Youth is wasted on the young. George Bernard Shaw apparently said that a long time ago. It’s a statement that exists in isolation, in those exact words not part of a treatise, play, story, or essay, as far as I can see. It’s got a resonance, a gut meaning, an intrinsic truth ring to it. Well, in medicine, there’s a similar saying. Or maybe there should be. Residency is wasted on residents.
How is youth wasted on the young? Those early in life have an expanse of years in front of them. They engage their lives in the peak of physical condition, with clarity of mind, the ability to do mental gymnastics, to really think outside the ruts of decades of thought. Because there are no ruts; there’s been no time to have made them! Despite this ability, oft times young lives are spent in self doubt, wishing for the time when they had more experience, more certainty, a clearer path. This, together with the expanse of years ahead of them make decision making less pressing.
Our hospital is currently experimenting with a hospitalist program. After decades of local hospital based physicians (ie local family docs with admitting privileges) sharing orphan patients on a rotating basis, we’re going with a system where one physician does all orphans for a period of a week, or a weekend. Originally, we would each take an orphan, one by one. On Monday, the first orphan would go to the first family doc on the roster, then next coming in to the next doc, etc. We would all normally end up with an orphan or two a week. Now, the “orphan doc”, takes all orphans currently admitted, and all new admits for that time period.
In essence, it was a return to the days of residency. All day, on the ward, looking after your little roster of patients. Do you remember those days? Ten, twelve, sometimes up to eighteen, but that was really pushing it. You could object, even back in the good ol’, bad ol’ days. More than 18 was simply too much. Do you remember?
What would you do now, with 18 patients to see during the day? Do you ever wonder what residents do with themselves? What you did with yourself?
Despite this, I volunteered with some trepidation. The reason we’re moving to this system is that it’s just getting more difficult. Inpatient care is now more geriatric, with multiple overlapping problems. It’s not just the difficulty of the patient, however. It’s more difficult to get to the office on time, unaware if you’re going to have a new admit or not, and how many. More difficult to get through your day at the clinic without interruptions, as orphan patients generate more phone calls, both from the ward, and from family members. More difficult to actually enjoy your clinic practice with the added stress and time pressure…So, I thought the week could possibly be fairly stressful.
My partners were supportive of my volunteering, and agreed to see any urgent patients that needed to be seen during my week away from the clinic. The week preceding my hospital week was a bit busier, and my manager tells me I’m already booked a week ahead. The new sexy is rapid access booking: I tried that for over a year, and it almost killed me, and my family. That’s for a small practice. However, I usually work through breaks and lunch, seeing urgent patients that day. I’m often booked a couple of days ahead, not a week.
The hospitalist days started out a little different, up at 0500h, office at 0530h, online lab checks for hospital patients, and lab work until 0720 or so. Home for an hour for breakfast, and to the hospital for 0815h. During that week, the proportion of time spent in hospital record review was of course longer. New admissions had past histories to read in addition to lab work for review. So, while usually I would be able to get the labs/ hospital data review done, and rounds done prior to breakfast, I spent the entire time prior breakfast doing labs, and getting ready to do rounds.
Rounds were…refreshing. Not daunting. Not crushing. How else can I describe a period where time was not an issue, where I could focus clearly on simply being with the patient? When I could actually joke with a nurse? All the cold hard time constraints felt on a daily basis were, for a five day period, gone.
I had told my manager that I could potentially be gone all day, and to only book my afternoon at my direction. Well, that phone call happened on a daily basis prior to noon.
I may have had an aberrant week. Perhaps my little cadre of orphans (they averaged 8-10 daily) was, well, little. Perhaps volunteers coming after me will have larger work loads. But as it was, I got the hospital work done in the morning, at a fairly leisurely pace, and had hours in the afternoon where I could see urgent patients.
None of my clinic patients were actually seen by a partner during my hospitalist week. None. They were either booked the next week, or I saw them myself in the afternoon.
And came out of that week simply rejuvenated. I felt I had a reconnection to what was important. It was like residency, only so much better. After almost 30 years of practice, I was not fumbling with self identity, fumbling in my pockets for scraps of paper, or fumbling the ball. I felt a real connection with orphan patients that I had never met before, almost equivalent to that felt with long term clinic patients. I was able to go to my first ward family meeting in almost 20 years, and able to spend close to an hour with one of my own patients, doing insulin teaching, and calling his family.
Come to think of it, that hour probably saved a couple of days worth of inpatient care. Simply because I could personally take the time.
Is time passing by too quickly? Do you ever want to reach back, reconnect with what’s important in medicine? Hospitalist work for a clinic physician.
I may have just seen my retirement. It’s funny, almost like going back to the beginning. This time, I’m not going to waste it with worry.
Does anything else in life go in a circle like that?