Monday, October 30, 2006

suddenly...it's November?

Time has been playing tricks this year - I can't believe my fourth year is only 3 months old, but at the same time I'm not entirely convinced it's almost November.

note: I have been catsitting and spent the weekend knitting, napping and petting the cats. As I type this, everything that was in my car is now in their living room. The cord that connects my camera to my computer is in that pile. I hope. Pictures when I find it. Or by another one.

My trip to NYS&W was my first time in Rhinebeck and I'm fairly sure that it won't be my last. As many have already said, the fairgrounds were swamped and the weather was great. The long drive down was good (but long) and both nights I slept better than I had in weeks. I did, er, whine a bit, but I'm going to plead exhaustion and wheel-
love and then promise to be much more agreeable next time.

I left with a new Forrester spindle (my second) and various types of fibers (some bought for the color, some for the feel (how could I leave the shetland bumps there? I couldn't keep my hands off of them!) and some simply because I've never spun that type and want to start building my experiences). Some amazing sock yarn and various lace yarns screamed my name, and I found a bin of books that were all half price.

All in all I don't regret any of my purchase. I do regret not being able to sit and spin with people, and not being able to say more than a passing "hi!" to people I would love to have spent at least a few minutes with. That being said, the conversations I had were wonderful and catching up with those I did see was worth the trip.

(Another highlight was that I got to see one of my wheels. Robin has been living in Boston and I have missed her - missed her more than I thought I would. I love that wheel. (Love.) Norma's mitten also loved the wheel - but that's another story.) I had less than 24 hours with her before I dropped her off with Gil (her maker) so he could replace some of the screws with bolts and give her a tune up. Handing her off - even to the person who used his hands to put it together - was hard.) I bought Robin from someone at the Maine Fiber Frolic and I know that I will never again find a wheel at such a great price. Gil knew the wheel as soon as he saw it, remembering that it had intially been a single tredle that he modified to become a double tredle; it's one of the first set he made, and I love that he knows it's ins and outs. It had been klunking and he has since fixed that AND given the wood another oiling. Now I just have to figure out how I'm going to get there to pick it up...


Physically stepping out of the medical world and giving my brain a chance to stop whirring with facts (of varying relavence) does funny things to me...it took several hours for me to fall back into myself, and stop the constant awareness that comes with being questioned at every move. Thus far my rotations have demanded a lot from me, and I've gotten critisicm at every turn, with every question I answer and the feeling of being judged isn't something that goes away easily or quickly. I continue to be the medical student that doesn't "fit" the "rules" and over and over again I hear about how I need to change, how I won't be able to continue to take care of patients the way I have been and that I am not nearly as efficent as I should be.

In September I spent the month at a rural health site; the Appalachian Trail ran through the town and I saw hikers with various injuries (who were thisclose to being done with their hikes and just needed to get through the last 200 miles), and Outward Bounders who had not showered in nearly three weeks. The site I was at happens to the only clinic in the area and they were busy, busy, busy. This site gave me insight into the difference between a teaching hospital or residency program (essentially a teaching clinic/hospital/etc) and just a regular doctor's office. The doctors who have students more often than not know how to ask questions, and guage what I know.

I've struggled with how to describe how hard that month was for me, and how I re-thought every aspect of my future almost every night as I cried and cried and wondered what exactly I'd gotten myself into. That feeling continued into last month, during my sub-I; the first two weeks were horrible. Not only did I have to prove myself to the patients I met, the residents I worked with and the ever-changing attending physicans, but I had to learn a new computer system, a new hospital layout and new schedule. The expectations seemed to change with every person I worked with and it quickly became apparent that my mindreading skills just aren't what they used to be.

I've said it before, but I don't thrive on competition - instead I back off and do all I can to get out of the situation, letting those around me fight it out. Continually questioning me and challenging what I know doesn't lead me to learn more - even if I know the correct answers, chances are good I won't be able to elaborate on the topic in those situations.

The above is just an aspect of medical education, but combined with attacks on my "style" and "compassion" it leaves me unsure of what I'm doing in this field. Over and over again, by more than one doctor, I've been told that I "spend too much time" with the patients, include too much information in my progress notes, and at one point I was told that I give the patients too much information.

