I am awash with the novelty of these new metrics by which my worth is gauged. For the time being, the world of test scores and teacher evaluations is lost in the fabric of the security blanket that was my life before internship. Instead, my concern is pulled haphazardly in multiple directions by the way I am perceived by my colleagues, the reputation I have with the nurses and pharmacists and ancillary staff, and most importantly by the fate of my patients and my impact on their lives. This is now the life of a medical professional I am living. What does it mean to be a good doctor or a good intern?
One of the most invaluable and counterintuitive lessons for the new intern is that simply being nice is not enough to achieve efficient and high quality patient care or to earn the respect of those one works with. Being too nice invites deferment of tasks to the naive intern. For example, it is common practice in my hospital for physicians to draw blood for arterial blood gases. Most nurses at this hospital who are asked by an otherwise unknowing intern to draw an ABG will insist that only MDs can perform ABGs, but when asked why, few will provide an answer (no matter how industrious, caring, and helpful they might be). One ventilated patient in an intensive care setting on my service required daily blood gas readings, and it ended up being my task to draw blood every morning before rounds after the patient’s central venous catheter was removed (which otherwise would have allowed for nurse-drawn venous blood gases). One of the nicer nurses said encouragingly, “Well, after this you’ll be really good at ABGs!” But what is so special about an arterial blood? Certainly nurses can handle staunching an arterial bleed, probably with more skill and practical knowledge than most physicians. It was quite surprising then when I discovered one morning that a new nurse taking care of my patient drew the ABG himself without any fuss before I could get around to the task. The respiratory technicians are perhaps the most adept at drawing ABGs. It made me wonder: what else have I been doing that is otherwise within the realm of capability, or perhaps the job descriptions, of others? Being too nice, perhaps, might poison the spirit of collaboration as much as being mean and fear-inspiring, especially when being too nice results in one feeling misused.
I have been, perhaps compulsively, obsessive in my insistence on promptness in my responses to pages and requests. In many ways, I hate “number pages,” short strings of numbers indicating the ward a phone call was sent from, usually representing a request from a nurse. Receiving these pages is like picking up a stray electromagnetic signal from a neighboring galaxy: one knows what direction it came from, but not much else. If I am trying my best to help others do their jobs faster and sooner, why don’t others have the courtesy to send a short message so that I don’t waste time on hold while I wait for them to finish a task they felt was important enough to preclude them from waiting for me to call back? I once found myself in the horrifying position of being on call when my cointern forgot to sign her pager over to mine: several hours passed before this mistake was discovered, and I found myself receiving an extremely angry call from the nurse manager of a unit whose nurses were trying to page the physician covering my cointern’s patients, pages that were being fired into the black hole of a pager in the off setting. When I apologized to the nurse in question later (not before hearing my name being casually tossed about like a sack of moldy potatoes), she and a fellow nurse seemed to find it quaint that I was very bothered by this mishap: “Ha, you thought you were going to be in trouble?” I was left wondering what to make of the confusing and widely variable expectations that nurses and doctors have of one another. A month later and after several more overnight call nights working closely with several nurses, I found that I had developed some small amount of reputation: “You’re covering Medicine tonight? (to the other nurse) Oh, he’s good.” How did this come about? What did I do to “be good?”
Much to my surprise and adding to the perplexity of my chronically fatigued mind, the feedback I have received from my residents and attending have been overwhelmingly positive. I have been incredibly tired, cranky, and impatient at times. I have been slow, mistake-prone, addle-brained, and overwhelmed nearly to the point of tears. And yet, both lenient and meticulous physicians have commended me for my knowledge, efficiency, teamwork, and compassion for my patients. Are physicians so easy on their younger and more inexperienced counterparts and so reluctant to criticize? I have certainly not excelled at displaying all of these traits at the same time. It seems that each attending physician and each resident has their own metric for excellence, and this furthermore varies from one specialty to the next. How, then, does one be good?