Schooling the Resident
August 11th, 2012
I had my (almost) 3 year follow up appointment this past week.
The good news: NED.
The bad news: The life of an oncology patient is still often beneath my dignity.
I arrived to the clinic early. Since I am a patient in a teaching and research hospital, this often means I get to help the new residents practice their clinical skills. I am an educator, so I believe in the value of this kind of training.
It’s just sometimes hard to take when I have lost a night’s sleep worrying about impending lab results.
So the newbie doctor went through his clumsy interview. I confess I was not a patient patient as he (re-)explained many aspects of my treatment and the side effects I am experiencing.
I thought, Oh really? The shooting pain down my arm might be nerve damage and lymphedema?
Yeah. I know. I’ve been going to physical therapy twice a week.
He proposed Cymbalta for the nerve pain. I brusquely told him that I am a Side Effect Queen.
Drugs are seldom worth the trade off for me.
I could tell he wanted me to like him and put him at ease, but I didn’t really feel it was my job. He has to get used to us oncology folk.
Then my real doctor came in and did her thing. I was relieved. She too wanted to talk me into the Cymbalta for my nerve pain.
Did the Cymbalta people take you out to a nice dinner at the last ASCO meeting? I joked.
No, they don’t make enough money off of me.
She knows how to roll with me. This is why I love her. She continued, joining in on the snark.
This is a low dose. It’s like licking a f***ing pill. If you don’t like it stop. But it won’t hurt you to try and it could help.
I turned to Junior Doctor and said, Watch and learn from the master.
I agreed to try the Cymbalta.
As my doc continued her thing, I noticed that the young one had started fiddling on his iPhone.
I felt my heart rate go up. A half dozen call-outs flashed through my mind.
Really? That camera is pointed right at me dude. Are you live tweeting your clinics? What’s the hashtag?
I can tweet it too and let my followers weigh in. Oh are you Instagramming? I’m pretty sure that violates HIPAA.
When he left the room for the exam portion of the appointment, I said to my doc,
Dude was on his iPhone. Not cool. You need to say something about it.
I will, she assured me.
After the appointment, I blew off some steam by posting about the incident to my social media peeps.
They came up with some snappy comebacks too:
Dr. Douche, does the AppStore have anything to help me find a better oncologist?
Hi. Is it Doctor X? Hi Dr. X. I’ll just take that from you: It’s distracting. You can pick it up from me at the end of my consultation.
So sorry. Is my medical appointment interrupting your texting?
This cap fest was gratifying in a sophomoric kind of way.
But I realized what I really wanted to do was get him to realize that this meeting was not about him.
To give him a good dose of empathy.
Listen, Doctor. I am sure you are a smart guy and have done well in school and studied hard to get to where you are.
Can you imagine that I did that too? I built my life, was moving forward, taking care of myself, my career, my family and then BAM! CANCER.
You are new to My Cancer but I am old hat now. I have been doing this for 3 years. Three effing years. Every time I come to one of these appointments, it feels like a lot of bull. All the pain, all the fear, all the bad times come back to the surface for me as I sit in this office, waiting for my latest news.
Treat me with humility: you don’t know the extent of my experience. Offer me information with the understanding that I may have heard this before: this has been my life. Don’t expect me to reassure you: that is not my job. I have a lot on my plate. You need to get your affirmation elsewhere
Oh, and also?
Put away that damned phone.
I realize that NED gives me the luxury to bitch about these details. I am grateful.
I hope that my griping helps those of you who are in treatment or are dealing with long term disease.
–
Epilogue:
I emailed my doctor to make sure she followed up on the phone. She did. Doctor Junior is sorry and won’t do it again.
I kicked the Cymbalta after one dose. It made me unspeakably nauseous. The Side Effect Queen continues her reign.
This entry was posted on Saturday, August 11th, 2012 at 10:15 pm and is filed under Survivorship, Treatment. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
I think all doctors need to be reminded that waiting for test results of any kind is nerve-wracking for most patients. Stress typically doesn’t make things better, and can cause additional issues. If they had any idea the pain the little things they do (or don’t remember to do) cause.
