(no subject)
hey y'all wassup.
so i haven't actually started doing any doctoring. i've spoken to a couple of patients. yay. but this is how our caseload went this week:
clinics on monday
7 consults on tuesday (crazeeeee) - but it was my first day so i didn't do any consults, just saw one patient to get an idea of what we were doing for her.
2 consults on wednesday - i saw another patient but basically we were doing the same for her as the first patient
0 consults today
(poor felipe on the other hand was at his hospital from 6am to 9pm yesterday!!! that's what you get when you do a surgery rotation.)
so it's been easy...but i don't know what i'm doing. the fellows have their research interests, clinics, meetings. i'm not allowed to participate in clinics, only observe, which is saddening because i love participating in clinics. the rest of the time i spend just reading uptodate. *sigh* but according to my fellow, 0 consults today means a crazy day tomorrow.
well i guess i haven't proven my uselessness just yet at least, because when i finally start doing consults, i'm pretty sure they expect me to come up with a reasonable plan for complicated patients who have really specialised problems. and right now i am only good at coming up with a skeleton of a plan for simple patients with general medical problems. but oh well. that's why i'm doing a LOT of reading right now. it'll be a steep learning curve *shrug*.
in good news though! somehow i keep being able to answer the attending's (consultant's) questions. it seems that finally i am managing to read up what i need to know before i need to know it. usually it's the other way around. i fail miserably at some line of questioning, go read it up, and then never get asked it again. it's not really been like that so far *knocks on wood*.
it helps that here, the attendings a) are super-awesome and nice b) love teaching and c) have a different style of questioning than in australia. for instance, in australia, a consultant will ask you a question, wait for an answer and then, when no answer is pending, stare at you like you're a moron as you get more and more nervous because you know you don't know, until you give up and say 'i don't know' only to get told 'just think about it for a little while' or get asked a different question that is somehow meant to lead you to the answer. and the whole cycle repeats.
in contrast, here in boston, the attending will ask you a question, give you a reasonable time to think about it and answer, and if no answer is pending, look at the resident, and then if no answer is pending, look at the first year fellows, who will usually have an answer, and if they don't, the attending will look at the second year fellow who will almost certainly know the answer if he's present, and finally, if noone knows, the attending will just answer the question.
i'm sure you can see that the bostonian method is FAR more agreeable in MANY ways than the australian method. first of all, noone gets humiliated; people higher up in the hierarchy are never made to seem less knowledgeable than people lower in the hierarchy. second of all, if you don't know the answer, well, there's no shame in not knowing, and there's no pressure to know the answer, just to learn it from your superiors. third of all, there's no reason to blurt out stupid answers, just to get the attending/consultant to TELL you the answer, but with the result that you paint a poor image of yourself. fourth, talking to an attending/consultant is far less stressful, which makes one feel more comfortable asking questions and therefore, makes learning a lot more easy and enjoyable. fifth, a lot less time is wasted because there's no waiting for an answer which is not, and never will be, forthcoming.
but you know what, i've always been in the 'ugh, stupid american' camp (possibly posting this information publicly is not a good thing to do, but i have friends who don't have lj who are following this blog), and now just after one week i really have to retract that viewpoint. in the airport when joe helped me out he said half-jokingly when i thanked him 'hey no problems, at least now you can go back to australia and tell everyone you met at least ONE nice american. i know we kind of have a bad rep'. but honestly, i do think that in general, bostonians at least are far more civil than some of the people living in perth. and it really shows even in the small things. getting into elevators, if you're in first, you go to the back, so that as more people come in they can fit. getting out of elevators, people just MOVE for you if you say excuse me. strangers say hello and how are you, just if you catch their eye as you're walking past them. if people bump into you, they apologise, and don't act as if you purposely got in their way somehow. people hold doors open for you, and say thankyou without fail and actually sound grateful if you open doors for them. people walk down the right hand side of the corridor, overtake by passing along the middle of the corridor, and then return to the right side of the corridor, just as if they were driving. despite boston being WAY busier and more populated than perth, bostonians don't even bother looking before they cross roads, or paying attention to the pedestrian traffic lights, because cars will just STOP for pedestrians - no traffic lights, no signs, no zebra crossing, they'll just STOP to let people pass. if you enter a building and look lost, and then start wandering down a corridor, people will say 'hold up, you look lost, surely i can help you?' and then INSIST on helping you. people's first response to you as a stranger is NEVER rude or standoffish or reproachful-for-no-reason. i might still disagree with the USA on certain things - the lack of public health for instance - but all of its inhabitants that i've met are classy, classy people.
okay i've blabbed for way too long. i'll leave it til tomorrow to tell you all about the hospital hierarchy here. you know what i mean - the resident/fellow/attending breakdown as opposed to the intern/resident/registrar/consultant breakdown (no, they're not quite equivalent). if i do it in this post, it'll be way WAY too long.
so i haven't actually started doing any doctoring. i've spoken to a couple of patients. yay. but this is how our caseload went this week:
clinics on monday
7 consults on tuesday (crazeeeee) - but it was my first day so i didn't do any consults, just saw one patient to get an idea of what we were doing for her.
