当前在线人数16258
首页 - 博客首页 - 美国医学教育博客 - 文章阅读 [博客首页] [首页]
My Experience as a Patient-- by Bhanu Wunnava, MD, Resident,
作者:USMedEdu
发表时间:2008-12-27
更新时间:2008-12-27
浏览:1399次
评论:2篇
地址:10.
::: 栏目 :::
现代医学vs“中医”
社会、艺术与医学
住院/FELLOW单位
中外医学网站精选
国内外医学交流信息
生物医学人物
力刀美加医学教育专
临床见习/实习/义工
医学生理学诺贝尔奖
医生助理(PA)职业
医学书籍照片及图谱
社会与医学瞬间定格
医学典故/医史杂谈
USMLE复习和考试
申请和面试住院医生
住院医生生活和工作
FELLOWSHIP
医生就业、工作及生
医学科普及问题解答
美加医学院申请/MCA
中美医学临床教育比
医学新进展及新闻
社会医学伦理

发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: My Experience as a Patient
发信站: BBS 未名空间站 (Sat Dec 27 00:25:54 2008)

My Experience as a Patient

by Bhanu Wunnava, MD, Resident, Family Medicine Program, Louisiana State
University Health Sciences Center, Monroe, La

Life is full of surprises sometimes good and sometimes bad. Good encounters
are enjoyable; however, it is the bad experiences or circumstances that
usually help a person to grow and better understand the complexities of life
. Such experiences, if properly analyzed, can give new wisdom, understanding
, faith, and appreciation of one's surrounding support system. It is for
this reason that I would like to share my recent experience as a patient.

I was recently hospitalized because of excruciating abdominal pain, which
turned out to be a hernia that needed to be surgically repaired. Before this
episode, I had never been hospitalized. Being a patient was a different
experience altogether for me. To play the role of a patient is strange and
humbling for a doctor.

I have seen thousands of patients moaning and groaning in pain in my
clinical experience, but I could only sympathize with their pain and
suffering. I could never empathize or identify completely with their anguish
and distress. Many of them would request more and more pain medication, and
even increased frequency of doses, as they were unable to tolerate the pain
. Before my hospitalization I had always thought that such patients were
abusing the pain medications unreasonably and unnecessarily.

However, when the tables were turned on me during my hospital stay, I found
myself behaving in the same way. I was constantly pressing the button to
call the nurse so that I could get additional pain medication more
frequently, because I couldn't bear the pain after my surgery. While doing
so, it never crossed my mind that the nurse would think that I, too, was
trying to abuse the pain medications.

My hospitalization also taught me the importance of family support and
friends. During my practice, I have time and again seen family and friends
visiting my patients, and many times I felt it cumbersome to repeat the
prognosis of the patient to each visitor. In the past, I never realized the
mental and even physical support it provided to the patient. But when I was
the patient, my wife, my family, colleagues, and friends were similarly
eager for news of my condition. It was comforting and healing beyond words
to be taken care of, cared for, and cared about by my loved ones. It was
such a wonderful feeling to know how much they were all concerned about me.
Moreover, this made me remember my patients who walked through the hospital
doors in pain by themselves or who lay in bed for days with no visitors.
From now on, I will be sure to give a few extra words of consolation and
support, and a few extra minutes of my time to such patients during my
practice.

After 36 hours of postsurgery hospital stay I was back on my regular diet,
and the doctor on call was supposed to make rounds that evening. I was
overjoyed at the prospect that I might be discharged that evening. I was so
impatient to go home, even though I was still in pain.

I recall that while working as a resident, I had often been tied up in my
clinic and thus had been late to get to my patients' rooms to discharge them
. I never realized how fervently patients wait to hear from their doctor
that everything looks good and they can be discharged. The waiting is never
ending for a patient. Now, playing the role of the patient, I had to go
through the same experience.

As it turned out, my doctor was called to perform emergency surgery on
another patient that evening, thus delaying my discharge by a couple of
hours. I never realized that every minute of the wait feels like an hour.
Those 2 hours seemed like 20 hours for me. And as I lay there waiting for my
discharge, I vowed to myself that in the future, I would try my best to
minimize the waiting time for my patients.

The entire experience of being a patient in the hospital taught me a lot as
a doctor, as well as a human being. It taught me to be a more caring,
understanding, and compassionate person not just to my patients but also to
others in my day-to-day activities. It gave me the strength to face the
unexpected, and often agonizing, battles life brings. This incident helped
me to learn humility, empathy, and faith.


--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 98.235.]

[上一篇] [下一篇] [发表评论] [写信问候] [收藏] [举报] 
 
共有2条评论
1   [USMedEdu 于 2008-12-27 01:01:32 提到] [FROM: 10.]
发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: Why America?
发信站: BBS 未名空间站 (Sat Dec 27 00:16:57 2008)

Why America?
By Madhav C. Menon, MD

In the last year, as I traveled around the United States interviewing for a
residency position, the question of why I chose America was put to me more
times than I had anticipated. It was a staple in every interview; other
times, it was asked by curious individuals I came across who had nothing to
do with the residency program. With some discomfort, I had to dig deep into
my life each time to try to find an answer for them.

