Invisible Immigrants

Hmm, seem to be reading the Times a lot lately. Was struck by this article, by its poignant subject, its proximity to where I'm living, and the fact that these issues are ones that we deal with daily in the emergency department.

Remembering the floods

I was touched to see this article in the Times. Our little crew moved away from Eastern Iowa just as the floods hit, and it was a very emotional experience.

District 9

I've been cycling between day and night shifts, which leaves some odd chunks of time off in the middle of the day. So a few days ago, unable to decide whether I should be sleeping in the middle of the afternoon, I went to see District 9. Then on my very next shift, a young man came in having his first psychotic episode. The subject of his psychosis? Among other things, he believed that he was trapped in -- District 9! By the end of my shift, I was beginning to suspect that I was, too.

Bitten

Yesterday we had a great teaching conference: how to protect yourself when attacked by the out-of-control/psychotic patient. For example, what is the correct reaction when a patient bites you and won't let go? Or when you are grabbed by the hair? (My answer to that one: "I'd just walk away.") There's a reason many ED docs don't wear their stethoscopes hanging around their necks....

Transitions

Very interesting article in the Times today: Doctors in Cuba Start Over in the U.S.

One thing that struck me was the way certain aspects of American medical training are addressed in this article. By coincidence, earlier today I was talking with another resident about how almost every article we see in the general press about medical training tends to use the same formulas and cliches.

"...most hospitals seek young doctors who can work long hours for little pay. A 40-year-old doctor is often deemed too old to be accepted in a residency program." Oddly refreshing -- and, in some ways, more accurate -- to see the issues examined from a different angle.

Contempt for the newbies

Reading this article, I was reminded of an impression that I've been developing as I spend year after year in medical training. Health care places enormous value on an individual's cumulative experience, and appropriately so. However, I often see that value expressed as disdain, even outright contempt, for inexperienced individuals -- i.e., people who are simply in an earlier stage of their training. I can't even count the number of times I've seen a student, intern, or junior member of a team publicly excoriated, not for incompetence, not for doing anything wrong, but simply for their lack of experience.

Case in point: a while back I was a few days into a new rotation, trying to operate in a system I'd never worked in before. I was trying to get a patient's visit wrapped up expeditiously, and made a mistake filling out a new lab form. A senior nurse walked up to me in the hall with the form, and in front of waiting patients flicked my nametag and half-shouted "you don't know anything!" in my face.

Now, I don't think that this person was actually questioning my clinical judgement or my ability to make reasonable choices about appropriate lab tests. We're all trying to do our best for our patients. And frankly, health care is very, very hard, and we all feel insecure about our own abilities from time to time (daily, even). But I'm frequently shocked by how often this comes out as what seems like little more than hazing of the junior personnel, simply because they're junior. I guess this is much on my mind these days because with every year's turnover I become more responsible for teaching -- and modeling behavior for -- junior members of the team.

Of course, I've been lucky -- the worse things that have happened to me during my training so far have been trivial compared to things that are routinely inflicted on trainees other places. But still, I'd like to think that there's value in consciously striving not to perpetuate these behaviors.