterious cases), VA Hospital (lots of liver and lung pathology – read alcohol and tobacco), the private upscale St. Thomas hospital, and the public Nashville General Hospital (affectionately called the “Nasty General”).  There was much less supervision at the General, and consequently much more responsibility.

  Two episodes I remember vividly (not forgetting for a moment all those Friday nights in the ER).  One was a older man who came in with dangerously high levels of potassium (it’s also what’s put in the IV used to stop the heart in lethal injections).  I asked my resident what I should do, and he said, “If I were you I’d get it down.”  So for the next 6 hours in the middle of the night I was all alone, looking up everything and doing everything I could to get it back to near normal.  I finally stabilized the patient without knowing that my resident was calling the nurse about every hour checking up on me and ready to intervene if I had lost my way.  A good confidence builder.

 Later as a more confident resident I was assigned to the screening clinic (affectionately called the “Screaming Clinic”).  It was flu season, and we took all comers (“come on in, sit right down”).  I think my record day was 130 patients.  I had already written several hundred prescriptions for decongestants, anti-histamines, cough syrups and the like, and after an all too brief check of their lungs (to rule out pneumonia), heart (rule out heart failure), examining their throats and lymph nodes (rule out strep throat, infectious mono, and the like) I’d just tear off a sheet from one of the prescription pads for each of their symptoms.  I didn’t think any of those nostrums would help a cold or the flu, but a kind word, “I hope you feel better,” and a promise of continuing care, “Come back if it’s not better in a few days,” I hoped made them feel that their discomfort was addressed.  It was conveyor belt medicine, and of course if you had an inkling something else was going on, you’d order some tests and follow them up. But I’m sure seeing hundreds of patients each day for weeks, I made some mistakes.  I just spent the days trying not to get sneezed on.

  Today’s New Times has an article about one medical school’s attempt to sort out from its applicants more empathetic, thoughtful students.

http://www.nytimes.com/2011/07/11/health/policy/11docs.html?hp

  When I applied to med school, one of the sections on the MCAT entrance exam was on general information (the arts, history, literature), an attempt I believe to find well-rounded students, not just those who had their noses buried in a biochemistry book.  Sadly they dropped that section soon afterward.

  I took the MCAT again about 20 years later and wrote an editorial in JAMA critiquing that decision and other changes that I thought were not productive.  We’ve now constructed a system that favors the high brain-powered student who can make the best GPA regardless of whether that person could make the best doctor.     

I’m a Hopkins tomorrow for an endoscopy – will let you know the results.

Love,

-Bruce

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3 Responses to “”

  1. Ashby Says:

    Now which end gets the endoscopy? Couldn’t help but notice the date for the latest entry: 7-11-11 which immediately reminded me of Root Boy Slim, aka Foster MacKenzie III (another infamous Yalie), who will forever live in my memory with his immortal song “Stealing from 7-11” which pointed out the obvious: to wit, “You got to steal from them, else they’ll steal from you.” Of course, he was also known for other fabulous hits such as “Mood Ring,” Boogie Til You Puke,” and “Xmas at K-Mart.” The DC music scene has changed so much.

  2. Chaya again Says:

    Had three this last year, no side effects and no information either, bad or good either way you look at it.

  3. grassflats Says:

    Well said. And lots of memories. Screaming clinic, Joyce the giant nurse in the ER, getting stuck in a snowstorm at the General and having to stay there for three days…and the tougher times. I actually discovered a patient who had been dead for some time when we walked into his room on rounds. We are paying much more attention to safety these days, but we’ve become short on the curiosity and commitment. I still believe it’s possible to have both. Good luck. Planning on seeing you in about a month.

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