Sunday, July 08, 2007


To work at my trade by the dozen and never a trade to know;
To plan like a Chinese puzzle -- fitting and changing so;
To think of a thousand details, each in a thousand ways;
For my own immediate people and a possible love and praise.

I used to think I was obsessive-compulsive. It was my strong point. My concern for minutiae made me a great medical student, as I had all the labs, all the studies, all the details of the patient histories, going back as far as the hospital records would allow.

Then I became an intern. As a medical student, I had charge over one, two, or at most four patients. These were acquired gradually, over a period of days, and I came to know them well. Now, on cardiology, I regularly admit six patients on a call night, and then I have to know them well enough to present the following morning. Gone is the obsession. Or if not gone, I realize that I cannot get information the way I am used to, cannot use the same organization. I must move faster, more thoroughly, more efficiently.

Case in point, one of the patients I admitted last night was only in the hospital because on his more recent discharge, his medication instructions were not clear. This resulted in him not taking a medication he needed. Now I know the intern who wrote those instructions wasn't intentionally trying to harm anyone, and in fact, he had all the information on the instruction sheet, he just didn't take the time to format it in a readable way. Even I couldn't figure out the sheet, and heck, I'm a doctor. But he probably fell into the same trap I do, having to discharge ten patients in a morning, typing furiously, dealing with the interruptions of pages needing to be returned, residents updated, patients seen.

I never realized the sheer volume of work that goes into being an intern. I was a good medical student, and a good sub-intern, but it is impossible to know what all is entailed in being a doctor, in being an intern, until it is your signature on those late night medication instructions, your fingers entering all those discharge orders, your head running on empty because you've been awake for 30 hours.

Probably I will never be a success in my own eyes. But when I make stupid mistakes, like today in rounds, actually forgetting to write down half of a patient's chemistry panel and asking my resident for the numbers in the middle of my presentation, in front of the cardiology fellowship director, it is easy to sink farther in my own estimation than usual, even. Sigh. The only positive I can think of is the fact that I'm learning the hard way, which tends to make a more lasting impression. I just don't want to destroy my chances of success here before I even start.

Maybe that obsession isn't entirely gone.


Alice said...

Nathan - You are so right. There isn't time to get things totally precise, the way we did when we were students. But everything we learn by making a mistake in front of the team, or missing a question on rounds, will definitely stick better than most lessons from medical school. And don't feel too bad, we are all making those kind of mistakes (as well as probably a few more serious ones in the next months). The interns do this stuff every summer.

(Right? )

Nathan said...

I sure hope so. But today was a bit better. The notoriously hard to please cardiology fellow (this is a guy to whom you can name almost any cardiology study in the past 50 years, and he will tell you not just the conclusion, but probably how many patients were in the control arm of the study as well) actually told me "good job." That almost made up for yesterday.

Alice said...

Good for you. That kind of fellow is hard to be around, because so often even when you get the question right, they go on to add so many details that your answer isn't so impressive anymore. :)

Ibid said...

Good luck, and sleep when you can. I imagine you'll need it.

Anonymous said...

i feel the same way about details and mistakes that you do. but i console myself by saying at least i won't make the same mistake twice --- i hope!