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      02-18-2013, 02:06 PM   #116
Thebigbus
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Originally Posted by M3takesNYC View Post
Depending on what your doing of course, it will very likely get much MUCH better after residency. My personality was simply not one to enjoy residency as residency in this day and age is far far far less indepedant as it used to be with insurance and medicare regulations requiring attendings to be increasingly involved, malpractice scaring all docs to not wanting to be as hands-off etc. I felt I was not able to truly be there for people with my best skills until I was out on my own and as much as I love the toys, money and fun stuff that goes with making money, I actually enjoy the feeling of the families and patients thanking me for helping them so much more than anything.

I think its a bad cycle for docs that lose sight of this. The more miserable docs who just go through the motions, really are not able to help patients and families as much as the docs that really have the desire to go out of the way to help, heal etc. (save a surgeon who miserable or not can heal!) But any doc where you talk to patients or think about diagnosis as your primary function will get much less praise from patients which in turn even further demoralizes you and makes you miserable as you watching the crumbling of healthcare.

If you go above and beyond to make a patients day or families day, than you get the extra appreciation which makes you wake up and not think about the crap system nearly as much which keeps you happy and the cycle of positivity continues.

The biggest lesson you can learn IMO, which took me until leaving residency and doing my own thing to really learn, was there is WAY more to helping a patient than simply doing the objective, tangible tasks we learn in residency. Ie. Prescribing meds, ordering the right test etc. All of that is important but the intangible smiles, jokes and ability to connect and comfort a patient is responsible for atleast half of the entire healing process and one that a lot of sterile residents and then physicians never get.

I used to think if I did not have a pill or a test to objectively use and order to "heal" someone, than I felt useless. I learned as I had more time to connect with my patients being in private practice (again it depends on your field and gig whether you have more or less time out on your own), I learned the healing comes from the moment I walk into see a patient: my smile, happy to see them, remembering something important about them, encouraging them, being available to them when they call outside of regular appointments, being INTERESTED in them as a person and interested in their medical situation as a whole. All of that has gone further in healing my patients regardless of what medical condition they had.

Sure the right medication and lab test is easy but honestly you can do that in your sleep after residency and I think we as physicians are missing the boat on fending off mid-levels by neglecting to see the value we provide outside our prescription pad.

Society is learning that you can stick a PA in for half the cost to write 90 percent of the prescriptions we do. However there is a confidence people still have in an MD and we do not use that to our advantage to apply it to the things I discussed. A person who feels their "doctor" is that caring and interested in helping them is someone who pays and values an MD vs. a doctor who walks in, does nothing but stare at a computer and writes a prescription which at the end of the day is replaceable on most fronts by a mid-level.

So while most docs sit back and bitch and moan about the system not valuing doctors or paying doctors, majority of docs are doing nothing to step their game and value up with the intangible's, the basic humanistic side of medicine that is almost forgotten.

We are the masters of healing and the public still views us as that but the public perception is not going to last as we continue to offer percievably nothing different than a PA/NP does to the public patient's eye.

I learned this on my own but if I could advise any young resident in here who probably thinks I am full of total BS, to remember next patient encounter to spend more time on the intangibles, while still clinching your diagnosis and prescribing/doing procedure, I believe you will start to see a reaction from patients that you may have never or rarely seen before.

Just my .02 as a guy out of residency 1.5 years who has done more learning about being a good doctor in 1.5 years than probably through 4 years of residency. I wish I could have hoaned the skill in residency but simply had nobody who talked about any of this stuff with any real conviction outside the context of lawsuit avoidance or hospital feedback scores
Excellent advice, and not $0.02, it's golden.

I like to think of myself as a personable person who cares about the person as a whole, and it truly only takes a few extra seconds with a smile, or some humor, etc, to help people see you're not just some guy in a whitecoat.

However, there are so many residents (and attendings) around me who simply do not have this, and it shows. There are a few of my own attendings who, after seeing a patient with me, the patient will look at me and say "I don't ever want to see him again. He has no bedside manner". To which I pretty much just have to agree, because it's true.

I think part of my disgust for residency truly is all the lack of independence and the new regulations/red tape added every WEEK (it seems). I realize the attendings have to be more hands on, but it doesn't help me be more motivated.

I think part of it is that I'm 33 years old (waited awhile to go back to med school), and I have a huge independent streak in me as well....which doesn't bode well for just being a little pee-on in residency.

I look forward to graduating and getting out. I think in my field (urology) we get an awesome experience with our patients, as it's quite "intimate". That will only get better for me once I have more control over my clinic and my OR schedule, etc. Regardless of the State control of medicine, I still look forward to relieving urinary retention, removing stones, taking out prostates, etc, etc. It's quite a fun field, and the relationship with the patients is priceless.

Last edited by Thebigbus; 02-18-2013 at 02:24 PM.
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