The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Monday, June 06, 2011

Testing, Testing, 1,2,3...

I'm not even sure how to do this anymore. And I doubt anyone is still listening. But apparently, Blogger will let blogs lie dormant for 2 years + without shutting them down. Huh. Who knew?

The danger in that is that inevitably, after practicing emergency medicine for 2.5 years, things will eventually wear you down enough that they will come boiling to the surface in a tsunami of resentment, irritation and rage at... well, everyone. At patients, at their families, at other doctors, at various support staff, at administration, at politicians... no one is safe.

And then, even if you thought you'd never blog again, you find yourself longing for an outlet... something that isn't satisfied by the soundbites generated by a Twitter account.

I may be back. Unless I can talk myself out of it.

Friday, January 30, 2009

Miss Me?

It's been a busy time since I last posted. I finished residency. For good. I worked full-time at a walk-in clinic, which made me realize several things:

1. I can deal with uncertainty
2. Walk-in clinic medicine is not bad medicine by definition. It is what you make it.
3. When you have no idea what is going on, have the person come back in a couple of days. If the problem hasn't resolved, it will likely have declared itself.
4. You really do prescribe the same 5 meds over and over.
5. Improving your flow at a WIC will carry over into other areas.

Most importantly, it made me realize that I would NOT want to do WIC medicine for the rest of my career.

Thankfully, I packed up my family and we headed down to our new town. And I started my new job. For the first time ever... I am THE doc. Staff. The buck stops here. The end of the line. Holy... crap.

After much time had gone by and I had no urge to update here, I wondered if it was time to hang up my blogging shoes. It's been a good 3 years. But I don't know that I have much more to say.

Then again, maybe I do.

I'll continue to ponder this one for the next little while. Thanks for your patience, for those of you still checking in here.

Wednesday, November 26, 2008

You Can't Make This Stuff Up

A gem from my job-search tour...

Here's the scene. I'm touring a beautiful office of the Family Health Team attached to the hospital of a mid-sized community. The physician recruiter, a retired surgeon, is chatting with my husband while I listen politely to the head of the Health Team. At one point, the recruiter says to my husband:

"All but one of the family doctors here are women. In fact, most of the physicians in this community are women. It's okay though... male physicians don't work hard anymore either."

Love it. My husband didn't share this gem with me until we were in the car on our way out of town. I couldn't help but laugh at how ridiculous it was.

Needless to say, this community is no longer on my list.

Sunday, November 23, 2008

The Home Stretch

I am 10 shifts away from the end of residency. Finally, I feel like things are coming together. Well, on some shifts I do. Other shifts, like today, make me feel like I'm an incompetent idiot. No difficult patients, no mismanagement, no problems... but a combination of little things that manage to crush any bud of confidence that might have been taking seed in my rookie brain. 

Here's a hint at how my shift went. First I started off seeing a teen with MSK pain. He had injured himself, kept playing sports, and didn't understand why it still hurt 2 months later. Gah. I re-x-rayed him to make sure that his injury hadn't displaced, and sent him out with a referral to the sports medicine clinic. Then I moved on to a traumatic finger amputation. It required a pretty extensive repair of several fingers and took me over an hour once the x-rays were done and the blocks put in (to knock out the feeling to the affected fingers). In the meantime I was working up a possibly biliary colic and an elderly gentleman with syncope. I followed that up with a therapeutic paracentesis, a suicidal teen and a pair of lower GI bleeds. I wrote admit orders (yes, we still do that at our hospital) consulted specialists and arranged admissions. And I did it all with nearly no help. I ran each case by my preceptor before discharge/consultation/admission, but otherwise barely saw him over the course of my shift.

In spite of this, my end-of-shift evaluation was mediocre at best. Among the comments:
  • When I was presenting my biliary colic case to him, I accidentally said 'cholecystitis' when I meant 'cholelithiasis'. So apparently, that means that I need to review my diagnosis and management of gall bladder disorders. Regardless of the fact that based on everything else I said I clearly just misspoke and didn't actually think that a woman with a relatively benign abdomen, no fever, no white count, normal abdo bloodwork and no ultrasound findings more compelling than sludge in the gall bladder actually had cholecystitis. But apparently that one brain fart means I'm an idiot. 
  • When I asked his opinion on anesthesia for my patient with the mangled hand I asked him if he thought I should do individual finger blocks or simply block the whole hand. On my evaluation he wrote that he thinks that I need to evaluate my anatomy of the hand if I think that a hand block is necessary for finger repairs. For the record, if anyone ever asks me if I want three separate finger blocks or a hand block, I'll take the hand block. But apparently, that question also attests to my incompetence.
  • In a 14-year-old with melena stool, I neglected to ask the patient about binge drinking. And when the surgeon asked me about his alcohol intake, my response was "he's only 14!". When I asked him, he did indeed binge drink every weekend. So I looked bad. And naive. Oops.
  • At the end of it all when I felt like I'd spent the entire shift being run off my ass, I realized that I had only seen about 1.5 patients per hour. My goal is currently 2-3. Sigh.
It really doesn't take much to knock the wind out of my sails. No matter how the shift went, I can't shake the feeling of incompetence. I feel like a complete impostor, and feel like if people only knew how little I actually knew I'd have my medical license pulled. Even when the shift goes beautifully, I have an irrational paranoia that the staff in my department all know that I had initially expressed interest in staying there after completing residency and was ignored. Like they're taking about me during departmental meetings and laughing that I actually thought I was good enough to work there. See? I told you I was losing my mind.

