My last two months of training were awesome! I was at the VA hospital in Denver learning how to care for patients who require hospitalization. My Hospitalized Adult Care clerkship had been an amazing part of my third year of medical school. My role as the medical student included sitting with new patients to find out why they were there and to get their stories. These veterans were sick, usually with 3 to 20 health problems (heart failure, post-traumatic stress disorder [PTSD], diabetes, depression, and more) that needed treatment. With a lot of coaching from my classmates and residents, we would build a list of possible causes of the patient's symptoms. I’d present a plan to my team designed to narrow down the list of possibilities and to treat each problem. I then had the opportunity to follow the veteran’s progress each day during their stay with us.
In our final lecture for the block, our instructor asked if any of us had examples of high-value care that we’d seen in the previous months. I was a bit shocked when many of my classmates were slow to respond. Finally, one actually said, “I hate our healthcare system. It's all bad, with very little high-value care.”
During the last two months of training, I helped an airman with congestive heart failure lose enough water and salt from his drowning body that he was able to again breathe well enough to go home. I assisted a marine with liver failure and encephalopathy in recovering his mind so he could talk to his granddaughter and make an honorable exit to hospice care. I helped a soldier totally overwhelmed by PTSD and alcohol become sober while coordinating a support plan for her and her family. I watched in awe as my amazing classmates did even more. Every week we got to see veterans go back to their lives after successfully being treated.
I fear that our classes are conditioning us to only see the faults and problems with our system—there are absolutely plenty to find! Our classes on liver disease would turn into a rant against the pharmaceutical companies. An instructor at a private hospital scoffed when I offered ideas for a homeless patient, irritated that he was faking his illness for a warm bed. I can’t believe how difficult it is to schedule a follow-up appointment for a veteran prior to discharging them from their hospital stay. I’ve already written about patient fails so I write this in part to remind myself, too. It is necessary to recognize the wins.
During pilot training, I grew accustomed to hearing only about what I had done wrong during my flight. It was easy to fall into the trap of thinking I was doing everything wrong. Fortunately I had some amazing instructors and experienced flight leads when I got to the F-15E, who were able to point out both what I had done wrong and what I had done well. Guys like Stump, Shifty, and Funcle were quick to point out successes so they would solidify in my memory while providing alternative techniques to fix my failures at the same time. This not only made me a better pilot, but it was also critical to maintaining high morale in our squadron. I'm lucky that I’ve had a handful of residents and instructors who do the same while teaching medicine. I find it easier to shoulder long hours and enjoy my work more when I know that I am improving and making a difference.
A national survey study from 2014 showed that 56% of medical students were burned out and that 9% of them had considered suicide in the past year (1). I’ve seen at least four headlines on depression in physicians within the last week alone. Our healthcare teams, my classmates, and I need to recognize the good that we are doing. The huge numbers of patients who go home from their hospital stay are proof that we are adding value.
1. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89:443-51. [PMID: 24448053]