Family, Healthcare, Observations.

Resident physicians: Too tired, or what?

Residents, or resident physicians, are young physicians who are completing their training by working, under the supervision of other physicians, very long hours for several years in a teaching hospital.  Concern is routinely raised regarding being treated by physicians who are still learning, and might be exhausted and perhaps making poor judgments.  Two current medical residents debate the issue.

A resident chimes in with his take on all of this (taken from a more extended quote on the Daily Dish):

“All of that said, most of us who have been through this would only go to a teaching type hospital because these are hospitals that typically have 4-6 resident on call physically in the building to see and evaluate patients. If you have ever been to one of the typical small private hospitals the only physician in the hospital may be the ER doctor who is already overworked with the 20 to 30 people in the Emergency Department (ED) and only see the admitted patients if a Code Blue takes place. Thus all other calls go to the doctor who is at home asleep and has badgered the nurses into not calling him anymore.  So despite the fact that we are tired, cranky, and not completed in our training, I submit that you are much safer being taken care of by the resident who hasn’t slept yet then the experienced guy sleeping 30 minutes away from you.”

Another resident, my son Jon, responds:

“Interesting point and possibly a true one, but I think it’s actually fairly weak compared to other reasons he could have cited. I think he misses a really big point, because the real reason that I would personally choose a teaching hospital to get my care as a patient would hands down be the following: Multiple minds working together for your careplan decisions. At a community hospital, you often are taken care of by a single hospitalist all by him or herself and they have no checks and balances for their thinking, their style of care, their way of practicing medicine.

Medicine is far from being a science, and it is far from algorithmic in a lot of cases and relies a great deal on one’s clinical judgment. While many members of the healthcare team taking care of you at a teaching hospital are medical students, interns, senior residents, and fellows (people who have completed residency but are now in sub-specialty training), all of whom are still 1-5 years away from being able to practice medicine on their own, they are all supervised by an “attending” physician, who has completed residency. This is good on many fronts. You have young, freshly trained physicians who are often times more up on the current science having just graduated medical school, and older more seasoned supervisors who have much more experience to guide them with clinical decision making. I, even only 3 months into my intern year, have already had many lengthy discussions about a patient’s plan on rounds with senior residents and attendings where we truly all put our collective knowledge and opinions together to come up with a final plan. A few of those times, even as just the intern, I have helped to better the plan because I had a different way of thinking, or caught a detail that was easily overlooked

This is not because I’m some kind of super intern, it’s just inevitable to have that kind of thoroughness when you have many eyes all looking at the same thing from slightly different angles. On top of that, teaching hospitals, particularly academic centers, or massive private hospitals (Mayo, Cedars, Case, etc.) often times draw the brightest attending physicians in the city, state, country, even the world. For example, on my Gastroenterology rotation at Cedars, I got to work with one of the best GI specialists in the country and he supervised every decision made on the patients we saw together. So, in summary, would it be the best place to have a baby, with medical students and interns peering over at one of your life’s most intimate moments? Probably not for most people. But would I want to be there if I was truly ill? Absolutely.”

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