decreasing our apathy

[la1]

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Dear Friends,

I am MS3 like many of you 🙂. At times it seems that all we do is "monkey work" that no one cares about. There is data that medical students are idealistic as they come into the medical school and get apathetic and "bitter" as they get more and more training. I think that sucks both for us (no one likes a "groucho") and for our patients. I thought that if you guys would post some of your experiences where you had actually made a difference, it may remind the rest of us about the idealism that fueled our pre-med years. Here is one story that happened to med student X told in the first person...

Last month while I was on neurology, I ran into one of my patients from 3-4 mo ago when I was on medicine. At that time he came in with a bad CHF exacerbation and we could not figure out what had caused it. I had gone through the differential for this guy several times and the only thing that would really make sense for him was CHF exacerbation secondary to alcoholism (nothing would fit his story, so we thought he may be not telling the whole story). The pt denied alcohol use over and over again. My resident said that etoh was probably the cause, but counseling him would not really make much of a difference since "drunks drink themselves to death, and there is nothing that we can do about it... it's just a waste of time ... and if not our team some other team is likely to see him back over here." The attending seemed to agree. The intern got his LFTs the day before discharge to convince ourselves that the pattern was at least consistent with alcoholism (so that we don't miss something that would come back and "bite us in the ass.") On the day of his discharge I ran over to him and tried to shmooze with him again. We had already developed a good relationship between us (the guy was in the hospital for a week or so) and after some cajoling he did admit that the day before his ED visit his brother got in town and they had a few too many beers. Believe it or not, motivational interviewing can be utilized even by a medical student, and by the end of our conversation the pt said that he would speak with his brother and make up to quit drinking. Remembering what my resident had told me I did not believe it, but showed him by approval and asked him to go downstairs and speak to the VA alcohol abuse people to help him stick to his resolve. When I told my resident about our talk he said: "nice try, but the odds are he'll be back here with the same problem soon." Guess what the pt told me last month whe I ran into him: he was dry since our last talk! I was kind of "jaded" after seeing all those "functional overlay" people pretending to have neurological problems, so this guys was like a breath of fresh air to me. I gave him a hug and he hugged me back! If I had listened to my resident I would have never even tried!

yours,

I-wanna-change-the-world

 

[tacrum43]

Yeah, I think it is rare that a medical student actually gets to make a positive difference for a patient. I know I've spent plenty of time on the phone trying to get outside records faxed over (which is especially fun to do while you are being interrogated by the nurses asking you if you're using the fax machine for actual hospital business). 🙄 However you do get to make a difference sometimes. I think the medical student's biggest asset is the amount of time they're able to spend with a given patient. It's much more than most of the other people on the team.

I was doing my Neurology rotation, which we do as a 4th year at my school, and it was my last day on the service there. We had a new consult in the ICU: a 90-something year old gentleman who came in with an altered level of consciousness and difficulty controlling his secretions upon admission. The patient was originally intubated in the ED because of the bulbar muscle tone issues, and I was the first one to really talk to him since he was extubated. No one knew what was going on and he had come in to the same hospital once before with a similar episode and the workup was negative. When I asked him questions I had to really lean in close to listen to his answers, but we established a good rapport and he confided in me. As it turned out, he was really depressed because of a BKA limiting his mobility and had tried to kill himself by taking a bunch of Ambien (which didn't show up on the tox screen).

I sure hope that he was able to get the help he needed, poor guy. Since it was my last day, I don't know what happened after that. But it did feel pretty good to make the diagnosis when it was previously unknown, especially since I'm interested in Geriatrics and I love taking care of patients like this. I got a couple of 'atta boys from the ICU and Neurology attendings too, which was nice. 😎

 

[ropeadope1983]

I'm confident that I've helped a lot of patients so far. Some examples:

-Started 3rd year a little timid on a tough rotation and found on at least 2 occassions that had I spoken up to ask the attending if he's sure that this is what he wants to do, a critical error would have been avoided. Luckily it didn't cost a life, but would have prevented some morbidity. This first opened my eyes to the fact that I can make a difference even this early. That same rotation I learned my lesson and was very vocal about advocating for a certain procedure that I just knew my patient needed. Nobody seemed to listen to me until about a week later when I was on a different rotation and I heard from my intern that when they finally did that procedure they found something they didn't expect. It was exactly what the patient needed, and he was discharged shortly afterwards with a full recovery after having been critically ill (and they previously didn't have a clue what was going on with the patient).
-On my current rotation my attending pretty much relies on me to get the full H&P and doesn't really verify (because it's all good baby). Most of the time my assessment and plan are right on and a few times I made my attending open to different valid possibilities he hadn't thought of (one of which he actually went with, rather than what his original impression was). Sometimes it pays to have an outside perspective that isn't totally integrated into a routine. I'm not sure whether or not outcomes would be that much different without me, but I certainly feel like an important player on the team.

There are many other examples to varying degrees. Bottom line is that we can make a difference if we work really hard and are persistent. I found that the biggest road block is worrying too much that I'm going to be wrong. This is the best time to not worry so much about being wrong because we have the biggest safety net at this point in our careers, plus you learn a lot even when you are wrong. I don't care about any of the times that I might get dumped on in any way because I'm keeping the dream alive that when I'm finally unleashed I will make a big difference. I've seen the difference between a doctor who is lazy and a doctor who has that drive and hunger, so I don't really feel apathy at this point in my career.

 

[J ROD]

Little steps can make a great distance....keep doing good work!! 🙂

 

[lulubean]

keep up the good work everyone!

as an intern and resident, you have even LESS time to talk to patients and even more busy work to do. but if you keep up those positive attitudes and hold on to that sense of compassion, you will become amazing doctors. and your patients will thank you for it.

it's so easy to become jaded in residency. and jaded residents/attendings are neither happy nor effective doctors. please don't let it happen to you!

 

[IMDoc607]

I go to work everyday looking to make a difference. I constantly read so when something goes wrong I can be of some assistance. Nothing is more fun to me than contributing to a positive outcome. I am the furthest from a idealist. Sometimes I get bitter, but I am waiting for that day where I am the person who makes the big difference. I remember a resident tell me that we don't study for boards anymore. We study for patients. I am not going to around to a patient and say oh wel sorry I don't understand why you are bleeding because I memorized the coagulation cascade for step 1 and then decided to forget it.

Its all about patients now and not about board scores.

**Look at my post history lol....I have my bitter times too!! lol

 

[ABCZXX]

This story made my day! Thanks 😀

 

[ABCZXX]

Idealists for the win! I love it when "experts" are caught in a self-fulfilling prophecy but that the curiosity and open-mindedness of the OP lead to that indescribable feeling he/she may have experienced. I was actually treated with complete apathy earlier today by someone from my alma mater when I was trying to do some crucial paperwork and I could tell they would be indifferent of me getting into med school of my dreams or alternatively getting hit and killed by a car! You probably made the patient feel amazing too and that's what really counts at the end of the day. I have actually been depressed all day thinking how humans can be so indifferent to those who are deemed inferior or just a nuisance. I am glad that there will be some idealistic doctors in the profession for a long time to come! 😎

Indifference is not a beginning, it is an end. And, therefore, indifference is always the friend of the enemy, for it benefits the aggressor -- never his victim, whose pain is magnified when he or she feels forgotten.

The opposite of love is not hate, it's indifference.

 

[rahulb]

having a patient tell you they haven't smoked in over a month is the one of the most satisfying feelings imaginable.