Thursday, December 1, 2011

The Day I (Almost) Got Fired During Residency

     When I graduated from medical school, my intention was to become a general surgeon. I was the first person from my medical school to be accepted into Emory University's general surgery program, which was really quite an honor. This was a year before the 80 hour work week legislation for house officers was passed, and there were a few months where my husband and I calculated that I had worked approximately 120 hours in a single week. About six months into surgical internship, I decided to change specialties and secured a spot in the anesthesiology residency for the next year. I really had not fully anticipated the amount of time I would be spending away from my family. I was so depressed that I considered dropping out of residency altogether. But, I still had six months of surgical internship to go, so I continued with my scheduled rotations, the most exasperating of which was the orthopedics service at Grady Memorial Hospital.
     Another female intern and I were responsible for patients on three separate orthopedics services, and the services were all a hot mess. Although we were not responsible for admitting the patients or attending trauma calls, we scheduled their surgeries, wheeled them to and from radiology ourselves, made daily rounds on each service, changed dressings and removed sutures and staples, but mostly, we sat in meetings with social workers to find placement for the patients who were homeless. It was incredibly disorganized, as there was very poor communication with the orthopedic residents, all of whom were guys, and most of which were concerned with only one thing: operating. Several of the patients had "fallen through the cracks," meaning that they had been deleted from the patient list, had not been discharged, or had not been seen by a doctor in several days. We spent an inordinate amount of time tidying up messes like that. Immediately after starting the rotation, I was plagued by calls from the social workers, telling me that I needed to do histories and physicals (H&Ps) on the trauma patients. This didn't make sense to me: I wasn't expected to attend trauma calls, which is where an H&P would be generated, so how was I to perform a detailed H&P days later?
     In talking with some of my friends who had already rotated through orthopedics, I learned that the H&Ps were fabricated, using bits and pieces of information from the anesthesia evaluation (many of the patients went straight from the trauma bay to the OR) or other consulting services. This really seemed inappropriate, bordering on fraudulent. The real issue was that the majority of the orthopedics residents viewed surgical interns as slave labor, and dumped whatever patient responsibilities they could onto us, so they could spend all their time in the operating room. I could understand the passion for learning their trade, but could not accept the disregard for their patients. In order to access the patient list for making rounds, we had to use a specific computer in a dreary little office. The screen saver on this computer featured new pornographic images every day: always women, and sometimes, women having sex with each other. This may not have been so offensive, had I felt that I was a valued member of the team, but seeing as how I was already feeling quite demoralized, I brought this, along with the H&P issue, to the attention of my program director, Dr. Hobson*. He was quite concerned, and informed me that "that orthopedics rotation has been a thorn in my side for years!" This, presumably, was because we did not receive much in the way of didactics or hands-on operating experience during the rotation....it was not a good learning environment.
     I felt myself beginning to crack a little bit...the workload was insurmountable and endless, and I was tired of doing other people's work. I kept receiving calls about an H&P that was needed on a patient who had been admitted many weeks before I even came on the service. That was it. I took a blank progress note, wrote "For H&P, please call Chief Orthopedics Resident", and placed it in the patient's chart. I then went down to the basement, in search of an Xray file on a patient who had gotten tired of waiting over a week for his operation and was transferring to another hospital. It wasn't long before I received a page from the chief resident, who proceeded to scream at me over the telephone, telling me how worthless I was, and that, by God, I was going to do that H&P! The tears started, and I sobbed uncontrollably, down in the bowels of that hospital. The people who worked down there rarely saw a doctor, and they were patting me on the shoulder, trying to console me, saying "I hate to see a doctor cry." I phoned Dr. Hobson, and his secretary told me to not to answer any more pages, to leave the hospital, and come straight to the surgery department office.
     It was the weirdest feeling in the world, leaving in the middle of the day, my pager convulsing. It was absolutely liberating. At that point, I really didn't care about what was going to happen to me. I just couldn't deal with having to do the "wrong thing" anymore. When I arrived at the surgery department, the secretary fed me candy from her file desk as I waited to see Dr. Hobson. He was very kind to me. He told me that although he wished I had not written the progress note, he understood why it happened. He told me to expect that the chief of surgery at the other hospital would want me to hand in my badge and resign from residency, but not to worry. He had all the ammunition he needed. His intention was not only to retain me as a resident, but to get his surgical interns out of that orthopedics rotation, and into one at a private hospital where they could actually learn something.
     I still have the letter which Dr. Hobson wrote, in my defense, to the chief of surgery's request for my resignation, and every now and then, I pull it out and read it. It is a reminder that there truly are like-minded people who will stand behind you under the most extreme circumstances. Within a few months, surgical interns were doing their orthopedics rotation at a private hospital, where they actually got to operate, interact with the surgeons, and expand their knowlege base. Although this didn't directly benefit me, it made my time spent on that dreadful service seem worthwhile.

