I look back on my intern year fondly. It was hard. And exhausting. But there is such an incredible feeling of satisfaction not only in accomplishing something that is difficult but also in knowing that you are improving. My husband and I were newlyweds. He was a surgical intern and we supported each other up the learning curve of hospital life. Post-call, over dinners of take-out and three dollar wine, we shared our experiences.
One evening my husband told me about rounding with his attending the morning after an especially busy call night. While making their way down the hall, seeing each newly admitted patient, the attending surgeon paused at the room of a patient who was not on the team list. The man looked terrible -- roughly 60 years old, jaundiced and somnolent. As my husband frantically shuffled through notes and lists wondering how he had forgotten an admission, the attending introduced himself and did a brief exam. Upon exiting the patient's room, he asked the team to add the patient to the list. My husband was certain that he had not forgotten any of the night's admissions and consults. "Sir," he asked, confused. "Is this our patient? I don't remember admitting him."
"This man needs a doctor," the attending responded simply and continued with rounds.**
That night, we laughed at the statement and attributed it to the quirkiness of a dear mentor. The year progressed and the phrase stuck with us. It came in handy as we retold the frustrations and challenges of new services, perceived injustices, and work left undone by other services or other residents. "Oh!" the listener would interject lightheartedly. "You're saying the patient needed a doctor!"
Later in our training, our use of the phrase reflected a more seasoned perspective. While supervising admissions, teaching and managing the very sick, we would also find ourselves caring for people who might traditionally be admitted to different services or were, perhaps, admitted for conservative reasons. As interns we might have complained but as seniors we would merely shrug and say, "I guess the patient needed a doctor." (Of note, this is easier when you are not the one doing the grunt work of an intern.)
I work in the pediatric emergency department now. There is a lot of discussion both during my shifts and in the global medical community about misuse of emergency services by patients. I hear the comments regularly.
"My parents would never have brought me to the ER for that."
"Didn't they call their PCP? It's the middle of the day."
"It's 2 am. This couldn't wait until the morning?"
On Twitter, other blogs and in medical journals, there is discussion as to how we can encourage proper home triage. I used to ask the patients themselves but have stopped unless it seems useful to my clinical decision making. The answers are always the same. The pediatrician's schedule was full. The parents could not take time off from work. They did not have a car. It seemed like it was getting worse. Someone was hurting. Someone was worried.
In all of these situations, whether expressed out of frustration or resignation, the statement "This patient needs a doctor" repaints the picture. What was once an injustice becomes a call to duty. Sometimes our job is not fair. Politics, fatigue, electronic medical records, work hours and someone else's bad day can all compete to cloud our outlook. While many of these things do need improvement, it helps to remember that at the bottom of this, there is a patient who needs a doctor.
**For my mom and others not in the medical field, a patient does not get admitted to the hospital without a specific doctor agreeing to care for him or her. The patient in this story was admitted to another hospital service but the surgeon identified him as potentially in need of surgical care.
In all of these situations, whether expressed out of frustration or resignation, the statement "This patient needs a doctor" repaints the picture. What was once an injustice becomes a call to duty. Sometimes our job is not fair. Politics, fatigue, electronic medical records, work hours and someone else's bad day can all compete to cloud our outlook. While many of these things do need improvement, it helps to remember that at the bottom of this, there is a patient who needs a doctor.
**For my mom and others not in the medical field, a patient does not get admitted to the hospital without a specific doctor agreeing to care for him or her. The patient in this story was admitted to another hospital service but the surgeon identified him as potentially in need of surgical care.
