The real doctor

 Sarah Silverberg is an R1 in OBGYN at UBC and an intern at St. Paul's Hospital.

 

 


Please let me take your history.

I know the triage nurse and the emergency physician already asked you many of these same questions. But humor me -- let me ask them too. After all, I was asked to see you by the emergency doctor who saw you. They knew I would ask you these questions, and felt it was necessary. They referred you to me, and like it or not, you’re now under my care.

I am the resident that was asked to see you. You ask me if you could see the real doctor. Unfortunately, I am the real doctor. At least, I am a doctor; one of the country’s medical institutions has granted me an MD. And while I know what you mean – that you don’t want to see the resident, and that you want to skip ahead directly to the attending – at this moment I can’t make that happen. My attending sent me down to see you because I’m the one on consult service. My staff is in the operating room, or managing the ward, or reviewing the three other consults we’ve been asked to see this evening with other residents and students. You’d be waiting a while longer if I didn’t see you.

I am a resident doctor; I have an MD, even though I look the same as I did when I was 16. I can assure you, I’ve been in school for another decade and obtained a few degrees beyond that. Please don’t try to complement me on how young I look - it only makes the conversation more awkward. When you start work at 6AM every day you might not feel like adjusting your makeup to try to halve the gap between perceived and actual age. I’m also sorry if I look younger than your daughter, but this is my 14th hour at work, and I have another 12 hours to go. But anywhere you go in the hospital, you’re probably going to encounter me, or my colleagues across the hospital services, so questioning my age will not yield a more-mature-looking doctor to take over instead of me.

I’m asking you the same questions that the emergency doctor did because they’ll help me decide what I can offer you. Sometimes answers change depending on how they are asked, which is why different doctors will ask you the same questions a few different times. It also reflects a broken aspect of our system; I often only get a few lines of information from the physician who last saw you summarizing what they know, leaving me to ask you about it all over again. They used that information to determine that you need to see me. I’m using that information to figure out the next step. Sometimes we use these questions to think out loud, so please bear with us. You had been reduced to an age, sex, and presenting complaint, and I am trying to flesh that out to come to understand you, as a patient, and as a person.

Seeing me does not mean you won’t get to benefit from the experience of the specialist. As a resident, I am working on behalf of the specialist, as part of their team. They’ll hear all about you, what brought you in, where you’ve been having pain, and what all of your test shows. They’ll allow me to suggest a plan, and correct me if I have erred. Usually they will come and meet you too. But it helps us all if you let me see you first, put together all of the information, and synthesize what is going on. I assure you this isn’t entirely a futile endeavor. After all, I’m the one who is going to organize appropriate follow up tests, document your case, coordinate your follow up, send notes back to your family physician. And I’m often the one with the most time to listen to you and answer your questions.

I know you’re in pain and discomfort, you’re exhausted, hungry, and cold, and that you don’t want to be here. This is not the time in your life that you have the most patience to teach me. But please let me take your history, so I get better, learn how to manage your pain, and reach a decision. I need to see this dozens – if not hundreds – of times before I’m maximally proficient at it. Please let me see you, so that I can gain something from it too. That way I too can one day be a fully independent physician, and become the attending physician you so desperately want to see. Then the rest, and there will be rest, will be history.

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