Let me tell you four recurrent stories.
1. Do you want me to get you a glass?
One night we went for pizza with my registrar and some of her friends in her batch who had just started in town. One of them arrived late. His pizza was served, and seeing that we all had glasses with our meals and he didn’t, I asked whether he wanted a glass of water, or anything. And he said, half jokingly:
“You don’t have to be an intern, you know.”
“Excuse me?! I would have asked anyway.”
Oh. My. I would have asked regardless of whether he was a registrar, consultant or medical student. Or whatever random person he happened to be sharing the table. I guess it would have been an amusing joke if I knew him well. But I had never met him and was rather offended that what I would do naturally was seen as trying hard to be a good water-boy (girl) intern.
2. Why wasn’t the second scan ordered?
“I ordered the first one. I can’t recall anything about a second one. I’m pretty sure I was away for a few afternoons too. “
There are two interns, or rather, an intern and a resident (second year graduate) on the team. Nearly every afternoon only one person is rostered on, and every second week we have a midweek day off. And so, you don’t know everything about everyone, even with good handover.
Sure enough, looking through progress notes, the resident was seeing this person for the days prior to this lady’s discharge and I wasn’t even present during the consultant ward round while they discussed the second scan, because I was setting up the meeting room, as I am assigned to do, for the weekly teaching session. And knowing this she asked again:
“Why wasn’t it booked? You did her discharge summary.”
“Yes I started writing it in advance, days before her discharge.”
In fact, I left gaps with astericks for the person on, on the day of her discharge to fill in. And the resident didn’t fill it in. I don’t think I am to blame for firstly, what the resident didn’t organise before discharge on a day that I wasn’t present – and secondly, for starting the discharge summary (out of goodwill to make things easier for the resident on my afternoons off). This is the sort of conversations that happen constantly. And this is what I hate about doing a ward job, about being a junior doctor.
I am not your scapegoat.
3. Maybe you are a doctor too
One of the other things I hate, is being the one to hassle other teams, unnecessarily.
“Yeah, ya know, I had a bit of tingling in my feet. Ya know what I mean,” the patient mentioned briefly on the ward round.
“Just get a neuro review.”
And this is what was insisted by the registrar, even after I did a history and physical exam, which found that the patient who has had these symptoms for the last ten years, symptoms that had neither changed nor were particularly bothersome to the patient. He was a known diabetic, and had chronic alcohol issues, but his sugar controls were good and managed through his general practitioner. His only examination finding was decreased sensation in the glove stocking distribution. He was already on medication for neuropathic pain.
Surgeons might not be general physicians, or general practitioners. But maybe you are a doctor too.
4. Just make up a story!
This is about a man, who had resolved urological issues, but was having episodes of light-headedness and unsteadiness when going from sitting to standing. Without significant postural drop in blood pressure. Essentially normal neurological examination. Seen as a consult by medical registrar who wanted a neuro review (yeah this is hospitals for you, pushing work from one team to another).
“The neuro reg will come and see this patient after clinic. He said there were a few other consults too, so it might be after lunch.”
“We want it now! You have to sell it!”
“I did tell him to let us know when he has seen him, so that we can plan for discharge. But it doesn’t even sound like much of a neurological issue, and there are no neurological findings.”
“Well just make up some finding! Get him to come sooner, and you’ll sound like an idiot when he does, but it’ll get done.”
Er… no. Are you saying that every patient in the emergency department should present with chest pain and shortness of breath so that they don’t need to wait in queue? Should every nurse page us and say patient has had fall with decreased consciousness and worrying vitals, because or else it might be awhile before we can come up and assess their witnessed fall, with no headstrike, and only small grazes to their elbows?
I trust that the person on the other end is intelligent enough to prioritise, and diligent enough to do what needs to be done as soon as he can attend to it, without needing a fabricated story. Making up such things is showing that we can’t see beyond own priorities, and convenience. This tension between pleasing man, and pleasing God / working with integrity is very uncomfortable indeed. Especially seeing how well sucks ups and brown nosers do, at least in the short term, in this heirarchical society.
I think, I take special encouragement through Psalm 73, in how we can envy those who are not “pure in heart”. How they can look like they are doing well. How this can trouble us deeply until we come before God, and realise how fleeting their successes are. And we take encouragement in knowing, God is holding our right hand, is our strength, and will take us to be with him.
When I tried to understand all this, it troubled me deeply
till I entered the sanctuary of God; then I understood their final destiny.
– Psalm 73: 16-17