Panda’s Approach to Clinics
While a somewhat amusing look at med student clerkships like Medicine, Pediatrics, and Ob-Gyn, I’d be doing a disservice if I didn’t say that I felt like Panda took the wrong approach to clinics.
Maybe it’s just different med school cultures, but he mostly starts out each one essentially saying the med student doesn’t matter, and isn’t really important to the team. If you don’t feel like you’re a valued member of the team, prove to your attendings that you are. Ask questions, take an active role, challenge yourself, ask for more responsibility, and most of the time, you will be rewarded. I was treated like an intern during my Medicine, Peds, Psych, and ER months. I had my own patients, and my attendings and residents pretty much let me manage my patients myself (with their oversight, of course). I wrote the H&Ps, daily notes, and discharge summaries. On my inpatient Peds month when I was on call, it was just me and the attending in-house! We managed the entire floor and PICU together ourselves. Did I do anything the attending couldn’t have done him or herself? Of course not. But I wrote orders, responded to questions from nurses, and got called throughout the night for admissions and procedures (again, with attending oversight). The medical student knows the patient better than anyone else on the team, and often I was able to provide medical history or dispo information that no one else on the team knew. Are you saving peoples’ lives? Often, no, but you’re learning how to, and if you don’t feel like you’re contributing to the team, you’re missing the experience.
Note: if month after month you’re having plenty of “slacking potential,” complain. Maybe it’s just me or my teams, but more often than not I was busy almost all the time–if not with patient care activities, note-writing, order-writing, etc, then with didactics or classes. Call me goodie two-shoes, that’s fine, but I’ve always preferred to work my butt off during clerkships and really try to learn a lot now than when I’ve got the MD after my name and people expect me to know stuff.
So an overall thank you to my programs and attendings and teams–I’d hate to be the exception! Make yourself matter, you’re paying for it dearly!
The key is, of course, that no matter how much responsibility you want to assume, you have no real responsibility. It’s all pretend responsibility. That doesn’t mean that you don’t follow your patients and know what’s going on but at the end of the day, they could take your note out of the chart and it wouldn’t matter one iota. Or you could, as I point out, disappear with no effect to patient care except that your residents might be a little pissed to have to do their own scut work.
After a day of looking up labs and copying them to a rounding sheet as well as other incredibly low-yield activities that could be done by a motivated sixth-grader I realized that medical training is clumsy, inefficient, and largely wasted time.
In fact, at many medical schools the students are not allowed to write in the charts and all of their notes are really pretend.
As for slacking, there is no point in killing yourself as a medical student, especially as you are only pretending to kill yourself. I’d rather, on most days, take a nap then hold a retractor in the OR for five hours answering the occasional trivia question. Since I’m not a surgeon, for example, most of what I did on all of my surgery rotations (and I have done seven months total of surgery) has been a waste of time. You could probably condense everything useful I’ve learned (chest tubes, central lines, indications, management) into two good weeks.
I like your blog, by the way. I’m going to link it on my blog if that’s OK with you.
I’m sorry Panda. One of the things you need to learn in medical training is staying power. Honestly, a lot of life(and Medicine) is just doing dishes. The paper work, the 5h depressed patient today, the 20th cold, and you get to tell them why they don’t need antibiotics, the fact that 95% of radiology tests are normal…
Meaningful sometimes must be found in mundane.
I sense you are wantng to “save lives”. I have practiced in the office, hospitals, ER’s for 17+ years and can count the saved lives on one hand.
But the desire for meaning in what we do is universal. Sometimes it is in the intimate scut details.
Attitude.
Essential.
No. Copying lab values onto a note when they are already printed and on the chart not to mention a mouse click away is nothing but chickenshit work that would not be done if there was no slave labor (medical students and residents) to do it. Academic hospitals are inefficient because they can be, not because this is the right way to do things.
After doing it one time, there is no edcational value in copying numbers onto a chart.
As for wanting to save lives, well, I guess you don’t read my blog.
I think that’s the difference, Panda (and I wasn’t at academic centers for many of my clinical months) — when I was copying down lab values, it’s because they weren’t in the chart already. *I* was finding them and putting them in for the note.
And I have to disagree on the concept as a whole–copying down lab values gets you thinking about a Chemistry or CBC panel so you can instantly recognize abnormalities and think quickly. You see something enough times it starts to become natural for you.
Panda’s right.
We’re all generally irrelevant to the care of the patient. Occasionally we matter–most times we don’t.
I’m with Panda on this one.
But the point is to learn–so ya gotta do what ya gotta do.
Oh…and we’re under a month left till the match…yes!
-Formerly The MUSC Tiger