MedZag has a great post up today. It got me thinking….
Yesterday, a group of us fourth-years were sitting around, chewing the fat — by which I mean discussing the residency application process, which most of us are starting right around now. We talked about the types of places we wanted to go for residency. Part of the joy and difficulty of third year is the constant rotating through not only various specialties but also various practice models. I spent maybe half my time “at home” — big private tertiary university inner-city insert-more-adjectives-here hospital. But I also got a chance to see how things were done at smaller private hospitals, large public hospitals, and even a five-week stint in the ‘burbs, at a community hospital.
I thought I’d love “the country.” I was at a point in the year where I wanted to get out of the city, experience something new and different. I thought I would love being at the community hospital, in the trenches, as it were, getting a chance to see the first and most common presentations of disease.
What I found instead was a group of happy, well-rested residents who liked their work and cared for their patients but had little interest in the “why” questions that make medicine so fascinating. Once, I saw a young immigrant with the signs and symptoms of colon cancer. No family history.
“You know,” said the resident as we walked back to the work room, “we’ve been seeing a lot of these lately. Young guys from Central America with GI cancers. Interesting, huh?”
“Weird. Do you think maybe there’s a pesticide exposure, or maybe dietary? Do they have oncogenes, or mismatch repair defects”
“I dunno.” She picked up a script pad to write him for a colonoscopy. We just treat them.”
That stopped me. Here was an epidemiological study simply begging to be given a good home, and it was passed up. Yes, I’m just the med student, naive, idealistic, no real concept of how long it takes research to be done. Yes, it’s just epidemiology (but then, John Snow’s work was “just epidemiology”). But flat out disinterest in a scientific question? Frankly I’d never encountered that before. But I suppose it is to be expected in a hospital that does not subscribe to UpToDate or PubMed.
What makes MedZag’s post come together is not just the well-written patient story, nor the introspection that makes the meat of the post. It is the use of that patient’s story, and the connection to another patient’s story, to formulate a question that can be investigated and hopefully answered. It is that interest in moving things forward that sets medicine apart. Not only do we learn to listen to stories and fight diseases, we also learn to step back from the singularity of the patient in front of us and be curious about the bigger picture. We have to relearn how to be the obnoxious three year old who is constantly asking “Why? Why? Why?” and how to harness that curiosity to the plodding work of grant-writing and IRB-approval-getting and retrospective-chart-reviewing.
Maybe you can only do that at big academic medical centers these days. Maybe that’s the only kind of place that can sustain research. I hope not. And I hope that my experience at this community hospital was an anomaly, that academic curiosity is alive and well in the suburbs. I do know now that I absolutely have to be at a place that encourages residents and faculty to ask questions and seek answers. If only you could search FREIDA by whether or not a program subscribes to PubMed!