Medical Miseducation, Part 1

Initially appeared on doktorko.com 11/16/2005.

When i was a Clinical Clerk, i used to do mind-numbing scut work.  For hours on end i would take Vital Signs with a frequency of Q4, Q2, and the dreaded Q1 - which would be especially essential in the ICU.  I would take the blood pressure, monitor the heart rate, count the breaths per minute, quantitate the urine, and do other esoteric maneuvers like checking Neuro Vitals (SPERM - Sensorium, Pupils, EOMs, Respiration, Movement), and measuring the CVP.  Move on to the next patient.  Repeat.  Monitoring anywhere between eight to twelve patients in the ICU (on a regular ward the number could be more than twenty), i would work my way through all the patients over the span of one hour, then turn around and do it again.  And again.  And again.  For twenty-four hours straight.  Somewhere in there an admission or two would be written up, some blood would be drawn, some NGTs and foley catheters inserted.

Dr. Despot (name changed, more for my protection than his) put in his two cents' worth on the matter: that us Clinical Clerks were not monitoring machines, that we were doctors-in-training , and that we should learn the significance of what we were doing, instead of just doing it like robots.  Hypotension - think of shock.  Fever - think of infection.  Tachycardia - think of SIRS.  And so on.

A sensible thought, but in practice this was impossible.  I guess the not-monitoring-like-robots concept did hold some merit - if we were actually allowed to apply it.  Consider: any time we missed monitoring by a few minutes, the supervising Resident would be all over us like a fly on a piece of dung.  Demerits would be handed out like gift certificates on Christmas - except that these gift certificates could be redeemed only for more hours of mind-numbing work.  We lived in abject fear of being caught having not monitored in the wee hours of the night.

Did we ever sit down to sleep?  Of course, when the exhaustion overtook us.  Did we ever study?  Sure, when we had 5 minutes left before monitoring the next patient and we weren't ready to just lay down and die.  Did we absorb anything?   Uh, let me put it this way: when you're bone and brain-weary like that, your mind loses all capacity to learn and becomes a solid brick.

Many years later, a little older and (hopefully) wiser, i look back and my miseducation with seething anger and more than a little bit of sorrow.  These days, i regularly work with medical students who are expected to do three things: 1. do a night call/duty six times in two weeks 2. learn by reading and asking their Residents questions the whole night through, and 3. not do any manual labor.  Their minds, not disillusioned and jaded like mine, are free to roam, to ask questions, and expand their horizons.  I've met third year students who know how to manage MIs and decompensated CHFs, which is more than i can say for some Residents that i worked with when i was still in medical school.

Consider: If during those interminable nights during our Clerkships we had been allowed to sit down and study, instead of doing slave labor passed off as a learning activity - how much smarter would we be now?

This is, of course, a rhetorical question.