2 consults on wednesday - i saw another patient but basically we were doing the same for her as the first patient
0 consults today
(poor felipe on the other hand was at his hospital from 6am to 9pm yesterday!!! that's what you get when you do a surgery rotation.)
so it's been easy...but i don't know what i'm doing. the fellows have their research interests, clinics, meetings. i'm not allowed to participate in clinics, only observe, which is saddening because i love participating in clinics. the rest of the time i spend just reading uptodate. *sigh* but according to my fellow, 0 consults today means a crazy day tomorrow.
well i guess i haven't proven my uselessness just yet at least, because when i finally start doing consults, i'm pretty sure they expect me to come up with a reasonable plan for complicated patients who have really specialised problems. and right now i am only good at coming up with a skeleton of a plan for simple patients with general medical problems. but oh well. that's why i'm doing a LOT of reading right now. it'll be a steep learning curve *shrug*.
in good news though! somehow i keep being able to answer the attending's (consultant's) questions. it seems that finally i am managing to read up what i need to know before i need to know it. usually it's the other way around. i fail miserably at some line of questioning, go read it up, and then never get asked it again. it's not really been like that so far *knocks on wood*.
it helps that here, the attendings a) are super-awesome and nice b) love teaching and c) have a different style of questioning than in australia. for instance, in australia, a consultant will ask you a question, wait for an answer and then, when no answer is pending, stare at you like you're a moron as you get more and more nervous because you know you don't know, until you give up and say 'i don't know' only to get told 'just think about it for a little while' or get asked a different question that is somehow meant to lead you to the answer. and the whole cycle repeats.
in contrast, here in boston, the attending will ask you a question, give you a reasonable time to think about it and answer, and if no answer is pending, look at the resident, and then if no answer is pending, look at the first year fellows, who will usually have an answer, and if they don't, the attending will look at the second year fellow who will almost certainly know the answer if he's present, and finally, if noone knows, the attending will just answer the question.
i'm sure you can see that the bostonian method is FAR more agreeable in MANY ways than the australian method. first of all, noone gets humiliated; people higher up in the hierarchy are never made to seem less knowledgeable than people lower in the hierarchy. second of all, if you don't know the answer, well, there's no shame in not knowing, and there's no pressure to know the answer, just to learn it from your superiors. third of all, there's no reason to blurt out stupid answers, just to get the attending/consultant to TELL you the answer, but with the result that you paint a poor image of yourself. fourth, talking to an attending/consultant is far less stressful, which makes one feel more comfortable asking questions and therefore, makes learning a lot more easy and enjoyable. fifth, a lot less time is wasted because there's no waiting for an answer which is not, and never will be, forthcoming.
but you know what, i've always been in the 'ugh, stupid american' camp (possibly posting this information publicly is not a good thing to do, but i have friends who don't have lj who are following this blog), and now just after one week i really have to retract that viewpoint. in the airport when joe helped me out he said half-jokingly when i thanked him 'hey no problems, at least now you can go back to australia and tell everyone you met at least ONE nice american. i know we kind of have a bad rep'. but honestly, i do think that in general, bostonians at least are far more civil than some of the people living in perth. and it really shows even in the small things. getting into elevators, if you're in first, you go to the back, so that as more people come in they can fit. getting out of elevators, people just MOVE for you if you say excuse me. strangers say hello and how are you, just if you catch their eye as you're walking past them. if people bump into you, they apologise, and don't act as if you purposely got in their way somehow. people hold doors open for you, and say thankyou without fail and actually sound grateful if you open doors for them. people walk down the right hand side of the corridor, overtake by passing along the middle of the corridor, and then return to the right side of the corridor, just as if they were driving. despite boston being WAY busier and more populated than perth, bostonians don't even bother looking before they cross roads, or paying attention to the pedestrian traffic lights, because cars will just STOP for pedestrians - no traffic lights, no signs, no zebra crossing, they'll just STOP to let people pass. if you enter a building and look lost, and then start wandering down a corridor, people will say 'hold up, you look lost, surely i can help you?' and then INSIST on helping you. people's first response to you as a stranger is NEVER rude or standoffish or reproachful-for-no-reason. i might still disagree with the USA on certain things - the lack of public health for instance - but all of its inhabitants that i've met are classy, classy people.
okay i've blabbed for way too long. i'll leave it til tomorrow to tell you all about the hospital hierarchy here. you know what i mean - the resident/fellow/attending breakdown as opposed to the intern/resident/registrar/consultant breakdown (no, they're not quite equivalent). if i do it in this post, it'll be way WAY too long.