Being a doctor can be hard, and giving patients what they deserve can be even harder. Patients can be needy, demanding, hard to deal with and harder to please. We have many more patients than we do patience. How we respond under stress says a lot about us.
Long hours, job pressures and difficulty communicating can stretch doctors to the breaking point, especially doctors in training. Work hours for doctors in their years of specialty training are pretty intense. When I was a resident physician, it was common to spend over 100 hours a week at the hospital. We were “on call” every 4th night, and call days typically ran from 7 am until at least 5 PM the following day. On that day after a call night, most residents passionately worked toward a single goal- getting done with their work and going home to bed.
This explains the intern's response when, as a senior resident, I paged him to discuss the care of a woman who he had admitted the night before. As the senior resident it was my job to oversee all of the patients cared for by the hospital team. It was 4 Pm, and I had just finished reviewing the admission notes for the elderly woman who he had admitted to a bed on the medical floor. In the intern's notes he had listed hyponatremia (low sodium in the blood) as one of the patient's diagnoses. Typically this notation would have been followed the cause if known, or if unknown possible causes and the tests ordered to identify the cause. Instead his explanation of the low sodium was simply- “cause unknown.” Nothing more was written.
While he may not have known the cause at the moment he wrote the note, a list of possible causes was available in any reference book, and it includes a number of potentially serious conditions.
Perturbed at the lack of thoroughness on his part I got him on the phone. I remember the conversation vividly.
“Hey Scott, what's with this “cause unknown' garbage in your note?” I asked with my trademark tact.
“I didn't know what the cause was!” was his reply.
“So look it up!” I said
"Okay, I'll do it tomorrow."
"No, you will do it now."
"But, I am post call!'
"Not my problem. This woman is in our hospital and deserves the very best medical care. If that means you stay until 10 o'clock, then you stay until 10 o'clock. We don't cut corners!"
"Fine!" he bellowed as he hung up. Boy was he mad.
At the end of the year at the graduation ceremony he sought me out. He shook my hand and said with a smile, "Thank you for making me good." I still get a warm feeling inside remembering the moment. I am still a demanding teacher, harder on students and even harder on myself. People deserve our best effort.
Doing our best and giving our all is a value that seems to be vanishing from society, even from the medical profession. I pray it will always remain a part of my practice.