Having had a few weeks on the floor, I can only truly see now how much I have left to learn. Coming up with a complete list of possible diagnoses, examining patients, and writing up all the appropriate documentation takes me hours, whereas my staff seem to do it effortlessly. It will come with time they told me but it almost seems impossible at this stage to imagine myself working as effectively as they do. I'm trying to take it one day at a time but it's hard not to regularly feel a little bit incompetent.
So far internal is exactly as I've expected it to be and nothing like I've expected it to be. I've been blessed with amazing staff who really value team work, wellness, and maintaining a good rapport. The patients, like in any setting, a mixed bag. The type of work - namely daily physical exams, charting, calling specialists for consults is exactly what I expected. What I didn't expect is the complexity of the cases managed on our floor and so much exposure to dying patients.
On a regular basis we do sit around a table, and as a team brainstorm diagnoses and possible issues, and occasionally jot down teaching points on the white board (House style). It is wild how differently patients can present for a given disease compared to how we learned about them in our textbooks and lectures. The cases we sometimes have are particularly complicated because they've already been worked up by family doctors and specialists to no avail. Now they end up in our care, much further down the line in their disease process and it is up to us to continue investigating and help manage the many health and social issues patients may experience.
That was something I found equally surprising; the number of older patients that come in because of an incident (such as a fall or an acute pneumonia or even caregiver burnout) that has left them in a state of health where they can no longer return home to their primary residence. They are then stuck in a difficult position of being in the hospital (when there may no longer need medical management) awaiting placement in a rehab facility or group care home. It's a phenomenon I expect to become increasingly prevalent with the aging population. It's difficult to manage on a systems level because there simply aren't enough resources and beds out there for our patients. We can't send patients in this condition home because it isn't safe, but then we also have people stuck in the ER who need to be admitted for care but can't because there are no available beds. This also leads to congestion in the ER, increased wait times for a bed, and undue stress on both the healthcare workers and patients alike.
I was also stunned to see how complex the doctor-patient relationship can be and how it can evolve as the disease process evolves, and as the patient nears discharge. I had a patient who started off very cooperative and pleasant. We had a good trusting doctor-patient relationship, however, as we got ever closer to discharge, most likely out of fear, this patient began to be more belligerent, angry, and even started sharing with me racist sentiments about other colleagues. Soon I became one of the few people this patient would be compliant with and it was very difficult for me to balance continuing to nurture this relationship while standing up for my colleagues and team members as they were the subject of discriminatory discourse.
Lastly, I did not expect to have as many palliative patients on our floor as there are. I have seen about 3-4 deaths in the first few weeks. You come in one morning and you see their room being cleaned and you just know. What I find hard compared to previous hospital exposure is it's not just one short encounter with these patients. You are seeing them, deteriorating slowly every day, sometimes for weeks. I find it harder to not feel as emotionally connected, I mean I see these patients more often than my own family. Names in the obituary column of the newspaper that were once strangers are now names that I can put to a face, whose journey I know all too well. For the first time in a long time, I find myself lying awake at night thinking about some of the stressors of work and the difficult patient encounters I had that day. I think it will take a bit of time to adjust and be able to sleep more peacefully. But for now, thank goodness for friends and exercises - my two pillars of support.
So far internal is exactly as I've expected it to be and nothing like I've expected it to be. I've been blessed with amazing staff who really value team work, wellness, and maintaining a good rapport. The patients, like in any setting, a mixed bag. The type of work - namely daily physical exams, charting, calling specialists for consults is exactly what I expected. What I didn't expect is the complexity of the cases managed on our floor and so much exposure to dying patients.
On a regular basis we do sit around a table, and as a team brainstorm diagnoses and possible issues, and occasionally jot down teaching points on the white board (House style). It is wild how differently patients can present for a given disease compared to how we learned about them in our textbooks and lectures. The cases we sometimes have are particularly complicated because they've already been worked up by family doctors and specialists to no avail. Now they end up in our care, much further down the line in their disease process and it is up to us to continue investigating and help manage the many health and social issues patients may experience.
That was something I found equally surprising; the number of older patients that come in because of an incident (such as a fall or an acute pneumonia or even caregiver burnout) that has left them in a state of health where they can no longer return home to their primary residence. They are then stuck in a difficult position of being in the hospital (when there may no longer need medical management) awaiting placement in a rehab facility or group care home. It's a phenomenon I expect to become increasingly prevalent with the aging population. It's difficult to manage on a systems level because there simply aren't enough resources and beds out there for our patients. We can't send patients in this condition home because it isn't safe, but then we also have people stuck in the ER who need to be admitted for care but can't because there are no available beds. This also leads to congestion in the ER, increased wait times for a bed, and undue stress on both the healthcare workers and patients alike.
I was also stunned to see how complex the doctor-patient relationship can be and how it can evolve as the disease process evolves, and as the patient nears discharge. I had a patient who started off very cooperative and pleasant. We had a good trusting doctor-patient relationship, however, as we got ever closer to discharge, most likely out of fear, this patient began to be more belligerent, angry, and even started sharing with me racist sentiments about other colleagues. Soon I became one of the few people this patient would be compliant with and it was very difficult for me to balance continuing to nurture this relationship while standing up for my colleagues and team members as they were the subject of discriminatory discourse.
Lastly, I did not expect to have as many palliative patients on our floor as there are. I have seen about 3-4 deaths in the first few weeks. You come in one morning and you see their room being cleaned and you just know. What I find hard compared to previous hospital exposure is it's not just one short encounter with these patients. You are seeing them, deteriorating slowly every day, sometimes for weeks. I find it harder to not feel as emotionally connected, I mean I see these patients more often than my own family. Names in the obituary column of the newspaper that were once strangers are now names that I can put to a face, whose journey I know all too well. For the first time in a long time, I find myself lying awake at night thinking about some of the stressors of work and the difficult patient encounters I had that day. I think it will take a bit of time to adjust and be able to sleep more peacefully. But for now, thank goodness for friends and exercises - my two pillars of support.
