Last week, Sarah Palin decided to scare the American seniors by telling them that the proposed health care plan is going to form a “death panel” that will actively euthanize everyone from Grandma to Ol’ Yeller. Of course, Ms. Palin has misunderstood what someone read to her. That said, from what I witnessed last night we might all stand a better chance with that option.
I was called by a nurse around 10:30 at night and asked if anyone had called me regarding a patient in intensive care. She read off some very abnormal labs and that the patient hadn’t responded to whatever the intern and resident had done. There was a consult ordered at 18:30 but not called to me. Of course, I had to get dressed and drive in.
I arrived to find a case of significant bradycardia (slow heart rate) in a man whose past medical history spanned a whole page. He had been treated with a smidge of this and a pittance of that. It was the classic medical resident approach. We’ll throw the smallest possible dose at someone not realizing that it has no chance in hell of actually doing anything for this particular patient with this particular problem.
I gowned up for a procedure on the patient at the bedside and the intern and resident strolled in. They actually had the nerve to ask me why the procedure was necessary. As if that patient didn’t have EVERY reason in the book. As if the heart rate could get any lower. There was simply no room for error here. If the patient’s situation got any worse, his heart would simply stop.
I don’t know if ten years from now this man would receive this kind of aggressive intervention as he does have a significant cancer in addition to his many chronic medical problems. That isn’t the point.
The knowledge base of these two trainees in particular is poor. I wish I could say that they are the exception. There are certainly still “stars” in medical training. They can tell you all 127 causes of arthritis or tell you what the latest leukemia staging is. There are also some conscientious ones. The rest however lack in both knowledge and initiative.
I often look back on my training and ask myself “when did I have a clue?”. When did I know things? When I was a third year student we were expected to know every detail about our patient. We were expected to read about their problems. Did I know everything then? I doubt it…but I worked really hard to compensate for what I didn’t know. Now, that seems optional. The next generation of doctors is going to be one of unaccountable shift-workers. They’ll be people who see medicine as a job rather than a career.
I think that the reason last night sticks out so much in my craw is that I KNOW I would have known this basic stuff when I was an intern. What’s worse is that the resident has 14 months’ experience at this point and should know how to deal with this situation. I also know that I NEVER would have asked the attending physician some of the questions that these two were launching.
On some level, they are fortunate. I didn’t yell. I educated, albeit at 1 am. My mentors would have ripped them a new orifice. I do feel guilty about one thing. I am finding as I get older that I am much more likely to give a male resident a hard time as opposed to a female. That isn’t to say that I am not openly displeased with the latter but I can think back to putting many male residents through the ringer when I know I would have backed off if they were a female. I doubt it was pleasant for either group but perhaps it’s because I think that medicine favors men and since they’ve had advantage over women, there’s less excuse. I don’t know.
In the end, I wind up being the faculty member that they won’t approach or the one that they say bad things about. They’ll never be able to say I’m not a good doctor though and that’s what I think matters. I hold myself and them to a higher standard. That isn’t to say that it will always be reached but it will always be reached for.
Health care crisis? What helath care crisis? We’ve got nothing to worry about. Who needs a death panel? These two will take care of everything.
The Last Spartan 