The puppets of medicine

December 6, 2007 at 6:05 pm (Clinical rotations)

I got my evaluations back today for internal medicine. On the whole I did well… except for the eval from my resident. She’s a fresh-off-the-boat foreign medical graduate who doesn’t understand how grade inflation works in the United States. She pulled me aside and said, “You did very well. I gave you a C.” Her comments section was loaded with praise, saying, “Very knowledgeable, works well with the team.” Under the needs to improve section, she had only one word: “unenthusiastic.” She told me, “I know you don’t want to do medicine, but you need to smile more on rounds.”

What!?! Rounds take four hours. I’m not some cheerleader who can come in and say, “Hooray medicine! Goooooo team!” Faking a smile is difficult when my job of pre-rounding is done by 7:00am and the rest of the morning is spent standing in the back of a crowd while my attending opines on starting another anti-hypertensive medication on our patient with the blood pressure of 140/80. Most of my time on rounds is spent fantasizing about having a threesome with my resident—who, might I add, is only minimally attractive at best, yet holds a lot of power over my evaluation.

In medical training we use the Socratic method to teach students. While the method is to find knowledge gaps and fill the holes in a young doctor’s education, the whole ordeal gets to be rather intimidating when the attending is interrupting the student and saying, “What are the components of Ranson’s criteria for pancreatitis?” or “What’s the half-life of labetolol?” Students call this method “pimping” because it’s such a humbling experience to have your ignorance broadcast to the entire team.

In a classic example of pimping this week, my attending wanted to see the differential diagnosis of pancreatitis. I admitted a woman to the hospital with severe upper abdominal pain. My attending asked, “Why don’t you think she’s having pericarditis?”

Me: Because the EKG is not consistent with pericarditis, she has not had any recent illnesses, she has no chest pain, and there isn’t a friction rub heard on physical exam.

Her: That’s right, she doesn’t have pericarditis. I just wanted to make sure that you knew that.

Well she’s not having a stroke, either. Would you like me to tell you why?

The good news is that I put together a patient tracking form to simplify my life on the wards. You’ll notice that I used the medfools card as an inspiration. Their card isn’t very useful for me because (1) it’s two pages and I can’t print double-sided, (2) the cards are too busy and loaded with too many forms I wouldn’t find useful, and (3) the checkboxes take up too much space for a medical student. Only an intern would need to accomplish that many tasks.

In the future, I’m going to make the boxes editable so that users can print out a nicely printed tracking sheet.

Patient tracking form


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