My local children's hospital is adjacent to a medical school. Therefore, the children's hospital is a "teaching hospital". This means that when you go to appointments and the Emergency Room and are inpatient and outpatient there are LOTS and LOTS of people checking on your child. This is not always a good thing.
Let me paint you a picture. Your child is sick, you are afraid they are getting to be a little more complicated than what you feel comfortable with at home. You know from experience that if you go to your Primary Care Physician they will send you for more tests at the hospital anyway, so you skip the PCP. You decide to make the drive to the children's hospital to have them check out your child. You pack up pretty much the entire house to make the trip.
The only way to see a Dr. today is to go to the Emergency Department. It stinks, but that's the way it is. Pretty much all specialists that you would want to see are booked 3-6 months out.
The shortest I have ever had an ED visit is 2.5 hours, but typically they are over 4 hours, sometimes a lot over 4 hours. Most of the time is spent waiting, waiting and waiting. Waiting for tests to be run, waiting for Dr.'s to come by, waiting for IV fluids to go in, waiting for meds to kick in, waiting so the child can be observed, waiting for rooms to become available, etc.
So to summarize...
- You have just changed and dropped everything your schedule to come to the hospital (not just for a few hours, but you had to look ahead for a few days and even weeks in case they are admitted inpatient)
- You are worried about your child being sick and/or wondering if they might actually die
- You had to make arrangements for all of your other children and worry about how they will cope with you being gone...yet again
- You packed up your entire house in case you end up having an extended stay at the hospital
- You are bored/tired/stressed from so much waiting
- You are thinking about all of the germs in the hospital
- The unknown is terrifying...what is wrong with my child? Will they live? How long will this hospital stay be? Are we thinking ICU or floor? Are we going to need more surgery?
Then comes the kicker...the RESIDENTS. (When I say Residents...I mean residents, fellows, interns...pretty much anyone but the Attending Physician).
I know they are going to medical school. I know they need experience to become a Dr. I know they are trying to help. But here are some reasons why residents/fellows/etc are so frustrating.
- They think they know more than you. They try to explain things that...ummm...duuhhh...I pretty much know more than you (especially regarding my child). I am not new to this game. I have been around the block more than a few times. And honestly, half the time the resident does not even know what they are talking about.
- Because they think they know more than the parents, they do not listen to you. A good experienced Dr. will compliment the parent and then ask "You know your child, what do you think is wrong?" or "You have done this before, do you have any feelings about what we should do?" or "You are a very capable parent, how can we help you?" or " You are doing a great job, how has your child responded in the past?" Residents do not compliment and they do not ask for the parents opinion or insights. Residents are trying to prove their own knowledge and worth.
- When you come to the emergency department this is how many times you have to tell what is going on (I am not exaggerating)
- Nurse or Medical Assistant when you check in (brief summary of symptoms)
- Registration (brief summary of symptoms)
- Nurse assigned to your child (I do slightly more than the brief summary...but definitely not the full story)
- Resident
- Respiratory Therapist (If RT is needed)
- Intern (Sometimes)
- Attending Physician
- Specialist (if a specialist is needed)
- Phlebotomist (not joking...they ask you what's going on...once again a brief summary)
- Other techs (CT scan, MRI, X-ray, etc...the brief summary again)
- If there is a shift change while you are in the Emergency Department start over and repeat numbers 3, 4, 5, 6, 7, 8
Then if you are admitted it continues...
12. Nurse on floor
13. Tech on floor
14. Resident
15. RT
16. Intern (almost always)
17. Attending Physician
18. Specialist (if needed). If more than 1 specialist, repeat story for each specialist.
Here are some suggestions to prevent "Story Fatigue". (Yes, I just made that up...but I'm sure it is a real condition)
- Have a printed list you keep updated with the child's medications, diagnosis, allergies, surgeries and hospitalizations. Bring it with you and ask the nurse to photocopy it for you. Let the nurse use the copy to update the information she needs, then ask her to give it to the Dr. Or keep the copy and give it to the Dr. yourself when they come in. Having this list frees space in your brain to think about the critical issues at hand, saves time and prevents things from being forgotten.
- Write down everything you can remember before the attending comes in. (sometimes I will use my voice recorder on my phone while I am driving to make notes about things I want to tell the Dr. then write them down when I have a minute).
- You should write all relevant previous history relating to the current condition (ie: she has a shunt and she is acting the same way as when it failed last time)
- Recent history relating to current condition in chronological order(ie: She has been sleepy since last Sunday, she started coughing on Tuesday, and today she started needing 3 liters of oxygen)
- Any one else sick at home and symptoms
- In the ED, when the first resident type person comes in, (as long as your child is not in a really scary/bad place) tell them " I know that I will have to wait longer, but I would prefer to tell the story ONCE when they can have the "attending" present." And truly, if they are in a scary/bad place...then your child probably met "shock protocol" and the attending is already there.
- If you don't want a resident working with your child you can refuse. I do not choose this option, usually I just say I want the attending present before telling my story.
- Once you get the attending present and are ready to tell your full story for the first time...have the voice recorder ready on your phone. Record yourself telling the story (while going through all of your written notes). Keep recording when the Dr. asks some clarifying questions at the end.
- Once you get transferred to the ICU or the floor, and they start asking for the story...just pull out your phone and push "play" on your voice recorder to tell your story for each person that comes by.
What tips do you have for dealing with residents? What tips would you offer residents in their quest to becoming a "good" doctor? Please comment below.
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