When I was a third-grade student, I attended boarding school in India. My
friend Balwinder went to America and brought back a most remarkable pyramid
of chocolate. It was as big as my young fist! I had never imagined a piece
of chocolate so big to exist. Astonishingly, Balwinder had a whole line of
those chocolate pyramids. He described his trip to visit his uncle in
America, telling us all about his uncle's mansion, which had its very own
swimming pool. He talked about the wide roads, the big cars, and his trip to
Disneyland, where he met Mickey Mouse (who, he observed, was much taller
than one would have expected). I vaguely remember that something twanged
within my heart just then, for America had conquered me from the moment I
first laid eyes on Balwinder's bar of Toblerone.

In early middle school, paperback books became the rage. If I remember
correctly, it was Ramswaroop who smuggled in the first Louis L'amour novel.
In no time, the Wild West had been recreated in our little town of Lovedale
in south India. The forested hillside of our school's large campus soon bore
names like Dodge, Tombstone, Kansas City, and the whole area was referred
to as Texas. Our free time was filled with talk of men and their reputations
with guns, as well as reenacting shootouts. We were students by day and
legendary gunmen by night. Vivid pictures of the rugged yet beautiful
country described in those books were being etched, almost indelibly, in our
imaginative minds. My heart silently yearned.

When you leave a boarding school to rejoin the rat race that is the real
world, a part of you dies. You wake up, your head leaves the clouds, your
feet find the ground, and you start to run in the race without even
realizing it. It is that small death and your performance in the race that
the world celebrates as success, so I kept running—right into medical
school. In those long days of classes, mud and grime from twice-daily bus
rides, and late hours studying, I had little time to dream of anything at
all, let alone America.

In medical school, I decided that I was going to work hard, something I had
not often done before, and I read all of the books I was assigned. There was
a newfound joy in becoming knowledgeable. I noticed that America was more
evident in medical school than ever before. Each subject came with a choice
between two books: the cheaper, easier-to-understand, poorly presented
abridged Indian version and the more complex, lavishly printed American
textbook—the so-called "gold standard." In fairness, the Indian books never
failed to convey all the information one needed; they were strewn with
tables outlining all the causes of everything, from pallor to pericarditis.
Yet, although they satisfied one's appetite for knowledge, they left me with
a pervasive feeling of having done something sneaky, like I had taken a
shortcut in a race. The American books encouraged me to read more; they made
few assumptions and, when they did, they clarified them perfectly. In
particular, they always seemed to me to answer the most important question:
Why? I thought a lot about America and what it must be like to be a medical
student there.

I soon realized that, no matter how informative, all the textbooks were
outdated, and one had to read journals to keep up with medicine. There again
, overwhelmingly, I found America. Nearly every original article, most
clinical trials, and almost every new drug came out of America. I started to
wonder whether everything original was American. I nearly exploded my brain
studying all the textbooks I could find so that I could get a residency
position at one of the best hospitals in India. I hoped that the training I
would get from practicing medicine there (evidence-based being the
proclaimed fad) would prepare me for the 'real deal.'

In my residency days, I silently endured a sense of helplessness, because
nothing I had learned could be applied to the majority of patients I saw,
who almost always faced a grim choice between bread for the family or
treatment of their disease. In that argument, the former usually won
convincingly. Even those who opted for treatment initially often quit midway
due to their circumstances. Meanwhile, the resident was there at the
patient's bedside as the patient died. The resident was well-read and could
recite the latest guidelines off the top of his head, but, for reasons
beyond the resident's control, he was unable to apply most of them. To the
family, the resident was merely a bringer of bad news, a messenger of death.

I thought the solution might lay in working among those who could afford
what I had to offer, which would let me see firsthand whether everything
that those books assured me would cure my patients' illnesses actually
worked. After completing residency, I worked hard to pass a seemingly never-
ending string of examinations, traveling by air, train, or greyhound bus as
needed. My purse felt the pinch, and I exhausted the goodwill of distant
relatives and old friends. All the while, I hoped that somewhere toward the
end of this long road lay the beginning of my inspiration.

Now, as I serve my internship in America, I have found over the last few
months that it is less than my imagination sequentially built it up to be. I
discovered that the Wild West exists no more (thankfully), the cold
temperatures leave me feeling as though the blood in my bones will freeze,
and snow only looks good in pictures, when it is undisturbed. I realized
that the sizes of the cars do not matter if you do not own one and that poor
people, at least relative to the cost of medical care, exist aplenty here
and that often, paradoxically, they are obese. I have learned that one still
has to look for inspiration but that the final words have not been spoken
yet and I will learn more as I gain experience here. I also know that I am
thankful I decided to make this journey, because otherwise I would have been
dreaming about it all my life.

