Another week has flown by leaving only four more in my M1 year. It is exciting to think that it is almost over, but I am also a little wistful. This ride is so much fun and I know it will be over so fast that I wish I could slow it down just a bit. There are really only two more “normal” weeks (if there is such a thing in med school) because the last two are devoted to finals and boards.
Our small group psychiatry met Wednesday at the VA. I quickly volunteered to be one of the two students to interview our first patient, who turned out to be a well-educated, middle-aged lady who was in an alcohol treatment program. She was quite talkative and our interview turned into something more like a conversation, as each question elicited a story and led us down a new path. It was also a little awkward to share the patient between two of us. We took turns asking questions so neither of us really got to follow the path we had in mind. Our allotted thirty minutes evaporated and we still had not gotten to all of the mandatory items on our interviewing inventory. The psychiatrist in charge, seated behind the patient, pointed to her watch, while I nodded and tried my best to look like I was carefully noting each detail of the woman’s narrative. It all seemed to end so anti-climatically. While I had not really played this scene in my mind out beforehand, now that the interview was being pre-maturely aborted, I felt like we were being short-changed. It was no longer just a required exercise that I needed to log, but a chance to do something for this lady.. We were talking to someone with a real problem and it seemed like we should go ahead and try to help her as long as we were all here and everything was going so well. I thanked her for coming, and wished her well, and then she was gone, whisked back into her 28-day program, probably never to be seen again by any of us in the room. Our group leader then critiqued our “performance” with the main shortfall being the fact that we did not get to all of the pertinent information. Neither of us had asked about a medical history, and we didn’t ask the all-important question of whether she had ever considered suicide. (She had been diagnosed as major depressive also.) Our psychiatrist leader puts a lot of emphasis on this question.
The second patient was a middle-aged trucker with a crack cocaine addiction. The two guys who interviewed him had a problem in direct contrast to ours. Their patient would answer each question with as short a response as possible. While our time flew by, theirs seemed to drag. I am sure it seemed even worse to them, as they had to strain at times to come up with questions to break the awkward silences. Eventually the real doc rescued them by asking some questions herself.
As we wrapped up the session, I was still troubled by the way things just seemed to end. I don’t think either of these patients was any better off for the experience we had just gone through. I don’t know if it was her experience or just cynicism, but our psychiatrist gave me the impression of being jaded to the plight of these individuals. This will be one of the tough things to face in medicine … the sheer numbers of people who like Thoreau said, “lead lives of quiet desperation.” Kind of a bummer.
Speaking of bummers and cynicism, I had another jolt of it today. My 11-month-old daughter McKenzie has been battling chronic ear infections and we had an appointment today to see a local ENT about putting tubes in her ears. This doctor has put tubes in my oldest daughter’s ears twice and also did an adenoidectomy on her back in 1997. We think a lot of him and he always shows a personal interest in us. When he learned that I was in medical school, he promptly told us that he would bill our insurance only, and if we got a bill from his office to throw it in the trash! Ah, the wonderful concept of “professional courtesy.” He examined McKenzie, who promptly began screaming like a banshee when anything came near her ears. I had to pin her down just to get the tympanogram readings. We set up an appointment to have the tubes placed in two weeks and as we were shaking hands with the doctor he told me, “Mark, you’ve really picked a bad time to enter the field.” He was referring to the stifling legal climate that is currently a hot political topic in Mississippi. There has been a large increase in huge judgments against physicians and it seems to be open season for the trial lawyers. There has been a major push to get some tort reform pushed through the legislature, but that has been a hopeless cause, with the majority of state lawmakers seemingly either trial lawyers themselves, or beneficiaries of the same. Many rural practitioners are abandoning the ob-gyn portions of their practice and other high-risk areas, due to inability to pay their malpractice premiums. It is becoming a huge problem and it seems many local doctors are just fed up. Our doctor told me that he wouldn’t see patients who were family members or worked for a plaintiff lawyer. It is discouraging to hear such talk, but it is everywhere. I liked a local editorial cartoon that showed a patient in the OR about to have an operation. One of the figures in scrubs was putting his gloves on and telling the guy, “We regret to inform you that there aren’t any doctors left to operate on you, but rest assured that we have some of the best lawyers around filling in for them!”