Not passing the exam really didn't help. It's not like I can justify things by saying to myself "well, the college thinks I'm competent enough in emergency medicine to practice independently"... clearly, they don't. And now I really regret writing the exam when I did. I would have been in a much better place mentally if I had just deferred until I was finished residency. I don't feel like I've gained anything by sitting it once already, and right now it's serving as confirmation of my deepest fears of inadequacy. 

This just sucks.


Wednesday, November 12, 2008

Time to Fess Up.

I didn't pass. There, I said it. It's official.

I'm okay with it. I know that it was a long shot. It was still a hit to the pride (hell, I think the last time I failed ANY exam I was about 19 years old) but I'm over it. And now I actually feel much better. I'm back to studying, but the stuff I WANT to know... not the stuff I think will be on some stupid exam.

Hopefully, it won't affect my employability. Most people just assume that since I'm not finished residency until December, that I haven't written it yet. I don't correct them.

So where do things stand now? I am 15 emerg shifts away from the end of residency. And in that amount of time, I also have to complete a research project (a study of consultant response times to pages from the ED and how the delay affects ED flow) and complete enough scans to become an independent practitioner of ED Echo.

Oh, and at the same time I'm still working at the clinic, looking for a job and trying to be a mom. Gah.

We're talking to four different communities right now, and visiting three of them next week. I'll keep you posted.

Wednesday, October 15, 2008

Bitter Barn: Population, Me.

I am SO done with this residency shit.

I am tired of having no control over my life.

I am tired of working my ass off for crappy pay.

I am tired of being the lowest rung on the ladder, and people thinking that they can shit on me as a result of that.

I am tired of having to listen politely while staff doctors bash each other incessantly.

I am tired of constantly being made to feel as though I know NOTHING, even if what I am currently not knowing is not something that I have ever come across before and will never use in my specialty of choice.

I am tired of the feeling that there are not enough hours in the day to do everything I want to do as well as I want to do it.

I am tired of every second of my day being taken up by SOMETHING, leaving me no time at all to do nothing. I miss doing nothing.

I'm tired of people expecting me to show up to things that waste my time, just because I'm told to. Sitting through the same academic half days that I sat through during my maternity leave is NOT helpful, nor is sitting through ICU rounds when the topic is the utility and outcomes of various strategies of hemodialysis. 

I'm tired of living in a place where I don't have any friends to just sit with and vent over a glass of wine. Not that I'd be able to find the time to do so, but anyway...

I'm tired of feeling like the staff in the emerg all think I'm incompetent. Part of that might be paranoia, but when you listen to people bitch about their peers for long enough you start to wonder what's being said about YOU behind your back.

I'm just tired.

Tuesday, September 30, 2008

So What Else am I Doing?

Now that I finally have time to talk about things OTHER than my emergency medicine board exams...

I got a new job. I actually started it in late August. Since my hospitalist gig wasn't really working out (I didn't like the one hour drive, I didn't like the fact that half the time my orders didn't get carried out, I didn't really like the 'hospitalist' role in general) when they started pushing me to commit to a more consistent schedule I took the opportunity to bail out.

Then, something better fell into my lap. I was working with one of the emerg docs in August when she mentioned something about a 'shift at the clinic'. I asked her if she did walk-in clinic work in addition to the emerg, and she confessed that she did. I say confessed simply because around these parts (and in most parts, I guess) walk-in clinic doctors don't have the best reputation. At best, they're solely motivated by money and cranking through patients as quickly as possible. At worst they're seen as antibiotic dispensers, willing to give patients whatever the hell will get them out of the office in the least amount of time. But this was an emerg doc that I admired, and here she was admitted that she also worked at a walk-in. Huh. Interesting.

I told her that I had looked into working for one past-time at the beginning of my residency and didn't know how to get into it. She told me that the clinic she was working at was always looking for docs to provide more coverage. She paged the doc who ran the clinic... and boom. By the end of the week I worked my first shift as 'one of those walk-in clinic doctors".

And I liked it.

Why?

Well, I can't deny that the amount of money that I can make in one short 5 hour shift is awesome. My $200K line of credit for medical school liked that part. But there were two things that I liked even more...

The first was the fact that I didn't answer to anyone. I didn't have to justify my decisions to a preceptor, and no one had the option of seeing the 'real' doctor instead. I finally felt full accountability and full responsibility... and I loved it.

The second was the fact that I felt appreciated. I never thought that was all that important to me, but it made a big difference. I understand that emerg is a pretty thankless job. You're seeing people at their worst, they're sick, their family members are worried and stressed, they're often angry at being made to wait for hours on end... I get that. But there were a few times... after seeing a woman in early pregnancy after a stillbirth, counselling a guy with first-episode HSV infection, reassuring a new mom that she wasn't doing anything wrong... simple things, really. But the patients were just so thankful to me afterwards. Maybe they expected the typical 'McMedicine' that walk-in clinics are famous for and were surprised that I took the time to sit and listen. But I was actually surprised by how much a simple 'thank you' meant to me. It made me feel a little narcissistic, but it was a stark contrast to the emergency department.

So I have a new part-time job. Emerg resident by day, walk-in clinic doctor by night. And mom at all other moments of the day. No wonder I'm exhausted.