Also, I think your doctor should have said something to the intern while he was playing with his phone. That is just beyond unprofessional. If he did have some sort of emergency, he should have excused himself.
I think he should be formally reprimanded with a letter in his file and such. A doctor or resident playing with a phone that contained a camera would make me physically & emotionally uneasy fearing he/she was photographing me.
I too am a patient of a teaching hospital. At my last full body dermatological exam to check for any more skin cancer the resident first examined me then my regular dermatologist. In December I had muscle flap surgery that caused some problems with the movement of my left arm. I cannot lift it all the way over my head. The resident asked me if I had any burning or itching or anything of the sort under my left arm. I said no. She told me I had the beginnings of a yeast infection under my arm and that she was going to prescribe an ointment.
My Dermatologist came in and examined me a second time while the resident gave him the rundown of her examination. He got to my left underarm and said – just as calm and cool as can be – that’s not a yeast infection that’s deodorant. I looked everywhere else in the room so as to not laugh. I was mortified for her. It’s gotta be rough being a resident. LOL
I had to chuckle at your story of this hapless resident, whose shoes I have been in a time or two. It’s August, which is early in the academic year, so you have very little experience in whatever rotation you are doing (e.g. oncology). You enter an exam room and meet a patient whose surgical scars are older than the parchment on which your M.D. is printed. You try to make intelligent observations (“This could be related to your lymphedema…” Duh.) and helpful suggestions but you soon realize that the problems patients face are far more complex than the ones you learned about in medical school. Then the senior physician walks in the room and you watch a real doctor-patient interaction unfold. There’s empathy and practicality, understanding and humor, and real-world knowledge from both sides and you wonder if/how you will ever get to that place with your patients.
About 10 years ago, a senior cardiologist and I saw a patient together. After rounds, he reprimanded me for putting my hands in the pockets of my white coat while we were talking to the patient. “It makes you look uninterested,” he said.
These days, I’m the guy giving the advice. “Understand that your patients often know more about their diseases than you do,” I say. “Listen to every word they say in the context of someone who is living with a chronic illness. Their individual issues are not painted on a clean, white canvas; patients have lives, families and careers, all interrupted by a disease.” Sometimes I tell them to keep their hands out of their pockets. Maybe now I’ll add the part about the phone.
Ouch. I feel that too CB. Same for me even in year six:
‘All the pain, all the fear, all the bad times come back to the surface’
Exactly. We are emotionally vulnerable as patients, and I’m sorry to hear your experience. It needs to be better and I think you were right to call out the junior doc. If the senior docs don’t train the junior ones how will we ever have empathetic medical professionals we need?
Sarah
I’ve never seen an epilogue in a post before! I’m glad to hear you followed up with an email.
Lani,
You’re completely right, putting him at ease was not your job. I love this, “He has to get used to us oncology folk.”
It seems he still has a thing or two to learn. I get the feeling your regular doctor said a few words to him after your appointment.
And unless his wife was in labor or a loved one was seriously ill, fiddling with his iPhone was completely inappropriate. As a cancer patient, you deserved better. Actually, any patient deserves better.
I think I wrote previously in response to this issue that part of the process of evaluating residents is patient feedback. Every institution handles this differently. Often, I get a survey in the mail requesting I complete it with anonymity. All residents undergo informal and formal evaluation, and any information provided by patients is part of that feedback. While it’s fun to entertain snarky repartee, it is ultimately more useful to provide real feedback that becomes part of the training. While interns (first-year residents and very green) and residents are still in training; that means they make mistakes. I’ve been a mentor all my life and a residency manager for several years, so I like to think I’m part of that important process and often do provide objective, often spontaneous, feedback to my physicians, the interns/residents and the process.
