The balance of power

• Training in medicine is tricky business. There’s a constant push-pull between learning and service, figuring out what you should be doing and doing it, power and helplessness. This next stage of my training is quite exciting. I’m getting more responsibility now – given enough rope to hang myself with, as they might say. And so far, I’m enjoying it (but then I haven’t had anything really emergent and scary either yet).

• Where I’m doing my rotation they have a hospital with 92 inpatient beds. The doctors I’m working with are responsible for the ICU and doing consults on the ward but they don’t act as Most Responsible Physician (read: Chief Decision Maker) there. Which means that being on call involves ICU clarifications (the nurses there and throughout the hospital are awesome) and consults in Emergency. That is sweet and pretty much unheard of in most teaching centres because usually being on call involves consults & lots of ward calls about people not producing much urine, being delirious, complaining of shortness of breath, etc which you have to deal with amongst all the consults. It’s usually busy busy busy. My experience has been steady yes, with time to process the new information and without the ward calls. It’s been very very sweet as an Internal Medicine rotation – renowned for being one of the most intensive rotations in bigger centres. Very lucky am I.

• This last weekend, I got together with my classmate and chatted about his week in family medicine. It sounds awesome and I’m sooo happy that I’ve chosen this specialty – definitely the right one for me. Interesting that he mentioned that one thing they really emphasized this week was that they weren’t allowed to introduce themselves to the patient by anything other than Dr. X. This is funny and I have to say that doing so, changes the dynamic. Most people don’t know the various names for the stages of our training and how a “medical student” differs from a “resident”. Heck! Most people don’t even know that female medical students don’t graduate to become a nurse. So I decided this week to employ the same strategy, to introduce myself as Dr. It feels weird still, somehow like I’m dressed up in clothes that are miles too big for me or something, that don’t quite fit yet but that I’m hopeful to grow into. Or maybe it’s the shoes. Too big. But that, combined with another piece of advice that a doctor here gave me the other day are laying upon me the responsibility that comes with my new role. He said”Act as though you are the only doctor left on EARTH. This is how you must think and act. Like there’s no one else but you.” He didn’t mean don’t collaborate but he meant to think hard about plans and treatments and not just defer all decisions to the attending physician you’re working with. Now it starts to be up to us.

• And the “it” that we’re talking about is so much more than good ‘customer’ service, or being friendly, it’s about so many things. Being approachable, non judgemental, communicating to staff & patients & families, advocating (aka showing up at the radiologists door to beg for a STAT CAT Scan), managing (learning dictation systems, computer systems, not to mention how much tests cost and how to be effective AND efficient in your use of health care resources), leading (it’s unbelievable to me sometimes how much initiative you need to show each day. It’s really true that you get out what you put in which is painful sometimes).

• But it’s good. Because I seem to have a bottomless thirst for knowledge of all kinds, but mostly served up with a generous helping of wit & wisdom.