Archive for the ‘Residents’ Corner’ Category.

Shadows

The professor stood before the class,
his body bent, for time has had its way.
His voice, hushed, drew them to him.
Its strength reflective of his day.

The student tells the patient’s story,
as she sits alone within the hall.
The professor asks a point or two.
Overhead a voice seeks those on call.

The student pleased as to her mark,
directs attention to the screen
where hang the sheets of celluloid;
scans there waiting to be seen.

The professor frowns, perplexed he
asks, is this the path we take to find
the nature of this patient’s illness;
no physical exam of any kind.

The student now herself confused.
What else is there to seek, to find?
I’ve told her story, you see the films
which clearly show the lumbar spine.

How is it now, he quietly asks,
we can plan the details of her care
having failed to inspect the patient
for signs of illness lurking there?

Of concern to me, our descent to this:
we relate that which the patient said;
then, ignoring wherein the illness lies
we sift these shadows for clues instead.

In shadows it seems we have lost our way,
the lure of technology perverts our quest.
Since it is the body that projects the pain,
probe it as taught; then, if need be, the test.

Clark Watts, MD

(written after listening to surgeons give the
medical history then proceed to the films
to justify surgery, September 2009)

Duty hour restrictions

Recently, the New York Times published an editorial reviewing medical errors in the setting of duty hour restrictions. (“The Phantom Menace of Sleep-Deprived Doctors” by Darshak Sanghavi, August 5, 2011). Dr. Sanghavi’s review of this subject noted that duty hour restrictions have not significantly decreased medical errors. He argued that increased sign-off frequencies left gaping holes in medical information for the “on-call” physician to make informed decisions. He cited the index case of Libby Zion, an 18-year-old who succumbed from serotonin syndrome that was undiagnosed and was blamed on the sleep-deprived intern. Dr. Sanghavi noted that lack of supervision and medical knowledge contributed significantly to Zion’s death and sleep deprivation was not the only culprit. He concluded that with improvements in “hand-offs” and electronic medical records, such mistakes are reduced. With these changes, more restricted duty hours (the new 16 hours a day for interns without overnight call) and a hospitalist system, the trainees will have fewer patients and more time to learn their field.

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Old school in modern medicine

From our current point of view many things seem to be “old fashioned”. Looking back from the year 2010 it feels strange that people were so excited about radio and television, as they are so “normal” nowadays. Still, only one lifetime away these things were not available. So what if we do not look back one century, but four? If we image ourselves in 1632, how would the world around us look like? No cars, no phones, no electric lights, no airplanes… how different would that be? How would medical doctors be trained in that time? Maybe not so differently after all….

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Should residents pay for their training?

In The Netherlands there is currently a political discussion about the question whether residents should pay for their training. Reasons “pro” and “contra” are exchanged, and both make sense – to some extent. Meanwhile, the two professional associations for Dutch residents are joining forces to prevent this idea to become reality. I will discuss both the “pro” and “contra” side, but my conclusion is clear: contra!

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The Future of Neurosurgery: A Resident’s Perspective

Change is a reality in all aspects of life and all fields of medicine. Neurosurgery residents are being trained in responsibility and patient care, however, the system itself is changing almost continuously. Understanding these dynamics is crucial to endure a career in medicine. Challenges include the intersection of technology and health care, understanding and modulating the “business” of medicine, and getting control of the medical-legal system.

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