Remember too that while the resident may have used poor judgment in accessing his phone during the session, he could have been using one of the many applications that doctors use on their phones for patient care. Also, hospitals now are increasingly expecting that residents use their phones to stay in touch with others, including supervising physicians, for contact on emergencies and other clinical matters. Cell phones in a clinical setting are tools of the setting and not necessarily a social networking plaything.
I appreciate your insight, Donna. But as I say in my post, my doctor agreed it was inappropriate and spoke with him afterwards. He was clearly doing the nervous email check/texting thing that is a prevalent tic among folks in their 20′s. There was no app he was looking up. What is more, as a twitter friend who develops apps for doctors said, any mobile device should have the camera eye shielded with a sticker during a consult. It is very uncomfortable to have a camera poised at you during an exam.
Lani,
I so needed to read this because all I could think was “right on, sistah”!!!! You nailed it — and in a wonderfully snarkilicious way I might add. Loved this entire post. You are right: being an oncology patient sucks and dealing with Doctor Junior would be especially irritating. I think Doctor Junior should be put in time-out or write on the blackboard 100 times: “I will not text during an appointment with a patient.”
CB, I love you. May I just say that? And Evan, I loved your comments. By the time I was doing my internships for physical therapy grad school, I was an ‘older’ patient, in my late thirties, which made a big difference. I may have been new to PT but I wasn’t new to listening to people & being able to demonstrate compassion. I was very grateful for that, believe me. Having been a patient myself a few times by then, I used to cringe at the way some of my much-younger classmates behaved in patient settings.
But there is nothing like being an oncology patient, is there? I almost feel sorry for oncology interns and residents. Almost, but not quite. I did an internship as a PT grad student in oncology. I asked for one — an unusual request in PT then, believe me — because we had had a wonderful, wonderful medical oncologist lecture our class in pathophysiology. He started off his initial lecture by saying, ‘If you have not faced your own feelings and beliefs about your own mortality, if you have not faced your own fear of death, pain, and loneliness, you will be of no use whatsoever to your patients.’ Wow, I thought. I love this man. And I listened. And learned.
Gah! Cell phone in the room! I would blow a gasket. I have patience getting the double checkup with residents. I have had some great and some not so great ones over the years.
Your griping helps me! Loving it and will read all of it. ‘so sorry, is my medical appointment interrupting your texting?’ he he. You are wickedly funny. Thanks
Thanks for sharing this uncomfortable situation.
I agree with your insights and all the comments above but I did want to say something in support of the resident.
One thing that I wanted to point out was that the resident was most likely using his phone to look up Cymbalta, to see if there were any side effects the attending physician forgot about. Or perhaps if there might have been an alternative drug that could have been better.
The problem is that you cannot tell what he is doing, was he texting, or worse taking pictures? My guess is probably not but I really can’t say.
If he was genuinely using his phone as a drug resource for your care do you think he should have vocalized to you why he pulled out his phone?
Also do you think it would have felt more comfortable if maybe it was a tablet instead of a phone. That way he could also show you what he was looking at.
Just some ideas I wanted to share as a 4th year med student.
Thank you for sharing this experience, it is something I will keep in mind.
Roy, I appreciate your comment. When my doc talked to him afterwards he admitted he was fiddling and texting. He was not looking up the drug.
One thing med schools need to think about is how to incorporate handheld technology into exam interactions. Two things come to my mind: 1. As you said, let the patient know the general purpose you have in pulling out your device (‘I am going to use a reference tool here to look something up.’); 2. Make sure a camera pointed at the patient has a visible sticker covering it to assure me of my privacy.
I teach undergrads and I know that many folks in their 20′s do have a nervous habit of phone scrolling. This does not belong in an exam room.
How hard it must have been to endure the junior doctor’s impertinence. NED does embolden us, doesn’t it? My snark meter has risen in proportion to how many years I’ve lasted since my encounter with chemo. Watch out, oncology world! And thanks for the tip on Cymbalta. I will probably avoid that if I get any nerve pain. I surely hope you don’t get lymphedema, or if you do have it, it remains a mild case. Take it from me: it’s not a picnic. xx