Tuesday, February 8, 2011

AMA Lobby Day

I’m writing this in the airport at Washington, DC. You have to pay for the Wifi here, of course, so I’m writing this in Word and I’ll post it later. I’m headed home from the American Medical Association’s Lobby Day. I left my dear family Saturday morning, and headed into DC, and I’ll be flying back tonight, Monday.



Saturday was sight-seeing day! First I had brunch with a former classmate who is now going to medical school at theUniformed Health Services college in Maryland. Then, I went around and saw the monuments, and the White House. I haven’t been to DC since the Boy Scout National Jamboree in 2001, so it was really interesting to see these sights with the eyes of a 24-year-old, and remember looking at them through my awkward 15 year old eyes. Such a difference, but both are so memorable. In the late afternoon, I went to the Freer Art Gallery at the Smithsonian. I didn’t realize admission was free!! There was a large Japanese art display that was simply beautiful. The attention to detail was impressive! It struck me as pretty nifty that, down the street from the seat of power of this nation, was a huge gallery dedicated to the humanities and arts. For humans are not just about cold, hard facts, and laws and regulations. We can appreciate beauty and emotion! Anyway, when I post this, I’ll try to include some pictures from my trip :D Finally, an old friend who works in DC picked me up and we had dinner and hung out at his apartment for the night.



Sunday, my friend had to teach a class at the Pentagon, so he dropped me off at a Starbucks near the US Capitol. I sat and got some studying done for my pediatrics shelf exam while I waited for the conference time to approach. Then I walked over to the Washington Court Hotel, where I checked in (paid for by the AMA!), dropped off my bags and headed down to registration.



We had a lot of meetings on Sunday. We had a few hours of “leadership training”, which seemed to be a lot of random verbage about staying positive even when you make a mistake, not giving up but continuing to practice skills, etc. I guess it was supposed to encourage us to not be nervous when we met the members of Congress! Whether it accomplished that goal or not, it was at least an interesting talk. We then settled in to discuss the issues.

We talked a lot about the cap on residency programs, and how the number of medical students graduating is increasing, the shortage of doctors is increasing, but the number of residency slots has stayed the same since 1997. More medical students does not mean more practicing doctors, if those students can’t get residency training anywhere! We discussed the “SGR” (Sustainable Growth Rate), which is the formula by which doctors get paid (and how we are constantly under the threat of looming massive pay cuts, because of short-sighted legislature in the 90s, that needs to be reworked). We went into medical student debt (a topic near and dear to my heart). We also talked a fair bit about malpractice lawsuits (“tort reform”), which is particularly relevant given the “Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act” or H.R.5 that is currently up for debate in the House of Representatives, which addresses that issue. To name a few! (Then most of us went to watch the Superbowl. I went back to my room and told my family goodnight via webcam, and got some studying done!!)



We had a full plate of speakers this morning! After a delicious continental breakfast, we heard from two formers US Representatives, and the Director of [Healthcare] Coverage Policy for the Department of Health and Human Services, and a few others. Then, we all marched over to the Capitol building and took a picture in front of it, of course! We then met with our respective Senators and Representatives. I didn’t actually get the opportunity to meet my Congressmen, since they were out of town, but I met with their legislative directors, and that was a wonderful experience, because they advise the Congressmen on the issues! They were incredibly receptive to what we had to say, and even were asking us further questions. What an awesome experience! I certainly felt like I was involved in actively advocating for my patients and my profession. How amazing to live in a country where I can just walk up to the seat of government and give my viewpoints and stories to the lawmakers!

Now I’m just waiting so I can love on my family some before I have to be in the hospital at 7am tomorrow. My flight should arrive around 9:30 tonight! Ahh, the life of a med student. But I wouldn’t trade what I do for nothin’!!

Wednesday, February 2, 2011

Hesitancy

I realized last week one of the hardest mindset transitions that I'm having to make as a medical student. It has to do with not really feeling like I belong, and the need to really make my patients...well, MY patients!

As a medical student, you can actually function reasonably well without ever having to ACTUALLY see a patient. You can read the chart, read what the nurses wrote, read what the nurses and doctors who saw the patient thought, evaluate the vital signs that are charted, look up their lab results, etc, all without ever stepping foot into the patient's room. Based on that, you have a pretty good chance of getting the diagnosis right! You can look great on rounds when presenting the patient, and even write progress notes.

As horrible as it sounds, I've been guilty of this at times. This was especially common when I was first starting out. The thinking often goes like this: I read that the patient was admitted from the ED at midnight, spent all night being poked and prodded for this test or that IV. And by the time I see them in the morning, they're just finally asleep. And then the rationalization starts, "Oh, just let the poor dear sleep! I'm on a medical student, after all. My physical exam doesn't REALLY mean anything." This week, it was patients on isolation. I had 3 patients to see in the morning. I found the first door, and a big sign was posted, "Contact Isolation". This means, to see the patient, I have to put on a gown, sterilize my hands and put on gloves before I see him. What a hassle! I decided to see that patient last. I went to the next door...same thing! I decided to try the last patient..."Contact AND Droplet Isolation"!! That means I have to wear a mask, too. Do I even have time to see these patients before rounds start?

Even when I do go in to see the patients in the morning (I DID go and see all three of those patients), I don't always do the best exam. If they're sleeping, I've sometimes just timidly asked them if they're feeling alright, do they have any abdominal pain? may I listen to their heart and lungs really quick? And then tiptoe out. After all, what does it matter. I'm just a student.

I had a patient a few weeks ago with severe cerebral palsy...a 23 year old male. That hit close to home. This man, my age, was in a crib, wearing a diaper and playing with a rattle. I'll admit it, flat out...I was scared! I was very uncomfortable, and I'm ashamed to say, my first day as his student, I chickened out, and didn't go in the room. The next day, I worked up the nerve and did my exam. Removing the diaper and seeing pubic hair was a real shock. I tried to be very respectful, but also keep in mind that this was MY patient, my responsibility, my privilege to see and touch and diagnose and heal.

I've come to a point where I never allow myself these excuses anymore. I DO try to be thoughtful of the need for patients to sleep, etc. At the same time, if they're my patient, I go in and see them: Even if the nurse is in there already. Even if they're asleep. Even if they're on isolation. Even if they have mental retardation. No matter what. I'm taking ownership of my patients. What a privilege I have to see these people, to care for them and help heal them. There have been times in the last few months that I have caught findings that went unnoticed by the rest of the team. A new, concerning heart murmur in a child that prompted a visit to the ED when I mentioned it to the attending. Worsening lung sounds that heralded the onset of pneumonia, etc.

I can no longer see myself as "just a student." I'm a part of each patient's health care team, and I vow to devote myself to their wellbeing and recovery. Even if that means waking them up at 6 or 7am so I can push on their bellies and look in their throats.