For someone so bold as I, this may seem like a ruse. Especially to Jeff! However, I assure these is my feelings. I am a bit apprehensive about actually being involved in pt care. I suddenly realized that within 17 months I am going to be involved in the care for others who will look to me to help them get better, offer sound advice, and comfort when necessary.
I realize most of this will be heavily supervised, but still…these are peoples lives I am involved in and responsible for. This is not a movie cue that I can erase if I screw it up and need to rewrite, its a live human, not a cadaver.
Was anyone else apprehensive or nervous about the start of that segment of their training? Please say this is natural and I am not paranoid over nothing.
Quote:
For someone so bold as I, this may seem like a ruse. Especially to Jeff! However, I assure these is my feelings. I am a bit apprehensive about actually being involved in pt care. I suddenly realized that within 17 months I am going to be involved in the care for others who will look to me to help them get better, offer sound advice, and comfort when necessary.
I realize most of this will be heavily supervised, but still…these are peoples lives I am involved in and responsible for. This is not a movie cue that I can erase if I screw it up and need to rewrite, its a live human, not a cadaver.
Was anyone else apprehensive or nervous about the start of that segment of their training? Please say this is natural and I am not paranoid over nothing.
Hey JP,
The more-senior members of your team are not going to allow you to do anything in the “learning phase” that would cause permanent harm to any patient. Most of your initial patient contact will be taking a good and comprehensive history along with a physical examination. Taking a patient history is mostly listening to what the patient is trying to tell you. You can’t possibly hurt a patient by doing listening and you can only help them.
After you have mastered the History and Physical, your next tasks will be drawing blood and writing daily notes. Again, you can’t do much damage to patients doing these tasks. About the time you are an advanced third-year medical student, you might get to do things like suture a wound, insert a central line etc. If you are on my service, I would have you inserting chest tubes and Swan-Ganz catheters too! I tend to bring my medical students along pretty quickly.
By the time you start internship, you will have both the knowledge base and the experience NOT to kill anyone. Again, if you have mastered all of the tasks along the way, you will be far from dangerous. The junior members of the resident team are supervised by the more senior members. Any senior resident who does not allow the juniors to ask questions is more dangerous than the junior resident.
Things to keep in mind thoughout medical school:
Never perform a procedure or task unless you know the benefits/risk ratio and are thoroughly familiar with the task. You can always get a more senior person to guide you.
Always “load the boat” when you have a crashing patient. This means notify the person who is above you about the patient not doing well. If you are the intern, call the chief early. If you are the chief, call the attending early. In other words, if your ship is sinking, take everyone down with you. The more the better.
Be open to learning from everyone. Even the patient care assistant or the housekeeping people can help you learn something. Just the other day, one of the surgical technicians showed me how to flip a sterile glove onto my hand in one easy step instead of struggling with the cuffs. This is a very practical thing to learn when you have to gown and glove yourself without contamination in the OR. (Sometimes the scrub nurse is too busy or if you scrub in after a case starts).
If you make a mistake once, don’t keep repeating it. No person was born knowing everything about medicine or its practice. By the very nature of the beast, medicine is a life-long learning situation. Forgive yourself of mistakes but learn from them.
Learn that helping a patient die is as important as helping them live. Death is always present in medicine and a great cure for some pathologies. Sometimes you have to give your patients permission to die.
Communicate with everyone on the healthcare team. The more information is shared, the better the patient care. If you have a question or disagreement with another member of the team, discuss the merits of both points of view. In the end, the most senior member will determine the outcome. There are no absolute rights or wrongs in patient care other than not doing your best at all times.
So relax, my friend and enjoy the learning. You have more to cram into your brain before you get too near a patient. If you never learn to put in an intravenous line, you can still place a great arterial line or central line.
Kids are not small adults!
Surgeons have the best job in the world!
Natalie
As usual, Natalie’s condensed a lot into a short comprehensive paragraph. I would just add a few things:
As a student, you share responsibility for patient care, yes. But your MOST important responsibility is TO LEARN. In my experience residents and attendings have usually been keenly aware of this and have emphasized that many of your patient care responsibilities are really learning tasks for you more than things that only YOU will be doing for the patient.
