Wednesday, June 27, 2012

My First Few Days

I started my internship on Monday. Let me just tell you, I am absolutely loving it. There are so many wonderful aspects to my job, and while I will admit that I'm a bit tired as I write this, I am so thrilled to finally be a doctor. Some of the best things about what I get to do:

>>The patients, both in the hospital and out. I am so honored to be able to care for people in some of their most vulnerable moments. In my current rotation, I am caring for patients with general medical problems in the hospital, and I also have clinic in the afternoon one day a week. I am already seeing such a variety of people, with their diverse personalities and ways of dealing with illness. Yesterday was my first day of clinic, and it was so exciting to actually be seeing people that I am now the primary care physician for. Some of the problems I saw were able to be treated with one visit alone, but one person I saw will be following up with me in two weeks. It is such a rush to be able to schedule someone to follow up with me! It's one of the things I love about family medicine- being able to build relationships with people over time, and take a step by step approach in helping them out.

>>The staff here. Everyone is so good at what they do! I'll admit that my pager has a way of going off every time I finally get to sit down for a second, but the nurses here are exceptional. They are extremely competent and very friendly. The same can be said for the rest of the staff, from program coordinators to discharge planners to pharmacists. It's really a pleasure to work with everyone.

>>My fellow residents. What an awesome group of doctors I get to work with! It is so refreshing to find doctors who are passionate and enthusiastic about what they do. The attending physicians eager to teach, my senior residents have been so helpful, encouraging and patient with all the things I don't know how to do yet ("Is this how you order an ultrasound?"; "Where's the interventional radiology lab?"), and my fellow intern class is really a solid group of doctors. Coming to work is a blast with such great people to work with! It's a privilege to be a part of both the family medicine department and the psychiatry department, because I get to work directly with twice as many incredible people, and both departments have really made me feel at home. The first two weeks of orientation there were so many "Welcome Intern" events that I couldn't even go to all of them!

It's so great to be able to work hard in the hospital and play hard with my kids when I get home. The new work hour restrictions laws only allow interns to be in the hospital for 16 hours at a time, so I'm getting a fair amount of time with my family when I get home, too. After clinic yesterday I went home and took my kids to the swimming pool and spent the rest of the night watching "LOST" with my wife. Granted, I'm on an easier rotation right now, and I'll be a fair bit busier during the two ICU rotations I have next, but I'm not worried about it. I love my job and have a great support system both in the hospital and at home. Life is good :)

Tuesday, June 19, 2012

Global Philosophies on Justice

A few weeks ago, I received my rotation calendar for my intern year. Every three months for the next two years, I will switch back and forth between family medicine and psychiatry rotations, since I am in a program to become board certified in both of these specialties. Anyway, I noticed that in December of this year I will be doing a month of psychiatry at our county jail. In this rotation and others in "forensic psychiatry", as it is known, I will perform psychiatric evaluations of inmates, be a member of the "expert witness" team at trials and propose/implement treatment plans for inmates with mental illness.

I think that my impending up-close involvement in the justice system is one reason that I have lately become more attentive to the system as a whole. One article in CNN today caught my eye for this reason(click here to view). The article highlights the looming implementation of a recently passed law in South Korea which allows the "chemical castration" of convicted serial rapists. At first, I was put off by this notion, but I find that my opinions are changing the more I think about it.

I wish to clarify that in tentatively supporting this idea, I am decidedly not echoing the boorish rants in the comments section below that article. Those comments, crassly suggesting that a serial rapist "deserves" only physical castration, exemplify the very American justice philosophy of revenge. From what I have noticed, the American justice system seems to place a large emphasis on punishment, and the general public seems to think that even the harsh prison sentences and the executions that still do happen in the U.S. are not severe enough to sufficiently punish inmates for their crimes.

