Thursday, June 21, 2007

The beginning of summer marks a transition in teaching hospitals. Senior residents graduate after completing their post-medical school training and the newly minted docs begin. For both groups it’s a time to get excited about entering a new phase of their lives. But for the full time attending doctors who teach in these hospitals, summer is bittersweet.

Residency is the time where physicians in training learn their craft, slowly gaining experience and responsibility. It is a time where the hours or work and patient care are long and are followed by more hours of reading and studying. Sleep is a precious commodity and often is lost when duty calls. Slowly, the attending doctor allows the resident to captain the ship when it comes to patient care and the relationship transforms from teacher to colleague.

But summer is tough. Residency programs, like surgery, can last 5 years or more. Nights of standing together, making treatment decisions, watching patients do well or die, bring teacher and student closer. Summer wrenches them apart. The resident is ready to get on with their life, start a career and establish a practice. The attending physician is left standing by, watching them go and feeling proud and sad at the same time.

There is little time for remorse, since the new MDs are arriving with eyes and ears wide open and are waiting their turn to learn how to care for people. The colleagues have gone and the students have arrived….again. It’s a never ending cycle.

For all the technology and information that is now available at an instant’s notice, the art of medicine is still taught at the bedside. The resident learns to be efficient in taking a history from the patient and tying that into the physical findings to come to either a diagnosis or an efficient plan to get to the diagnosis. From there, it’s another step to learn about the most appropriate treatment and hopefully the jackpot is a patient who says thank you. And this learning process occurs one patient at a time.

The joy of being cared for a teaching hospital is the knowledge that you are helping train the next generation of physicians and that there are plenty of doctors, newer and older, on your team, trying to make you better. The downside is that you may get asked the same questions three or four times and extra poking and prodding are expected.

A generation ago, patients were asked to stay an extra day or two in the hospital just so they could be presented to all the residents and medical students at teaching rounds. Rashes were felt, heart murmurs were listened to, common and uncommon findings were displayed, all to educate. And patients actually stayed! With budgets tight, nobody stays an extra hour let alone a day. But on occasion should you or a loved one be in hospital, your physician might come in and ask if a group of docs or nurses could examine you. On one hand, it’s a little disconcerting that you might be interesting, but on the other hand, it makes for great cocktail conversation: “Guess what happened when I was in the clinic last week?

The new docs who are arriving will have to adjust quickly to what it’s like to have an MD after their name. Aside from needing to learn their craft, the teaching duties will start soon. September is just a couple months away and the medical students are coming.

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