clinic · MS-3 · surgery

“We don’t care what they say.”

Sometimes, as a student, you see an interaction between a doctor and a patient that makes you shudder. And sometimes you see something that makes you proud to be in this crazy profession.

I had a clinic patient some time ago who had been in a car accident and was concerned about a mildly asymmetric sterno-clavicular joint.  Since the car accident, he’d noticed that one side was red and swollen and generally more prominent than the other.  Another medical student and I took the history together. (This really does make a difference; once you take a history from someone they become “your” patient, and you want to make sure they get the best care; just plain shadowing doesn’t do that for you.)  The patient was decidedly less than thrilled to be examined by mere students, but we assured him he’d get to talk to a “real doctor” before leaving.

So once we got back to area in the back where the residents and attendings were chilling, we presented the patient. The CT scan performed at a prior visit showed no evidence of fracture.  We were told to “go tell him he needs PT.”

“He really wants to talk to an MD,” I pleaded.  So the attending gamely went into the room and started off with “I’ve looked at your scan and we’re not going to operate.”  The patient kept insisting that he didn’t want an operation, either; he just wanted to know how to bring the swelling down.  They talked at cross-purposes for a while before agreeing on PT and ice and follow-up in a month. A little later, the other med student and I saw the radiologist’s read of the CT, which suggested a particular congenital syndrome as the etiology for the asymmetry.  When we pointed this out to the resident, she blew it off, saying, “We don’t care what they say.”  She was referring to the radiologist, of course, but she might as well have meant the patient.

Contrast this with another clinic patient I saw.  She was one of those patients — the type that comes in for evaluation of her left flank pain but also wants a Pap smear done and her diabetes meds refilled and her bunion looked at and a million other medical complaints of various severity addressed in the space of a ten-minute free clinic visit.  The resident was beautifully patient with her, setting up an appointment in gyn clinic next week and reminding her that her PMD had to write the glyburide script and giving her a referral to a podiatrist.

Afterwards, the resident confided to me that patients get “off track” all the time; “that’s one of the annoyances about outpatient medicine.”  But you’d never have guessed, from her discussion with the patient, that she was annoyed. Later that day, I saw her help another patient figure out a complicated insurance issue that would have dictated where she could get the surgery she needed.  That’s the sort of resident I want to become.  I know from experience that I can be snippy when sleep-deprived, but I hope I don’t take it out on my patients.  I’ve seen residents with a sense of entitlement and residents with a sense of service, and I want to be in the latter group.

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