25 April 2014

Fast asleep

An attending physician who I had just met was going to evaluate me in a "observed patient encounter." For about an hour, he would watch me perform a history and physical examination on a hospital patient that I had never met. Then, I would have to present my findings to him, arrive at a diagnosis and treatment plan, and write a detailed note. I explained that my performance on the activity would constitute a substantial portion of my clerkship grade.

The attending had never done this activity before. He was willing to participate, but felt that he was not the right man for the job. "I've just met you," he explained. "This would be better done by a doctor who has worked with you for a week or two, and knows your abilities and your personality." Then, the attending waxed philosophical. "This stage of your medical training can't be very enjoyable," he said, "what with complete strangers evaluating you all the time."

"That part isn't very fun," I replied. "You probably don't miss being a third-year medical student."

He stiffened. "Not to diminish what you're going through," he said, "but when I was a third-year medical student, it was much, much worse."

I am sure that he is right.

I think the best example is overnight call. Historically, a rite of passage in medical school has been pulling long shifts, many of them overnight. Some of my residents talk about having taken overnight call every third night as medical students, meaning they worked all day, through the night, and into the following day.

My experience has been different. Some nights, I voluntarily stayed late or through the night. During all of third year, though, I was only scheduled for one overnight shift. And even that time, I didn't have to stay overnight. When I showed up at 7 PM, my very nice resident told me that I could go home. (I stayed anyway, for kicks.) Part of the reason is my medical school, which has (humane) policies that discourage overnight call. It is quite possible that I will pull zero overnight shifts as a fourth-year medical student. All bets are off for residency, though.

Am I losing out on some educational opportunities by only being on the wards during the day? Probably. But not much teaching happens at night. And I am glad that I was able to spend nearly all of my nights as a third-year medical student comfortably in bed, asleep.