(***to expound: I know that in the face of managed medical care and low insurance rembursements doctors see as many patients as they can to make ends meet; but if I only have three patients to see in a four hour time period, why wouldn't I spend a full 15-20 minutes with them? Every single patient that I "spent too much time with" told me that they finally felt as though they had answers to all of their questions. Many told me that they hope I never change, and those statments kept me going during the moments when I was ripped into by docs who felt I was simply wasting time.

regarding too much information in my written notes: I can plan for that if I know who will read them (and only write in abbreviations or short, short sentences), otherwise I've found that it's much easier for me to include too much information than not enough. (I was never told that my notes were too long last year...)

re: the patient having too much information - I believe that patients should know what they are diagnosed with, and what their tests show. A patient who has had a stress test and echocardiogram deserves to know that it showed they'd had a heart attack. When the future might include a cardiac catheterization and the pt is getting pressure from cardiologists and the general doc to schedule the procedure, I think evidence that they had damage to the heart muscle is important. The other docs argued that it wasn't important in the scheme of things or that they already knew the results. (they didn't know and thanked me profusely after finding out)

End expounding.***)

I suppose the best way to put it is that I am tired, and having to be in these sorts of situations (throw in living in dorm rooms and moving every four weeks) is wearing me down. I have thought more about where I want to do my residency, and what is important to me for my future. I will get through this - it will pass - but right now it's hard to keep that in mind.

Tomorrow I start a surgery rotation with a breast specialist and I am looking forward to picking it up where I left off after my radiology rotation. My clinical skills exam is at the end of this month and with Thanksgiving thrown in there chances are good time is going to start speeding up. With only 30 weeks and 5 days left til graduation, I can’t say I’m sorry to see it start to move quickly.

19 Comments:

Blogger janna said...

I think that, in a way, what you're seeing is 'real world,' rather than academia. It's too bad that there are still doctors out there who think patients don't need as much information as possible, when we know that's not true. However, after viewing medicine from the academic side for 20 years, it was frustrating to see it from the other side when both my parents were seriously ill. In both cases, the attitudes seemed to change when they realized I had medical knowledge, but it made me wonder what 'regular' patients get.

I think this will change, but it's slow. Many of your fellow students would like their patients to think of them as all-knowing, but that has changed. The health care professionals' attitudes need to change, too.

Sorry to rant in your comments, but I spend all day around doctors and other health care professionals. Some are fantastic; some are not..... Never think that you're spending too much time with your patients, or that they don't deserve that time.

12:34 AM  
Blogger Liz said...

Give me a doc who gives "too much information", a generous helping of her time, and "compassion" any day, please.

Hang in there, K.

8:29 AM  
Blogger Sara Skates said...

Hang in there - hoops, you gotta jump through 'em to get to where you wanna go. Which is the goal....once you're there you can practice doctorness the way you want and decide yourself.

hear hear on the never can have too much info thing.

8:52 AM  
Blogger J. said...

I agree with Sara - jump, jump, jump for the next 30 weeks and then you can stop... and if I had a doc who would tell me more rather than less I would be over the moon!

Hang in there and enjoy all that new fiber

9:02 AM  
Anonymous Nancy J said...

Please Always be compassionate and tell patients as much as possibile. We all have the right to know what those tests indicate and what the future possibly holds. Not being told what the tests indicate is happening and being pushed aside for another patient in another horrible medical cubicle is what makes us non-medical-field-people hate going to doctors. When we feel comfortable with a medical professional we will go back to him/her and receive much better medical care and healing.

Glad you could get to Rhinebeck and indulge in all the fibery fantasia.

9:03 AM  
Blogger Liz said...

Just a quick 'thank you' for taking the time that you do with your patients. I work for a physician membership organization, and I know the pressures everyone is under to see many patients. But I'm also a mom who spent days 8 through 11 of her baby's life at the hospital with the baby -- who, it turned out, had viral meningitis (but we didn't know it was viral until the final bacteria cultures came back negative after 48 hours). The doctors would swoop in, speak in medical-ese, and move on. I'd be left trying to get some uninterrupted time with the nurses (who were each responsible for many patients) to ask my questions and get answers to them. A doctor who explains what is going on to the patient is invaluable. Hang in there. Know that you are doing the right thing. Eventually the world will catch up with you -- it has to; the way things are going just isn't working for anyone.

By the way, we (apparently) met at the Mass Sheep and Wool fair back in May (at least I think it was May); I've been reading since then, but hadn't posted before this.

9:17 AM  
Blogger margene said...