In contrast, the South Korean law seems to actually be an attempt to decrease the risk of repeat offense. "Chemical castration", as the article describes it, involves a mandatory injection of some compound (I won't speculate here what the compound might be) which would theoretically decrease the sex drive of the convict, but that is all. Those sentenced under this law would stay under close scrutiny for three years and receive treatment for up to 15 years. As I think about it, in the United States we already use antipsychotic or sedative medications for violent inmates even if they do not consent to treatment. Are sexual offenses all that different? I haven't thoroughly thought through the potential implications of such a move, but it doesn't seem like an unethical leap.

And after all, shouldn't our focus as a society be on rehabilitating criminals with intent to reintegrate them into the fabric of our society, rather than retaining our current system which encourages repeat offenders and establishes a rather large population of citizens who cycle in and out of prison for life? To take an extreme example of a rehabilitation-based system, consider the example of Norway. Last month, I was reading this article about the "World's nicest prison", located on an island off the coast of Norway. I encourage you to read the well-written, if lengthy, composition. It details the Norwegian judicial philosophy, including their short prison sentences and emphasis on teaching convicts how to return as productive members of society, and providing those opportunities.

Such a system doesn't leave the vengeful with much satisfaction, but I ask you to consider, should our focus be on making ourselves feel better about the proper retaliation against an offense, or should our focus rather be on reducing the "recidivism" rate, or risk of repeat offense after a criminal is released? Say what you will about the Norwegian system, the numbers don't lie. The Norwegian recidivism rate at 3 years out is 16-20%. In the U.S.? It's 43-50%. Food for thought.

NOTE: I greatly appreciates responses/discussion, but please keep it civil. Thank you.

Saturday, June 16, 2012

So, I'm a Doctor

A lot has happened since my last blog post. A LOT. My wife, our two kids, two dogs and I have moved cross country in an F-150 pulling a camper trailer full of belongings to our new home in our old hometown. We decided to rent a two bedroom apartment for the first 8 months or so, so we could find a home to buy that we are truly thrilled about and not rushed into. We've been out here for just over a month now, insanely busy but loving every day in the Golden State.

The first few weeks were primarily related to getting settled in to our new apartment. The hustle and bustle of acquiring furniture, unpacking boxes and deciding where everything should go filled our days. Then, last Sunday, I officially became a doctor. I wasn't able to make it all the way back to Ohio for the ceremony, but the graduation for the Class of 2012 came and went, leaving me with the coveted letters of M.D. to place at the end of my name.

Then, this Tuesday, it all started to become intensely real. Every day since has been crammed with orientation, paperwork and meeting people. Most of my orientation events have been with the Family Medicine department of the medical center, since they start a bit earlier than the Psychiatry department. I cannot begin to express how excited I am to be working with these incredible people- the staff all seem to be incredibly organized, efficient and thoughtful, the program directors and faculty seem to be involved and friendly, the "older" residents all seem excited about us joining, and I think my entire intern class is really a solid group of doctors.

Our wonderful Family Medicine department realizes how important it is for the interns to all get to know each other, so they sent us all for a half day at a team building adventure camp. What fun! We learned a lot about each other, and most importantly have learned that we can trust each other, which will be invaluable starting on the 25th, when we actually begin working in the hospital.

Also exciting has been the two days we spent getting certified in resuscitation. We spent one day on "neonatal resuscitation", meaning what to do when a baby is first born and isn't doing so well. There was a sophisticated infant mannequin that would cry, wiggle, turn blue and breath, depending on how well we were doing. Our team really knew its stuff! The following day was adult resuscitation, from BLS (Basic Life Survey) to ACLS (Advanced Cardiac Life Support). Basically, it's the steps of what we all do as a team when a "Code Blue" is called in this hospital. There are a lot of steps involved! But at the end of the 8 hour day, we all passed our "Megacode" simulation test and got certified.

The rest of our time has been filled with equally important but less thrilling events like training on our electronic medical record (really top of the line), and filling out page after page of paperwork. Next week we will get orientation more specifically to what we will be doing in the hospital (and learning our way around it), meet with our faculty mentors to discuss our specific goals and interests, and wind down the week with a pool party for all residents, faculty and families before the big day on June 25. Everyone try to stay safe and out of the hospital for a few weeks while we figure out what we're doing, ok? :)