I started 3rd year this week with surgery as my first rotation—hence why I haven’t updated in a while. If first impressions are anything, I won’t be going into surgery. I been working 12-15 hours a day as a scut monkey for my resident. Somehow, we can’t get a nursing assistant to print lab results and transfer vital signs from the nurses’ tracking sheets to the medical chart. Instead, we need a medical student to transport patients, hold gauze until the resident needs it, and push the cart with X-rays all in the name of “learning.”
For my first day, I was scheduled to arrive at 7AM. Wanting to make a good impression, I got to the hospital at 6:50, found my team, and introduced myself as the new medical student. The resident replied, “Rounds started at 6. Put your bag up and get to work.” I knew immediately that I was in for a long month.
My team consists of 1 resident, 2 interns, and 2 medical students. We have any number of attendings; and at the beginning of this week, we had 18 patients that we were following. To make matters worse, neither of the interns want to become surgeons. They’re on the service only because they’re required to. Instead of assigning patients and pre-rounding, our service requires the medical students to be familiar with everyone on the census. Also, we’re the only ones that perform physical exams. I noticed on the first day that none of the doctors bother carrying stethoscopes. Therefore, the fate of a patient’s physical is up to two 3rd-years who are still inexperienced with catching subtle clues on the exam.
The service is very malignant. When rounding with the attending, he will only speak to the resident—and then only to criticize him. If the attending asks a question and the resident is wrong, prepare to get yelled at. If the attending asks a question and the resident is right, prepared to get yelled at, too. If you’ve ever seen The Devil Wears Prada, you’ll understand how the process works.
The worst part of it all is that I haven’t been in surgery at all this week. I’ve done so much scutwork that I haven’t seen a single surgery. I don’t even know where the OR is. I may very well be the first medical student to get through the clerkship without ever seeing a surgery.
Instead, I fill my time with useless conferences where the resident presents the week’s cases, and then a group of dinosaur attendings yell at him for two hours. They feel the need to participate in these conferences so that they can inflate their egos by belittling someone with less knowledge and experience. By the end of the conference, their egos have swelled so large that they begin insulting each other and the whole ordeal becomes an orgy with everyone trying to get on top by putting down the rest of the group. In addition to not learning anything during this conference, all hell broke loose on the floor during that 2-hour period.
I got back to find that one of our patients suffered a seizure and another had a pulmonary embolism while we were gone. As I was on the phone trying to get a consultant to come take a look at one of the patients, my intern walked into the nurses’ station and announced, “Some guy fell in the hallway out here… There’s a guy on the floor out here… He’s laying right over there.” The rest of that day and the next were filled with damage control to keep from being sued by every patient who gets annoyed with their nurses’ lack of lightning fast response.
To make matters worse, my attending just left to go on vacation. I probably won’t be in the OR next week, either. In addition, my resident’s wife had a baby this week. He left the service one afternoon so she could give birth and announced that rounds would start later the next morning. I got to sleep in until 5AM.
I just finished STEP I. Time to start studying for STEP II. Sarcasm and humor to follow.
One of the more exciting trends of extending medical privilege to mid-level providers is that of granting prescribing rights to psychologists. While this idea is not originally mine, I’ll jump on as a fan and claim that licensed psychologist should be allowed to pursue a two-year post-doctoral certification program to obtain prescription rights. Similar to a PA’s training, this new program will require 1 year of classroom work and a year of clinical rotations, with an emphasis on psychiatric experiences.
Two states already have similar programs where Ph.D.’s can spend time learning pharmacology and can then receive a medical license to work under a psychiatrist. With the national shortage of shrinks, particularly pediatric psychiatrists, I would have thought physicians would be eager to have some help in providing medical therapy to mental health patients. Unfortunately, many doctors are against the idea of allowing psychologists to practice medicine.
Some psychiatrists throw out arguments such as “their training isn’t as extensive as ours” or “they wouldn’t be equipped to handle co-morbid conditions.” These points are certainly valid, but we already grant PA’s the right to practice restricted medicine with only two years of training; why shouldn’t we open the doors to others?
Certainly psychologists would not be equipped to work on a patient’s other medical issues, nor should they care for floridly psychotic patients. However, I see no reason that why a psychologist couldn’t write a prescription for Prozac as part of a therapy program. You don’t need 8 years of training to know that SSRI’s are an effective method of treating depression, and you certainly don’t need all of the years of experience to know the adverse effects that can come with giving a mind-altering medication.
The bad news is that psychologists haven’t been on their best behavior. They point out that most psych prescriptions are written by primary care docs, not psychiatrists. Some of the arguments that the psychology crowd throws out include “most MD’s only have six weeks of psychiatry training. Therefore, they are not qualified to fully work with mental health patients, either.” Don’t think that MD’s have only six weeks of training and then they’re done. After two years of basic science to learn how the body would respond to those medications, physicians have lots of training in internal medicine to learn more about clinical aspects of neuropharmacology. The “six weeks” is a time period thrown around to minimize physician training and to try to make grad school in psychology seem more robust than it really is. I’ve heard similar arguments about the length of the pharmacology courses in medical school. True, my pharm class only lasted for a month, but I can guarantee that I’ve been learning drugs for a lot longer than that.
I would love to see other states follow the model led by Louisiana and New Mexico. With adequate pharmacology training, psychologists can make a valuable impact on medical mental health.
I’m always full of ideas. People ask me all the time for various solutions to their problems. I should get the telephone number 1-800-IDEA-MAN so that people could call me anytime day or night with their questions. A typical conversation might go something like this:
CALLER: Hello, Idea Man? I spilled red wine on the carpet and can’t seem to get the stain out. To make matters worse, my son dropped his candy bar on the rug and walked right though it all. What am I supposed to do?
ME: Calm down, Ma’am. All you need to do is get some club soda and a roll of paper towels and that stain will come right out. Just make sure that the roll is lint-free so that you won’t have soggy red bits of paper towel rolling around on the carpet.
Just like that, another problem is solved.
My idea this week is to allow 4th year medical students to receive licenses as physician assistants. The way I envision it is that people who have taken Step 1 and Step 2 should automatically become PA’s. Medical students who have gotten that far will already have more education and experience than a fresh-out-of-school PA. I say these hard working individuals should be paid for their time.
Think about it: students could moonlight during their easier rotations to make some extra cash. While the sub-internships will be difficult, students will certainly have free time during their history of medicine course. Given the pay scale of an average PA, a medical student should be able to make $1,000 in a weekend. The hospital gets weekend coverage and prn service while the student gets paid. It’s a win-win situation for everyone involved.
Some critics might say that a medical student is only partway through the educational process. While true, I am not suggesting that students practice unobserved. If a PA can be trained in two years to work under the supervision of an attending, certainly someone with 3+ years of training can do the same.
Signs that I’m hitting the wall:
1. Today I poured a bowl of cereal and then put it in the microwave.
2. I only leave the house once a week to get groceries. I’ve forgotten how to talk to people and make eye contact with the cashier.
3. I’ve given up shaving until the boards. As I see it, I’m not going anywhere that requires shaving. Unfortunately, I’m afraid that strangers are going to start offering me their loose change because they think I’m homeless.
I haven’t posted a story in a while, even though I’ve got a few ideas floating around. I’m just too tired to be cynical and angry at the poor job my medical school did at preparing me for the boards.