Whenever someone asks me "why America," many pictures flash before my eyes
as I try to gather my thoughts: a chunk of Toblerone, gunfights on the
hillside, textbooks with fancy print, the New England Journal of Medicine,
all the deaths that I haplessly pronounced. Despite this collage of images,
I have never figured out how to put everything together during those brief
encounters to fashion a reply that was even remotely eloquent. I sincerely
hope that I have done so now.


--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 98.235.]
 
2   [USMedEdu 于 2008-12-27 00:59:57 提到] [FROM: 10.]
发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: Efficient and Effective Rounding
发信站: BBS 未名空间站 (Sat Dec 27 00:35:17 2008)

Efficient and Effective Rounding

David Gilchrist, MD
Resident

Zachary Geidel, MD
Chief Resident, Family Medicine Residency Program

Department of Family Medicine, University of Massachusetts Medical School,
Worcester, Mass


We all face the challenge of being efficient in our practice of medicine, as
well as being humanistic with our patients. This becomes evident in the
office setting and in "rounding" in the hospital. It is possible to be
efficient in our work without cutting corners and to have more time to get
to know the patients we serve. We preface these suggestions by acknowledging
that all teams and models in the healthcare system are different and vary
in nature. Therefore, the strategies and tips mentioned here may not always
be the most efficient, depending on the particular situation of your
practice. Nevertheless, several key principles are characteristic to being
efficient and using time effectively during rounding.

Plan Ahead
An efficient team anticipates what may occur during the course of the day
and what pitfalls may present that could interrupt the flow of the day. When
an admission is mentioned, gather the paperwork needed for the admission,
scan the computer for old records to fill in information, and get to the
emergency department with at least part of your admission note already done.
This will help you to get a patient admitted faster and allow you to spend
more time to get to know more about the patient's general medical condition.
This extra time you gain by becoming more efficient also enables you to
access clinic notes and review records that will give you a sense of how the
patient's health has evolved and possibly review notes that include details
of the social information the patient may not put forth at a brief
emergency department admission. Once the person is admitted, start the
discharge paperwork, discuss the long-term plan for the patient, and keep
case management well informed, so they can prepare discharge planning.
Always using those few minutes of downtime to think ahead and determine the
long-term plan is key to being efficient.

"Pretemplating" the daily progress note for the next day is another part of
planning ahead that can save time. When doing so, leave subjective comments,
key physical examination sections, and any active problem on the list open
for filling in while rounding. Nothing is set in stone in a template, but it
helps you to hit the ground running in the morning. In addition, by writing
down your plan for the patient, you have committed on paper what the plan
for the day is. The daily notes could be filled in by another team member,
while someone else asks the patient questions, or they could be finished
while someone else writes the orders. Making rounding a team effort is also
a key component of being efficient.

Be Intentional
Be intentional about all that you do. This includes being intentional in the
questions that you ask and using the moments of downtime to get to know
patients. Once you have found yourself being more efficient with daily
paperwork and details of each day, you will find more downtime. What you do
with this downtime is critical to being efficient and intentional. This is
the time to use to "touch base" with patients with whom you didn't get to
spend enough time during rounds, or with those who present a particularly
difficult case. This time can also be used to dictate information on
discharged patients, prepare notes for the next day, update discharge
paperwork, and even to study. Frequently, people will say they have no time
to study or read outside of work, but it is all about being intentional.

Work as a Team
Work as a team that is made up of many parts. This can sometimes be the most
challenging for many reasons, the hardest of which is that no two people
are the same in the way they do something. Interns frequently feel that they
have little say in how things are done, but nonetheless they are part of
the team. Even as a senior resident on the cusp of finishing residency, you
are under an attending doctor who may do things the exact opposite of how
you would do them.

The first part of the team concept has to start with the intern and the
resident learning how to best work together. Learn to trust one another,
based on experience and competence. The second part is to work with the
attending on how to manage the patient, with some back-and-forth dialogue,
knowing that the attending of record is ultimately responsible for the
patient and has the final say. Accept it. Move on. Finally, there are nurses
, social workers, case managers, consultants, nutritionists, and others who
are all part of the team that takes care of any one individual.

Learn to communicate with the team effectively and frequently. Communication
is key within a team. Come up with a plan as a team on how to round,
whether it means starting on the top floor and working your way down or some
other variation.

In the end, making an in-patient service run smoothly is about being
effective and efficient as a team, but it is much more enjoyable when it can
be done in such a way as to be enjoyable. Learn to enjoy the experiences of
residency, and realize that your peers are going through the same
experience. Learn to have fun in the midst of fatigue; it goes a long way
when everything does not run as smoothly as planned.


--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 98.235.]
 
用户名: 密码:
发表评论
评论:
[返回顶部] [刷新]  [给USMedEdu写信]  [美国医学教育博客首页] [博客首页] [BBS 未名空间站]
 
Site Map - Contact Us - Terms and Conditions - Privacy Policy

版权所有BBS 未名空间站(mitbbs.com) since 1996