“As a student, you are not important enough to kill anybody.” This is how it was phrased to a friend’s third-year class as they started rotations. While it sounds a teensy bit harsh, it’s true. Even though you’ll be the one rounding on post-op patients, checking their labs, recording their I&Os (intake and output), you will have a resident who is making damn sure that you know what you are doing and that your data are accurate. And whether you say you’re hearing bowel sounds or not, or crackles in the lungs or whatever, they’re going to listen too. There will be no treatment decisions made on just your reports or observations.
I can’t agree enough with Natalie’s comment that learning to do a good, thorough H&P - and especially the H part, history - is key. Getting the story from your patient before you ever lay hands on them is going to tell you most of what you need to know. Hopefully this is something you’ll get to practice during your first two years. If not, during your first rotation as a third year, attach yourself at the hip to your resident and go through a few H&Ps together until you’ve got the hang of it. Then do as many as you can until you’re pretty confident that you’re getting a lot of useful information. And THEN, don’t get deflated when you spend a ton of time getting amazing details from a patient, only to have a senior resident walk in and ask ONE KEY question that never occurred to you. That’s experience and you will get lots.
But more than anything, remember that your JOB as a student, and your responsibility, is to LEARN; your learning takes place as a member of the patient care team but your responsibility for patient care is totally supervised.
Thanks both of you. In second year we are drilled in Physical Diagnosis in proper H&P endlessly here. We do endless hours of case work on real patients and hospital work at Ealing Hospital and St. Thomas A&E (ER). The realization is that we know we are going to be held to a higher standard than our USMG counter parts. As a result we get hammered here in knowing how to do an H&P blindfolded and with earmuffs on. We also get a ton of work in oral exams on evaluating patients by a panel of doctors in differentials and such. Second year here is called Hell Week.
I suppose it is just one of those things that is an unknown and you tend to be apprehensive about it until you get into it. I think the prep work at Ealing London and St. Thomas will help alleviate that a lot.
I was very aprehensive about the whole patient care thing too (as were many of my classmates). Things will get more and more comfortable as you go on. When I think back to my first few H&P’s just a year ago (which were much more H than P) I laugh at why I was so nervous about doing this. It’s so natural now I don’t even know what I was worried about early on. It’s totally natural to be nervous and aprehensive…but it will all work out in the end as it has very every doctor on the planet.
Natalie,
A great response with some useful information.
I guess the thing to remeber is that no-one wants to see you fail. Everyone will want you to do well and will help if needed. People being people, though, means that sometimes they are grumpy or just plain busy. That doesn’t mean that you are on your own.
Something for everyone to remeber.
Craig
This was great advice. Although I am no where near this point in my journey, it is nice to read about these things, knowing that I will probably be in the same shoes a few years from now.
Lots of good advice already. I have heard that it takes 5 years or so for most people to stop feeling like they are going to kill half of their patients. In truth, I think a little fear is a good thing. It helps keep you from getting careless.
Ps – an hour ago I place my first NG tube. I DID NOT stick it into the lung or poke a hole in the guys stomach. Huzzah!!
steve
UNECOM class 2005 and olde pharte doc wanna be.
(currently in the BMC medicine call room)
Joe,
nat is right, you won’t be there alone. It isn’t like ER where you see a nurse in one episode improvise a trach from a straw. Nursing and medical training are set up much the same way, just tons more info. You will go through sets of skills under strict supervision, do the skills supervised, get checked off, and then do that skill as you learn new ones. It is a building process, and I have a feeling that medicine is no different from nursing in another aspect: you will learn MUCH more after you are out of med school! It is a constant learning experience. You won’t know everything all of the time and no one expects you to, tho it may seem like it. Relax, keep on your toes and you will do fine.
Kathy
Thanks for all of the great advice. I still feel the same way. At work, I have no problem working with the trauma patients who have just come out of surgery. My learning curve now is getting comfortable doing the H&P (esp the P part) on people who aren’t half zonked out. I have to say though, my school doesn’t let us touch a patient during the first year, making us learn to take a history well and I can truly see that I am much more comforatble and better at it than I was 18 months ago (but still knowing that I have a long way to go). I can only hope that I get the same type of feeling when it comes to actually touching my patients for the physical. And some day I will see the optic nerve and the vessels in the eye!!
Tara