Thursday, November 14, 2013

Rambling Rant

I need to find a way to get my hands on groups of medical residents both junior and senior alike and perhaps the Fellows too and provide for them the education I need them to have.

Our children's hospital is a training hospital so like it or not your appointment can be determined by the skill, competence and confidence of the resident assigned to the doctor you are really there to see.  The resident comes in first does his assessment then must go back and report to his supervisor who it is you really want to see. They discuss possible treatment plans THEN the RD (real doctor…oh don't you residents get your panties in a bunch…I know you are doctors, just not the fully accredited one I want), comes in repeats the exam or parts thereof and states the plan.

As useful as this is to the resident and probably the attending too, it can add a lot of time to a short appointment.  What it can also add is a lot of frustration for the patient and family alike.

It is highly possible that I am old enough in the tooth that I have lost patience with the system.  That would make sense however what I have learned about myself as I have aged is that I have more patience for things that will result in the greater good.  So wherein then does the problem lie?

I believe the answer to the question is two part.

1.  I think the phrase is "I do not suffer fools gladly".  I appreciate the learning curve students are on.  I appreciate the difficult nature and volume of information that must be absorbed and respect those whose brains are big enough to take on the task.  Mine is not.  I am also mindful of the gruelling schedule they are forced to live.  All that being said GET YOUR ACT TOGETHER!  Come in prepared.  If I have to fill out five pages of information prior to the appointment I'm going to assume it is because someone at sometime thought the age at which my sixteen year old learned to drink from a cup was important!  Read it.  Skim it even.  This will then help you approach the patient and family members in such a way that your assessment will be accurate thereby your diagnosis and treatment plan will follow suit.

2.  It is possible that because there was a resident who either was exhausted or scoring at the bottom half of her class at the helm the day Ailish died that it might subconsciously be playing a roll in my attitude in the last few years.  I think it has made me want to skip the middle man and go straight to the top.  I don't want to have to work my way to the top anymore.  I have put in my time.  Paid my dues.  My daughter paid with her life.  I'm sure that sounds all so dramatic.  The fact was that Ailish probably still would have died if the resident had been brighter, the nursing staff being able to distinguish sleeping from coma and me using the big mouth I have for better advocating rather than sarcasm.  The fact remains a resident was assessing during the day and not knowing she needed to be calling in the RD (see above).  You would think that because there was the orthopaedic resident who was amazing and fought so hard to save Ailish's life once he was called in late in the game that it would cancel any negative attitudes I currently have.  Sadly that might require maturity and perhaps letting go of deep seated anger and guilt harboured in my soul….

Coma NOT sleeping
The real answer is likely somewhere in the middle but mainly lies with me being old and crotchety.  I actually do relish the training of new physicians especially when it comes to my children who's disabilities fall in the severe to profound range.  I want them to see my kids, learn about their diagnoses and see them for the individuals they are and not what the literature says they should be.  I want them to learn the compassion and patience it takes to examine them and the social and communication skills it takes to work with the parents.   They are going to be practicing medicine long after I am dead and gone and it would be great if we as a family had a hand in them being able to sat
had seen a child with such and such and they presented like this….

I really do want to be part of their education.  They just need to quit p@#$% me off!

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