It's unimaginable to me what it must be like for you to be living a life of constant frenzy and criticism. You are learning so many things about yourself, the medical profession and in the end you'll have answers as to what type of Dr. you want to be and where you'll fit in best. In the past 5 years I have Dr. shopped. If a doctor saw me for 10 minutes and didn't talk to be about possible diagnosis, just ordered tests...I fired him on the spot. When I found a Dr. who spent 30 minutes talking to me, helping me and figuring out what to do...I stayed and have gone back to him. We all need to say more to our docs about what we will and will not accept and maybe we can change the system. Good luck. I'm thinking of you and sending good thoughts.

11:35 AM  
Anonymous Anonymous said...

You're in a tough spot. On the one hand, you need to be able to adapt to your surroundings and do things the way they do, but on the other hand, you need to learn what methods work best for you. Will there by major repercussions will there be if you don't do things their way? Maybe you can search out a residency that will allow you more flexibility? It all sounds awful and hard and I sure don't envy you one bit.

12:44 PM  
Blogger Katy said...

Eek. Can there really be such a thing as too much compassion?
Keep your chin up, Kristin--you are just the kind of doctor that I would take my family to see.
And I wish I had more of a chance to hang out with you at Rhinebeck; do let me know if you'll be in western MA at any point!

12:59 PM  
Anonymous Laurie said...

Margene and Martha hit the right notes. At this point, the criticism is simply theoretical. It becomes real time next year. Find a program that fits you. Recognize That Is What Medicine Is, as practiced where you are doing your rotations. It's hard to make a difference in the system, but it's worth trying.

2:39 PM  
Anonymous naomi said...

I agree with everyone else...compassion and communication are good. And I sympathize with you--I can't quite believe it's almost November, but mid-September seems like eons ago.

Are you still planning to come to Philly at some point?

4:48 PM  
Blogger "Grandi" said...

Welcome back! It is amazing to read how you were scolded for talking to patients!!! Please don't stop! When my dad was dying of cancer in his lung and pancreas this last summer, we didn't realize that no doctor had actually talked to him!! They talked to mom and me and we knew how serious it was, but he was totally blown away when the hospice folks stopped by to chat with him!! He had no idea he was dying, and we didn't realize that not one doctor had bothered to give the him the results of his tests and proceedures!!!

5:17 PM  
Blogger Maggie said...

Hang in there, Kristen...it took me a loooooong time before I could let "it" all roll off my shoulders. Even in this place everyone has something different to say and no one can agree on anything...so, pick what's right for you and let the other stuff roll.

4:52 AM  
Blogger Carina said...

Wow. My hubby could've written that rant when he was in med school. Word. For. Word.

You are not alone. You are not the only one who doesn't like competition or too much time pressure or the pimping. You are going to be an amazing doctor because of all that, not in spite of it. Trust me on that--I live with a great doctor who has been through all of that and come out on the other side as one of the most popular and busy docs in town.

You really should consider doing residency in a community hospital. Hubby did his in Kalamazoo, MI and ended up learning so much more than he would've in some big academic place. They're more laid back there and will bite your head off if you don't leave full notes or take enough time with a patient. The rules are different there, at least just different enough to feel like you can really learn to practice medicine.

That, and when you interview, they put you up at the fanciest place in town and will even get you a jacuzzi room. ;)

11:59 AM  
Blogger Theresa said...

As only one year on the other side, let me tell you that it does get better. Really. It does. I now have a clinic of 50 patients for whom I provide primary care, and it's great. Great. Great. You'll finish paying your dues here, and someday not too long from now you'll be able to practice the kind of medicine you want.

11:05 PM  
Anonymous Bookish Wendy said...

keep hanging on girl (picture cheesey 80s poster of kitty hanging off a branch here). i am thinking of you often as I negotiate the medical community from the other side. yours is the good fight...you can do it.

2:08 PM  
Anonymous elisa said...

Sometimes the only way that I get through a particularly bad day (that is usually part of a particularly bad week, month, whatever) is to repeat to myself: The best thing about this day is that at some point, it will be OVER.

Every day passes, and at some point the bad stuff should pass, too. Just continue to do what you feel is right, and understand that you are making decisions about YOUR future, and other's opinions are just that - opinions.

1:51 PM  
Anonymous Kristin said...

Don't get discouraged. You will develop your style, and will eventually only have to be accountable to yourself, not the attendings who are telling you that you are spending too much time, or writing too much in your notes. And where you can write less will become more apparent as time passes. And ultimately you will have to do what is write for your patients, and I think you have the right idea there. Hang in there.

7:43 PM  
Anonymous rashad said...

hello there! i'm rashad and we've never met, but i was googling "med school" and the like just to see what i might be up for in a few years. just wanted to let you know that i really enjoy reading and learning from what you have to say.

2:13 PM  

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