Reflections

Last fall I worked with a professor in healthcare humanities during a research elective.  It was a great opportunity to get feedback on my writing and reflect on some of my clinical experiences.  A few of the short pieces I wrote during that time were recently published, some others are still in consideration.

Numbness – a short anecdote I told a medical student starting clerkship about patient-centered care.  Part of the 2016 CFMS Annual Review.  Lots of great stuff: CFMS Annual Review 2016

In The Fade – talking about small group learning and the need for openness in discussions.  Included in the National Geriatrics Interest Group’s annual publication. NGIG Publication

Labouring – reflecting time spent on the labor & delivery ward during clerkship and patients not being given the chance to use the comforts available. The Muse Issue 3

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“You Should Go Into Medicine”

As an undergraduate student I interned in a microbiology lab and this advice was given to many co-op students by the head of the lab, a kindly middle-aged researcher.  They were so proud sharing what they had been told, that they should be doctors.  A number took the advice and are now in residency or practicing.

Later, working in the same department I decided to ask about the advice he had given numerous times.  “Because they aren’t smart enough to do research,” was his reply.  He went on to explain the job stability and opportunities of a medical career, but I was struck by the contrast between his motivation and the reactions of the students. In this case what is usually considered a compliment was in fact an insult.

Holding Hands

It is hard not to be touched by patient stories. Stories of illness, loss, struggle, abuse, and more. I am often been moved by them, at times feeling tears build only to blink them away and maintain my medical persona. For a time I felt that I should not let these emotions show. Last fall a friend shared a concept with me call moral injury. It is used with veterans that are experiencing long standing psychological consequences of combat exposure. As expounded by Dr. Jonathan Shay this involves the transgression of moral norms in a high stakes environment by someone in authority. He also talks of the need to share ones story as a path to healing. I immediately saw the applicability to medicine.

No veteran will every trust you if you conceal yourself behind a neutral, non-reactive ‘professional’ facade. If you want to weep; weep. If you want to vomit; vomit. The veterans will regard that as a sign you are listening and that you are hearing what they are saying. Dr. Jonathan Shay Link ~6:20

Hearing this was validating.  It helped overcome the hesitancy to be moved deeply by patients. While respecting boundaries I have held many hands and listened to patient’s stories, and I believe they can tell I’m present both intellectually and emotionally. What I’m doing isn’t out of the ordinary, but I’ve had a number of patients thank me and appreciate their stories and concerns being heard. These connections have made clerkship far more rewarding than simply an accumulation of knowledge.

Halfway

Seems like it was New Years a second ago and now February is ending. This marks the halfway point of our clerkship training; hard to believe.  Internal Medicine is out of the way and Family Medicine starts on Monday.

My IM rotation ended with strong feedback from the attending. A nice way to end a block.  I’m sure I’ll feel somewhat lost for the first few days of the next one: learning the EMR, way they enter orders/present cases, etc.  Good to end a block on a positive note to transition into new territory.

IM ended with six weeks of CTU.  This was split between an adult in-patient unit and one focusing on those over 75 years-old.  It was nice to see care in the adult and elderly population and learn to deal with different issues, from endocarditis and liver cirrhosis to CHF and palliation for metastatic cancer.  It was quite a range and required a good deal of study/review at home.  This was also the first rotation where we were given responsibility for everyone on the floor when on call.  During pediatrics a resident was always present to cover floor issues, here we did consults in the ER and covered the floor.  Terrifying the first couple call shifts, especially since we can’t order anything.  A combination of responsibility and powerlessness that can be quite unnerving. Over time I learned to prioritize, which questions to ask when paged and paired up with one of the residents to co-sign orders.  Very stressful, but I also learned a lot.

Off to a rural family medicine placement tomorrow.  Going to be quite a change.  I’m hoping the experience in IM gives a good foundation for it.  Working with 4 different doctors in a group clinic, will be a change.  Family Medicine is an option I’m considering for residency, so the next few weeks should aid in that decision.

Shiny Bellies

Just a silly observation, but after two weeks in the outpatient clinic  the majority of pregnant ladies we saw are waxing their bellies, and seem to be doing so to coincide with their appointments.  Uh, thanks I guess…

The next two weeks are on delivery service, first week nights, second week days.  Will be an adjustment from seeing OB/Gyn patients in clinic.

Forging Healthier Doctors

Exploring wellness issues in medical training, the current efforts to address these issues and some paths forward.  UWOMJ Fall 2013.

The move towards physician wellness is needed to form a
connected, caring network of peers working together for their own
and their patients’ wellbeing.

Towards Healthier Doctors

The Hidden Curriculum & Family Medicine

The messages sent to students not only devalue the work of our peers, but the patients and communities they serve.

A recent article in Scrub-In’s September issue covering aspects of the hidden curriculum in medical training and tensions between specialties.  Pg. 20-21.  Read online: http://scrub-in.dgtlpub.com/2014/2014-09-30/home.php