Saturday, October 13, 2007

Saturday Reflections

If you ever have to be admitted for care at a hospital, the chances are good that you will be cared for by young people. Specifically, most of your physicians will be young. (Important note: thus far all of the hospitals I have been in are teaching hospitals; my comments therefore are affected by a skewed sample set. I will share with you my observations anyway.)

You might think that you would want an older, more experienced doctor to care for you when you are sick enough to be admitted overnight. On the surface, I would too. But I'm beginning to realize that the lifestyle of a care provider who works in a large inpatient hospital just is not compatible with having older on-call staffs.

Fortunately, saftey does not appear to be an issue for patients at teaching hospitals. Such care centers have many many checks built into them. This is one of the reasons a hierarchy needs to exist in medicine. Stratification varies between hospitals; consider the following hypothetical care structure.

One medical team may cover 30 patients on three services and work with three attending (medical faculty) physicians. Each of those attendings may have responsibility for 5-15 patients. The team is run by two or three senior residents; they've been on the wards for two or three years and are nearly finished with their training. Then there are 3-5 interns, sub interns and junior residents who are the workhorses of the team; they have direct contact and primary responsibility for the medical care of 4-6 patients. Usually teams only have 1 or 2 medical students, who do recommend care for their 1-3 patients, but also are learning and need approval for anything related to medical orders. We students can spend more time with the patients and families and can track down information important to them or the medical team.

All of us on the team spend some of our time working 'on call,' This also varies between hospitals, but basically means we work around the clock to admit new patients and cover for the care of other team members' patients. The on call part is what selects for young people. We are generally more physiologically equipped to stay alert for 30 hours straight every four days and have less social commitments (family etc) than our older colleagues. Yet between age 25 and 35, we are mature enough to handle responsibility and have learned enough to be competent.

I think that's why your hospital doctor is so young.

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