My plea for us to be better to each other
July 24, 2014
We’re checking back in with our newest CHEST blogger, Dr. Rohit Devnani. Dr. Devnani recently began his fellowship in pulmonary and critical care medicine, and we’ve asked for a sneak peek into his journey. Here he discusses the hurdles that exist in being a health-care provider and offers some solutions for individuals to make a change.
By Rohit Devnani, MD, @RoRo_Nani
And it begins! Two weeks into my Pulmonary and Critical Care fellowship at Indiana University, and I have learned that my nervous system works really well. A little anxiety is healthy, but I’ll be using this post not only to discuss an important topic (physician behavior) but also as a pep talk to myself to be better. First, however, a peek into day one of fellowship:
Gabriel Bosslet, our soon-to-be fellowship director, gave us an overview of the program. Remarkably, what made residency training at the University of Chicago such a rewarding experience, for me, I anticipate is going to make fellowship at IU equally amazing: a culture of support.
My first impression of the Pulmonary and Critical Care division at Indiana University is that the division includes a group of individuals who are extremely dedicated to each other. Our first month of fellowship is filled with lectures given by the faculty, and Gabe is making a point to be present to introduce every single lecturer. Totally unnecessary but completely appreciated! Aside from myself, all the other fellows completed residency at IU and are already familiar with the staff. But it’s a sticking point, for him, to ensure that the culture of collegiality resonates through the program.
And it does. In fact, one of my co-fellows, Amber, told me that a senior fellow had already offered to cover her weekend call so that she could go to a concert. That’s right, Mary, the senior fellow, is willing to field pages on critically ill patients over the weekend so that Amber can rock out to Kings of Leon (with Young the Giant and KONGOS, who are awesome, by the way)!
This is more important than just making friends; this is about being in an environment that trains the right kind of fellows.
What is the right kind of fellow? That brings us back to the matter at hand: our behavior. Physician behavior is what determines not only who is the right kind of fellow, it determines who is the right kind of doctor. To illustrate—it’s an oft-experienced phenomenon, the game of personality roulette that comes with opening up the paging directory as you pray covering the pager is one of the good guys and not one of the [unicorns]. Everyone knows who the good guys are. Ask the medical students. They will all point to the same fellows who are their favorites. Ask the interns and residents. They will also point to these same fellows as their favorites. These are the fellows who are supportive to the overwhelmed, calm in the face of chaos, and simply pleasant human beings. When you see one of their names covering the pager, it’s a sense of pure relief.
Yet despite a general consensus on who are the model doctors, some people seem to lose their way during the course of their training. Click to Tweet this.
Some become so unpleasant that just the possibility of having to interact with them can be anxiety provoking. These are the [sprinkles] who are overbearing on the overwhelmed, who contribute to the chaos by being degrading, and who are downright mean. Everyone knows who they are too: the cardiologist who berated an overnight resident for not knowing a patient’s partial thromboplastin time (PTT) from memory, the urology chief who yelled at an intern for placing a Dobhoff tube in “his patient,” the gynecologic oncology fellow who, in front of the resident, told a patient that she would soon not have to worry about being under the care of such a poor doctor.
I understand that we all have our moments when we deal with frustration. I can’t claim complete innocence either, having on occasion screamed to a room full of co-residents, “what the [pizza] are those guys thinking?!” after getting off the phone with the ER. But this wasted energy does not help anybody. On the other hand, I remember once getting paged by a surgery intern exasperatedly asking for some direction on how to deal with a patient’s blood pressure of 150/95. “Um, stop checking the blood pressure” I jokingly told him. But then after I explained to him that it was not a big deal, he was incredibly thankful. How hard was that? He was asking for help. That’s our job. Be helpful.
Tangentially related, Akhil Narang, a colleague and good friend of mine, wrote an article tying resident cynicism to lack of support from hospital administration. I highly recommend checking it out. As a former chief resident at the University of Chicago and eternal optimist, Akhil’s pulse on resident development led him to perceptively ask: “I wonder if, down the line, the less cynical residents become less cynical fellows, and subsequently less cynical attendings.”
Yes.
And the culture of health care is ripe for breeding cynicism. We have enough to deal with when our efforts are compromised by struggles with awful EHRs, persistence of pagers (seriously, even drug dealers have moved on), and noise from the administrators and the insurance companies. Oh and in my case, the stresses of trying to take care of patients who are on the verge of dying and their families who are on the verge of having their worlds collapse. The least we can do is be good to each other.
