Yesterday Luca and I went to the doctor*. Before we went, I went over in my mind whether I cared if a medical student did the history. I decided that I'd be ok with it since it would be an opportunity for my husband to see what I went through when I was a medical student.
It was a moot point anyway, since there were no med students rotating at that site that afternoon. But they did want to know whether I minded being seen by a fellow. I asked which fellow just to make sure, and I didn't recognize the name so I said ok.
She was very professional and pleasant. And then I found out she's starting as a Master's student in my department a week from now. Woohoo!
Here's hoping she won't be one of those fellows who sits in the communal PhD student office chronically annoyed that the PhD students are talking in their own office. But you know, it is OUR office, not theirs, and I have a hard time feeling terribly bad for them since they have their own offices -- often private and with a door! -- someplace else on campus.
I knew the attending from when I'd done a rotation there three and a half years ago. Actually, I recognized a lot of the staff. They were all like, "You look really familiar...." and I kind of just let it go. Except when the attending said it, I said, "I think I presented to you once, and you were nice to me, so I figured you must be ok."
And then I added, "Plus, it would be really weird to see Dr B, Dr. S, or Dr. G because they all work in my department and I see them around a lot. I didn't know you, so I thought that would be better."
She agreed. She told me that she felt that it can be difficult for doctors to find physicians because you don't want to go to someone you know, but you also want to go to someone good. She emphasized that if the doctor knows you as a friend, it's hard for them to remain objective, and you really want objectivity when you go to see the doctor.
This is borne out by the research, of course. Nicholas Christakis found that patients who knew their doctors for longer periods of time and presumably had a closer relationship with them systematically overestimated survival time among patients with terminal illness.
Though, it turns out that this Dr. and I do share a biostatistician. She made a joke about how it was probably a good thing that she routinely skipped Thursday morning seminars at my department, otherwise we probably would have met as colleagues at some point.
At any rate, the visit went well, and now I have 1,000,000 follow up tests to go through. Woo!
This summer really sucks.
*No I am not pregnant.
6 Pearls of Wisdom:
"You're a medical student aren't you? Why don't you take your own history, examine yourself, and then present it to the attending when she comes back from lunch."
Yep, that's pretty much how it works.
Isn't it annoying that we always have to put in that * or else get bombarded with "are you pregnant" questions? :)
Fizzy -- Tell me about it.
OMDG - Lest you mistook my comments regarding med students having other med students treat them on the other page, of course I think you should have a right to decline to be seen by someone you know! (the point I was trying to make is that any patient - med student or not - should have the right to decline as well).
I previously worked in a position that required me to make presentations on a controversial health policy to various groups (nurses, physicians, boards, patients, etc...). It made for awkward appointments when when the physicians I was seeing for my own health care wanted to debate the policy. Ugh.
Anyhow, I'm sorry to hear that this recent appointment is leading to lots of follow ups. I hope that nothing serious has emerged and that you are getting at least some time to enjoy your summer.
Penelope -- I think we're in perfect agreement re: trainees seeing patients (actually -- haha!). It can be very awkward as you pointed out, and patients should always have the option to refuse without repercussion. It has always made me a little upset when an attending would be a jerk to a patient, ostensibly on my behalf, just because the patient didn't want to be seen by me. Maybe they have a good reason, you know?
On the other hand, it's probably a mistake to always assume that the care you see will be worse just because a trainee sees you first. What a lot of patients (not you) don't understand is that a patient's history gets more detailed and nuanced with every person who hears the story. The med student takes the neurotic compulsive history and physical may not be so great at putting the pieces together. The resident hears the story, and starts putting the pieces together, and then comes up with some more directed, specific questions that the med student didn't think of. And then finally, the attending gives the most refined view. I have also definitely seen attendings completely overrule what the resident thought after seeing the patient him/herself. Also, when only one person takes the history, important details can easily get lost.
I once saw a woman with an arrhythmia, which is what she was admitted for, but her presenting complaint was acute abdominal pain. the resident completely blew off the abdominal pain and focused on the arrhythmia instead. Before I presented the patient to her, she'd been transferred to the ICU for change in mental status. And guess what -- she ended up having an emergency laparotomy for the abdominal pain, which could have been the harbinger of mesenteric ischemia (from a clot thrown because of her arrhythmia), and could have killed her (it turned out it wasn't, thank goodness). Everything turned out ok, but that was definitely a case in which things might have been different had I been able to present the case to the resident before she tanked.
Plus she was a really lovely woman who had an amazing sense of humor, even though she was a little crazy and used a lot of cocaine. The rest of the team focused on that part, not her good attributes.
So I guess my point it, not always but often, having more eyes review your case is a really good thing.
Thanks for the kind words. I haven't decided whether to blog about this health problem since I have a creepy ex bf who reads this blog (woo.), but we'll see.
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