*name changed
Cardiology Guy, The Heathers, and Me (A Related Post) 

7 comments:

  1. Every medical student, resident and fellow has his/her stories of immense fatigue, exploitation and injust treatment at the hands of colleagues and superiors. That is part of the American medical education. It will break you to fit in the medican choir and act like a slave for the rest of your life. Why do you think is it that so many American-trained physicians are so seemingly without compassion and conscience and political engagement? They all made once the decision for themselves that all that counts is career and money.

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  2. @gman, my hope is that American medical education will change for the better. I have heard that several medical schools are adopting more of a personality-based approach in selecting candidates. Perhaps that would eliminate physicians who are lacking in social skills. Fear not, though, because I know quite a few compassionate physicians, both in academics and private practice, who treat their patients, coworkers, and colleagues with dignity and respect, and whose primary motivation is good patient care, not the almighty dollar.

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  3. Somehow I doubt the personality-based screening will do anything but screen out the most intellecually capable candidates in the quest for mediocre but identical cogs. These cogs will still be broken down and rebuilt by the psychopaths who run medical schools. Medicine is not a profession (they gave up their autonomy long ago), but rather a cult (compare residency stories with accounts by ex-Scientologists, Ex-Mormons, Ex-whatevers).

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    1. Hmmm, cogs, psychopaths, & cults, huh? Intriguing, if somewhat bizarre opinion, Anon. It's a little too convenient, I think. Definitely wouldn't classify medicine in general as a cult, even though it does share some cultish features, e.g. sleep deprivation. Mind control/cog mentality is not inherent to medicine itself, in fact, it's quite the opposite. However, the insurance companies certainly do their best to try and rob physicians of their autonomy. That's capitalism for you. So, I have to disagree that medicine is no longer a profession. Most of us haven't given up fighting the good fight. Thanks for commenting...as opinions go, to each his own, right? :-)

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  4. I came across your blog while searching residency stories. I am a 27 year old late bloomer. My father just recently had a life threatening operation abroad that went bad. Thankfully, he is now being treated in the United States for about two weeks now. I am currently going to school to be an RN but with all the time being spent at the hospital, I realized I want to become a surgeon. I never felt so sure. I tried getting advice from family but they seem a little discouraging. No one has yet graduated from college. I am aware of the sacrifices of time, family and school. Some of the doctors i spoke with say it is difficult and competitive to get into medical school as well. It would be a waste of money and time for a person my age. My first three semesters in college felt a bit wasted because I was not sure if I wanted to be an RN. Just thought I can get another doctors opinion? I'd appreciate it.

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    1. It is difficult and competitive, but you never know until you try. I was 34 when I began medical school, and I started my surgical residency at the age of 38. Prior to medical school, I was an RN for 7 years, working in the neonatal ICU. I ended up switching to anesthesiology after my intern year, mostly because I knew I couldn't commit to a lifetime of work coming first. I found my happy medium. Best of luck to you in your decision-making process!

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  5. Thanks a lot! That helped :-)

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