Nearing the end of my five months exposed to the clinical environment, this theme of selflessness has come up in almost every rotation. "To be a good doctor, you need to be there for your patients 24-7" my surgery mentor had said to me. This resident sleeps about four hours a night for the last four years, surviving on four large coffees a day and two large meals. They explained to me that only when you are are there almost all the time can you truly monitor your patients' statuses and capture deterioration early. But what about their health?
During neurology I watched in awe of an incredible, compassionate doctor that was there for their patients at least 12 hours a day and took money out of their own pocket to open their own clinic to care for even more patients. Despite unimaginable hardship in their personal life, they handled it with grace and continued to give their patients exceptional treatment. But what about their health?
In my rotation through ophthalmology I watched numerous doctors push through 60 patients in one day when they were only supposed to see 40. Between emergencies and other people handing off patients, the workload was insane. To accommodate everyone, the average appointment time was between 2-5 minutes. Even with these short appointments, most patients wait between 5-6 hours for to be seen because of delays. The regulars know to bring books and food to last them the day. For the doctors, it is the norm to start at 8 am and not get to eat lunch let alone use the bathroom until 4pm. When I asked one physician why not just cut spots to plan ahead for emergencies, they replied: "I could cut spots but then these patients wouldn't get seen. Some of these patients have glaucoma and need regular follow up. If they can't get an appointment, they get lost to follow up and without proper care could go blind. I could take my lunch for 30 minutes at noon but I can't bring myself to do it knowing some of these patients have already been here for 3 hours". Many of these delays are due to failure in equipment - scans not working, instruments being out batteries, etc. With budget cuts they are not allowed coloured printers to so they cannot make copies of patient scans (and they do not have scanners). What about everyone's health here? I asked what the biggest issue was and they said a lack of staff. However, no one wanted to take a paycut to hire another staff member.
We know the system is broken. But at what point should it become an individual doctor's responsibility to compensate for it? The lengths they go to for their patients is incredible but at what cost? To what point should we praise people for sacrificing their own health for the good of others?
When I think about that lifestyle and making those kinds of sacrifices, I don't know if I want to do that. Does that make me selfish? Heck I don't know if I can do that. Is it wrong to want to give 110% in every interaction but when I need to eat lunch, stop for a 20 minute break leaving my patients waiting? Or would that make me less of a good doctor? As a young medical student preparing to enter clerkship I am scared of this choice that I will inevitably be facing; who is more important? Them or me? I suspect the answer is some sort of middle ground, but will the culture even allow me to make that choice? Even more worrisome, will I be penalized for it? For the time being, as I sit surrounded by textbooks and notes, I will stop everything and enjoy my dinner. Savour every bite, every spice, and try not to think about it.
During neurology I watched in awe of an incredible, compassionate doctor that was there for their patients at least 12 hours a day and took money out of their own pocket to open their own clinic to care for even more patients. Despite unimaginable hardship in their personal life, they handled it with grace and continued to give their patients exceptional treatment. But what about their health?
In my rotation through ophthalmology I watched numerous doctors push through 60 patients in one day when they were only supposed to see 40. Between emergencies and other people handing off patients, the workload was insane. To accommodate everyone, the average appointment time was between 2-5 minutes. Even with these short appointments, most patients wait between 5-6 hours for to be seen because of delays. The regulars know to bring books and food to last them the day. For the doctors, it is the norm to start at 8 am and not get to eat lunch let alone use the bathroom until 4pm. When I asked one physician why not just cut spots to plan ahead for emergencies, they replied: "I could cut spots but then these patients wouldn't get seen. Some of these patients have glaucoma and need regular follow up. If they can't get an appointment, they get lost to follow up and without proper care could go blind. I could take my lunch for 30 minutes at noon but I can't bring myself to do it knowing some of these patients have already been here for 3 hours". Many of these delays are due to failure in equipment - scans not working, instruments being out batteries, etc. With budget cuts they are not allowed coloured printers to so they cannot make copies of patient scans (and they do not have scanners). What about everyone's health here? I asked what the biggest issue was and they said a lack of staff. However, no one wanted to take a paycut to hire another staff member.
We know the system is broken. But at what point should it become an individual doctor's responsibility to compensate for it? The lengths they go to for their patients is incredible but at what cost? To what point should we praise people for sacrificing their own health for the good of others?
When I think about that lifestyle and making those kinds of sacrifices, I don't know if I want to do that. Does that make me selfish? Heck I don't know if I can do that. Is it wrong to want to give 110% in every interaction but when I need to eat lunch, stop for a 20 minute break leaving my patients waiting? Or would that make me less of a good doctor? As a young medical student preparing to enter clerkship I am scared of this choice that I will inevitably be facing; who is more important? Them or me? I suspect the answer is some sort of middle ground, but will the culture even allow me to make that choice? Even more worrisome, will I be penalized for it? For the time being, as I sit surrounded by textbooks and notes, I will stop everything and enjoy my dinner. Savour every bite, every spice, and try not to think about it.
