Senior-itis

I can't believe less than 12 months are left in my residency.  I wondered going in who I would be and what all would transpire when I came out.  When I got into medical school I had heard that becoming a doctor would change you.  I went in with that and a determination that I wouldn't let it, but you can't help what you experience and your experiences change you for better or for worse.  It's about like I thought, I'm not better or worse for it, just different.  I've found strengths I didn't know I had and sadly weaknesses too.  I'm starting to get anxious to start this next part of my family and I's life. If I think about it too much my head fills with a billion scenarios as to what will happen, as usual it's never any one of the hundreds I concoct, usually a mix of many.  That's something I've learned about myself in the last couple of years, even if it's horrible, if I expect it, I can handle it.  One of my greatest fears/annoyances are the things I can't expect, I compulsively try to expect the unexpected and I think my job has only made me worse in that respect.  Every single day at work as I hand my patients over to the new doctor taking care of the patient I'm trying to handle problems and foresee hangups before they ever occur, I think if you have the slightest tendencies before residency you come out full on OCD.  I'm hitting the sack, as I'm finally tired enough to sleep, these electives depress me, one other thing I've found out about myself, I need real work to burn off energy or something or else I just spin my tires, it's so dumb that on these "easy" months I can't keep it together, but the hard ones I'm straight as an arrow.  It's like those old farmers that finally sell their ground, they're so attached to it in another month you find them six feet under it.

Newbie Doc

Standing Up

There have been times during my life I've tried to stand up.  Where I've tried to lead and failed.  I have to admit I'm not the best orator and I'm not the most charismatic, so getting slapped down is what I've come to expect when I try to make changes.  With the media pumping me full of pessimism, the government showing me what not to do, and the masses showing me how to eat the crap shoveled to them; I've slowly but surely learned to keep my head down and do what's best for me and mine, forget the rest.  But, we are all connected, and despite my pessimism, maybe one person can make a difference, maybe I can make a difference.  I'm scared to try, to stand up among so many and to risk failing so publicly, yet maybe it's this fear that has put us as a nation and a global economy where we are today.  Maybe that fear pushes us to selfishness, then to greed, then to evil.  Maybe when given the choice to put my head down and look after myself, I should hold my head up and look out for everyone else a little more often...even if I fail, even if they laugh.  I was working on inpatient this morning for the first time in months, perusing vital signs I glanced a blood pressures of a patient of mine.  My system was running and it was catching hypertension in my patients.  No one knows it was me that changed that.  Years from now they will be catching patients with kidney and heart problems, where before they might have slipped through the cracks.  As a resident you do what any doctor can do, you don't feel like you're making a difference.  If a kid is dehydrated, give him IV fluids...anyone can figure that kind of stuff out, if I wasn't there to write the order someone else would be.  But, today I did what few in my program have done.  When I leave that hospital, I will still be saving lives there, I will still be making a difference in children who come there.  My effect will outlast me.  I won't get any medal for this, maybe a pat on the back from the people who knew I was working on it, but I gained something greater than that.  It restored my faith that one person really can change the system, that I can change the system, and that I need to keep trying to change the system.  Maybe I can't speak well, but maybe my actions can speak for me. 

Newbie Doc

Tele-Doc

There are alot of things you don't get taught in medical school, things that would have been useful to know. One of those things is dealing with family members as patients. If I got any teaching in it at all it involved the words "don't do it". However, my family and friends base is primarily centered in the rural communities, and that has given me a different take on it all together. One of the things I never really empathized with was the comment that I'd heard espoused from so many doctors whom I respected, (insert rural community)..."could really use a good doctor". As I child I never felt medical care was lacking, that we were treated poorly because of where we were. When I was sick I drove to doctor that was 30 minutes away, hell some drive longer in the city to see a doctor where I work. What was this disparity that everybody I looked up to spoke of. Now I know. I remember the first time I really took the reigns of a patient that wasn't in my perview, my little brother. He lives 20 plus hours away from me. I in no way, shape, or form have a right to treat him medically, but I was forced to. He and my parents came to visit my family, one of the rare times they get to. During that time he got sick. I really didn't pay attention as to what his symptoms were at the time. For me when I'm a doctor, I'm a doctor, and when I'm me there is no part of me that is thinking medically, so I really didn't pay attention. But, I remember calling my mother a week or so later and he was still sick. The person who treated him gave him a 7 day course of augmentin and steroids. Talking on the phone, listening to what they gave him, I finally snapped. This was rediculous, he had at least been given the same treatment 6 or so times that year. I was at a crossroads, do I step in and figure out what is going on or do I continue to let my little brother get 'roided up while this doctor pockets his check. I stepped in. From that moment on I began taking more interest in my friends and family from a medical aspect and everytime I've added another case to bulster my underling reason for this, there is a huge deficit in rural medicine (especially in pediatrics). What I've come to understand is there are two types of doctors working in a rural practice. There is the excellent, intellegent doctor I'm happy to count in my ranks (he is there because he wants to be), and there is the doctor that hides there because he/she couldn't get a job anywhere else (the rural community is desperate for care and counts some care better than no care at all). Were I talking to an aspiring medical professional and they asked my advice, what I would recommend is this. If the friend or family member is willing, take a detailed history and if possible exam. Don't treat or test them if at all possible. Instead use your medical knowledge to search out an appropriate physician or specialist in there area that can see and treat them without bias. Do this and everyone will win. The patient in question gets the best care, you have no pressure to treat or guilt in treating (in certain instances), and the specialist gets good buisness as they should if their reputation has lead you to them. There are times I don't follow my own advice and will treat someone I know, however I would do this everytime if I could get away with it. It's a very important personal lesson to the new doctor, not only for yourself, but for the family and friends that will often suffer needlessly if you don't. Newbie-Doc