First week's impressions

Well, it's been a long week, mostly occupied by rounding on the medical wards. In observing and understanding how the medical education system here works, I've been trying to figure out my role here, and how I can best contribute. To be fair, I've only been at one hospital so far (a private hospital) and have yet to go to the University Hospital, where things may be very different. But these have been my impressions so far.

If I thought rounds at home took too long sometimes, I won't think that anymore. It's not uncommon for our rounds to last hours. Hours upon hours of standing (or inconspicuously leaning against the wall for added back support) while I listen to the medical students and residents present patients and while the attending teaches. This may sound very much like home, and it is, except for a few quirks:

-Students here tend to speak very slowly and quietly, and also seem very timid about speaking up, or even answering questions they know the answer to. This results in a gaggle of people standing around a patient's bed, while they all strain to hear what the presenter is saying, and then stand there expressionless and quiet when the attending asks a question. In that sense, it's a good thing that patients here don't feel more empowered to participate in medical discussions like they do at home, or they would probably be very openly frustrated with us. Disorganized presentations turn into prolonged teaching sessions at the bedside, which then often result in no clear plan for the day (or no change from the previous day) and then the whole group walks away. I get the feeling the patient has no idea what just happened, what will be happening that day, or how much longer they will be staying. I should mention that lab results and radiology results are so slow here, it's not uncommon for a patient to be waiting for three days for a result, with nothing happening to them in the interim. So if there is no plan for the day, it may truly be because nothing has changed from the previous day. We have patients who have been in the hospital for three weeks or more.

-I have also found the attendings to be even more hierarchical than they can be at home. They have no problems openly insulting and chastising the residents and students for things they do not know the answer to. I'm not used to this, and I think it's counterproductive to a positive learning environment. The attending I've been working with this week, while a very good teacher with a huge knowledge base, can be pompous and insulting at times, in a totally irrelevant way. I don't want to hear your personal views on a patient's religious beliefs, or your frustration that a patient's skin biopsy was actually sent to Germany for analysis ("A colonial hangover!").

-Finally, I've found that overall, the knowledge of the more senior residents I've met so far seems behind that of the same level resident at home, although it's hugely variable. And they don't seem to be leading or teaching the interns/medical students. This in turn makes the interns lazy, and they do not seem to be doing the jobs that are expected of them, leaving the residents to do all of the work (write all the notes, ensure orders are in and consults called).  I've actually watched the interns start presenting a patient, and then not know anything that happened to them in the past 24 hours, have no vitals signs or lab results written down, and to not have done a physical exam that day.

I think this last piece is something I can help with. Not only teaching some clinical knowledge, but helping them to be better teachers and leaders of their interns, and in turn, teaching the interns to be better organized and more responsible. All of that said, in the small teaching sessions I have done so far, they know their book knowledge very well, and they seem very eager to learn. And trying to teach them things I have been doing so routinely for so long, has made me realize what I don't know as well as I thought I did.

Lots of reading coming for me this weekend. In addition to going to a pottery class, an ultimate frisbee game, and a run with the running club.