Resident Wife

A Little Knowledge

While waiting for my husband in the hospital cafeteria, I tried guessing people's places in the pecking order. Age isn't always a giveaway when you're playing Spot the Attending (my husband, for example, started medical school at 30; his class ranged in age from 20 to mid-40s.) Sometimes it's subtle (attendings look less harried than residents) and sometimes it's not (pimping a group of terrified interns over coffee does not make you a Socratic sage; it makes you an asshole.*) Residents are easy to spot; they shuffle, slump and drink pharmaceutical quantities of caffeine. Medical students look more eager than residents; the light hasn't quite gone out of their eyes yet.

After a few minutes, I got bored and started thinking about all the hospital stories I've heard that would horrify the man-on-the-street. (The winner involves an overhead page for "Code Blue, anesthesia, morgue...Code Blue, anesthesia to the morgue." The runner-up involves medical students copulating in the OB call rooms.) I know more about the inner workings of hospitals than I ever wanted to, and I probably know more about the inner workings of the human body than most people of similarly unscientific background.

A little knowledge is a dangerous thing, though. I may know a Mac blade from a Miller, but I don't pretend to know how to intubate. I'm smart enough to be acutely aware of the depth of my ignorance about medicine; hell, I never got past organic chemistry. Acknowlegding this has had an effect on my role as a patient. I'm much less likely to question a physician's judgment now, because I know how long and how hard they train to do what they do. Physicians are human, though, so, I'm not advocating blind faith. I still ask questions and believe in second opinions, as long as the second opinion is coming from a real MD; not a nutraceutical guru, aromatherapist, chiropractor, phrenologist, politician, homeopath, astrologer or ambulance chaser.

I've noticed another effect since I "married into the profession." Every doctor I see is more relaxed around me now. My rheumatologist, for example, is much more at ease with me, to the point of overestimating my understanding of what the hell he's talking about. While I appreciate his confidence, I tuned out after "new test" and "more sensitive." I only care about the test result; I don't care what citrulline actually is. I don't have the background to understand it, so I won't waste my time reading about it.

Too much information is definitely preferable to too little, though. A lesson in What Not To Do:
Patronizing Dermatologist: I'm going to run a couple of blood tests.
Me: OK. What for?
PD: I don't want to say, because it can occasionally be associated with something serious, and I don't want you to look it up and worry unnecessarily.
Me: (Slackjawed silence, as the alarm bells in my head go DING DING DING and I make plans to look up the name of the test on MD Consult the second I get home.)

He could have just said that he wanted to rule out something rare. Such a statement wouldn't have surprised me so far into the looking-for-zebras phase. Would I have looked it up if he hadn't waved a goddamned red flag in front of my face? Probably not. But I did look it up, and while I didn't have a prayer of understanding the biochemistry, I was still able to figure out what he was testing me for.

The test was negative, but I was climbing the walls for days. A dangerous thing, indeed.

*Definition of pimping and more ranting below the fold.

10 Second Conversation

(Phone rings)

Me: Hello?
John: Hi! Who's that character who's covered in fur and wears sneakers?
Me: Gossamer.
John (turned away from the phone): Gossamer!
John (back into the phone): Thanks! And the whole OR thanks you. Love you! Bye! (Click.)

Perhaps it's best not to contemplate what's happening in that operating room right now.

Liability Crisis By State

Now that John is about to start his last year of residency, the recruiters are starting to call and send glossy brochures. ("Come work where the zip code is EIEIO!") Intrigued, I googled the term "liability reform" with the name of the state and specialty group, and hit paydirt. (I always find the coolest things by accident.)

Doctors for Medical Liability Reform has a lot of state-specific information on the liability/tort reform/malpractice issue. This is so much more informative than the AMA's site.

This should be required reading. Get the whole story here.

Increasingly, Americans are at risk of not being able to find a doctor when they most need one. Doctors have given up their practices, limited their practices to patients who do not have health conditions that are more likely to lead to lawsuits, or have moved to states with a fairer legal system where insurance can be obtained at a lower price. (U.S. Department of Health and Human Services, 3/03/03)

My prediction is that things are going to get worse before they get better. I'm not at all surprised that a physician would suggest refusing treatment to trial lawyers. (It makes for an amusing fantasy....) I have my doubts about the effectiveness of Dr. Hawk's stunt, though. Such saber-rattling will draw attention to the issue, but may ultimately backfire. I'm all for letting market forces do their job, but even the Queen of Schadenfreude feels an occasional ethical twinge.

Status Quo Kills

Residency sucks. I don't need to preach to the choir. But for those of you not intimately acquainted with this soul-crushing indentured servitude, I offer up the following rant. Please read and heed; the life you save may be your own.

According to The National Academy of Sciences, 98,000 people die from medical errors each year. That's as many as from car accidents, AIDS and breast cancer. While the National Academy (laudably) indicts the system rather than excoriating physicians and nurses, the problem of fatigue must not be glossed over. The ACGME regulations are a step in the right direction, but you can drive a truck through the loopholes.

Fluffy ACGME Jargon

Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities.

Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care....

What This Really Means

Even when hospitals abide by all the rules (ha!), the four-week average means that the resident caring for you or your loved ones may have worked over 100 hours already in the past week, including the last 24+ hours, during which he may not have slept at all. And this is par for the course, NOT an anomaly. Consider that someone who has been awake for a mere 24 hours straight is effectively drunk. Yes, drunk. Too drunk to drive, in fact. Being awake that long produces the same cognitive deficits as a blood alcohol level of .1%. Is this the man you want removing your appendix? Delivering your baby? Performing your dad's bypass?

The new rules don't do a hell of a lot. So, next time you're in a hospital, ask a few questions: Has the doctor treating you slept in the last 24 hours? How long has he been awake? Do you trust him with your life?