My last day of medical school

I got to the hospital at about 6:00 am in the morning and none of the other doctors / team members were there yet. I decided to round on all of our patients that we were caring for and treating. I would enter the room of each patient and ask them how there night was and perform a focused physical exam depending on their pathology and also look for any new problems. I would then check with the overnight nurse and document any overnight complaints or problems. For example one of my patients had tried to escape and was found outside having a cigarette. Noted. I really did not mind this as this patient has terminal cancer that has metastasized throughout his entire body and his days are numbered. I had to tell the patient this was not wise and that he could not just leave and smoke. In my mind I was thinking "smoke 'em if you got 'em" at this point.

Another goal of pre-rounding on the patients is to followup on all of the consults, and procedures we had ordered from the day before to see what kind of progress had been made. Did hospice come and see patient #1? Did social work find a nursing home placement for patient #2? Did anesthesia do the epidural for patient #3? Did the infectious disease doctors see patient #4 and make their antibiotic recommendations? Did ortho come by and evaluate patient #5 who is recovering from the total hip replacement they did several days ago and have still not followed up, despite numerous calls and begging attempts. The answer to all of these follow up questions at the government hospital is unfortunately no.

This makes the day's work frustrating and stressful as I need to followup with the various specialties and needed services and kindly beg to get the work accomplished. I was all over it and started making my calls to there various doctors and one by one started to get the list taken care of and checked off. While doing all of this I have to document everything and of course deal with new situations that pop up. The nurse will come in and exclaim "Patient #2 has low blood pressure, what should we do?" I would respond accordingly and make the orders and run them by my senior to verify that he agreed and we would move forward.

The day was busy and there was not a lot of time to think about how this was my last day of medical school. Finally at around 6:00pm my senior looked at me and said "isn't this your last day?" and I replied triumphantly: "Yes" and he said "go home already!" I quickly grabbed my stuff and made a dash for the exit before I could get pulled into another crisis. I walked out the front door of the hospital and walked toward my car. I was dumbfounded and even emotional but it still had not sunk in that I was done.

I am done....

Sub Intern in a Socialized medicine hospital

Here I am finishing up my last rotation as a medical student and I chose to do this part of my training at a government hospital. This is socialized medicine. All the patients are seen free of charge and all the doctors, nurses and ancillary staff are paid by the government. The doctors do not have to carry the same type of malpractice insurance because they do not get sued and if they do the US government steps in as the one being sued so the doctor faces a different form of liability than a private doctor would face in a regular private practice.

The first thing I have notice is that no one really wants to work. Everyone spends a lot of time trying to avoid work. If the emergency doctor can refer the patient to the medical floor he/ she will and if the medical floor doctors can get the patient admitted to the ICU or surgical floor or somewhere else they will do it. There is a ton of pass the responsibility at all levels of care. Often the patients are left confused and wondering what is going on because no one takes the time to communicate the plan to the patient.

I am not saying that nothing gets done or accomplished because we are treating lots of patients but we are very inefficient and slow. Often our hands are tied because the CT scanner is backed up or ekg tech has exceeded the government allowed number of ekgs so they have to stop doing ekgs for the day. There is red tape and paper work which makes doing very simple tasks like taking the patient's temperature a 7-10 page document that multiple people have to sign off on each step of the way. This creates many opportunities for error and many bottle necks in the process.

A patient that would be in a private hospital for 23 observation gets trapped in this government hospital for 3 - 5 days and have multiple tests and unnecessary things done or necessary things not done because of all the red tape and confusion. Imagine the DMV. It is a lot like the DMV and there is almost zero customer support. No one looks at the patients as customers but rather the patients represent more work. It is really sad.

On the good side, because I am motivated and want to learn a lot I am able to get procedures and do things that I might not get to do at a private hospital. The patients are very grateful for even the smallest acts of kindest. They are not used to being talked to in a nice manner, so when I say "Hi Mrs. y, how is your morning?" She grins and appreciates the gesture.

More stories to follow. I have seen a bunch of complicated late stage cancer this past week and some other crazy illnesses.