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.

Wednesday, March 28, 2007

Drawing the Line

One hard thing about residency is figuring out where to draw your line. And I mean this in a few different ways.

First, you have to figure out how much of "you" you're going to give to your job. In medicine, it's awfully easy to have your job become your life. Not to say that this doesn't happen with other jobs. But in medicine, where the job becomes your life for certain periods whether you want it to or not (see posts from 11/05 - 12/05 when I was an intern on general surgery for a shining example) you sometimes feel guilty for not throwing yourself in headfirst. Unfortunately, there are very few (i.e. none that I can think of) residency programs that are not harbingers of the future. What I mean by that is that if you're working your ass off for five years, you're kidding yourself if you think life will be sweet once you're done. In all of my toughest rotations, the staff were there too-- coming in on weekends to check on their patients, getting phone calls in the middle of the night informing them of significant changes in their patient's status, staying well past 'normal' working hours to get things done... and these happened when they weren't on call.

The second line that you need to learn how to draw is the one between 'personal you' and 'professional you'. I have heard enough stories of doctors who routinely have neighbours showing up on their doorstep asking them to look at their child's rash, or asking for a note for work to be wary of mixing the two. I'm hope that for me, a part of that will be avoided by the fact that I go as Mrs. Husbandslastname socially and Dr. Maidenname professionally. Currently, only two of my neighbours are aware of what I do for a living (and neither of them were told by me). That being said, I don't live in a very close-knit neighbourhood and people generally keep to themselves. If I lived in a smaller town rather than a mid-sized city, my Clark Kent persona would likely be far more difficult to maintain.

Which leads to line number three-- prescribing to self and others. By 'others', I mean people who don't fit the formal definition of patients... friends, family, co-workers, and acquaintances. We've all done it at some point. When a coworker asks for for a quick script for Cipro for a UTI-- she's had one before, and has all the symptoms, and is really uncomfortable. Most of us wouldn't think twice. But are you comfortable asking the coworker the same questions you'd ask a patient? Sexual history? Discharge? Painful intercourse? None of us would do a pelvic on a co-worker, but I've seen more than one case of genital herpes initially misdiagnosed as a UTI. What about even more benign stuff-- a script for physio to make an insurance claim? A req for bloodwork for a friend who needs her thyroid levels checked regularly but can't get in to see her family doctor for another week?

That complicates things. For those without a family doctor, something as simple as getting a prescription refill or a referral could mean hours sitting in a walk-in clinic to be seen for seconds by a physician who lets them talk for less than 30 seconds before scribbling a script and leaving the room. But that doesn't make me any less responsible for my actions if I choose to interpret the guidelines loosely.

And there ARE guidelines. The college policy states that:

Physicians should not treat either themselves or family members, except:
  • For a minor condition or in an emergency situation,
  • Only when another qualified health care professional is not readily available.

Unfortunately, these are very open to interpretation.

So for now, some residents will have no qualms about prescribing to friends and coworkers. Others will refuse in the spirit of erring on the side of caution. For the rest of us who fall somewhere in between, we need to figure out through trial and error where our own line will be drawn. And the sooner we figure out where our personal boundries lie, the easier life will be.


Blogger Midwife with a Knife said...

I actually have a blog post on the same topic cooking. What a coincidence! I really rarely treat myself any more. I have decided that:
1) I'm not a very good doctor to myself
2) I appreciate the value of being able to talk to a doc who isn't a friend of mine about my health. It's hard to let someone else take care of you that way sometimes, but if I ever had problems with my vagina or with depression or any one of a number of other personal issues, it's nice to have a doctor.

I also no longer prescribe for family or friends except under unusual circumstances. I had a family member ask me for narcotics once, and I decided to make a rule and stick to it. I also had a friend forge a prescription once.

10:26 PM

Blogger 911DOC said...

good advice. you are right about residency and the light at the end of the tunnel. many years out now and it isn't much better (except for the pay).

6:44 AM

Anonymous patientanonymous said...

Though provoking and well written. As always.

7:10 PM

Blogger medstudentitis said...

the hard decisions never end, do they?

11:54 PM

Blogger Shazam! said...

There is light, you get to decide what it is. I work part time, earn about 2/3 of my colleagues and still make plenty of money to cover loans, bills & join a healthclub. I'm happier too.

As far as treating colleagues, we had a strict rule that it was legit ONLY if they were fully signed in to the ER as a patient and were subsequently treated as such.

I recently wrote a Valtrex Rx for a nephew of a friend whom I work with, and regret having done so so as not to set a precident.

2:59 AM

Blogger Fat Doctor said...

So it seems a friend has a partner who keeps a stash of Demerol at her home and will tell patients who call on the weekend to just come on over and get an injection. Hmmmm. That does seem to a blurring of the line, don't you think?

8:56 PM

Blogger View from the Trekant said...

Re: "not a good doctor to myself"

An MD calls my cardiology practice (in remote past, details disguised) and tells me that he is having 10/10 substernal chest pain radiating to neck with shortness of breath . . .but declines to go to ED or to come over to my office because he is in a full clinic and is too busy. (!!!!)

I think we are terrible docs to ourselves and really do better if accountable to another.

IV demerol at home? That goes beyond line blurring I would think.

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