Thursday, December 10, 2015

The Worst Question To Ask When Interviewing For Residency

What do medical students look for when they are interviewing for a residency spot? What sorts of questions should they be asking when they go on their interviews? Should they ask about the intensity of the patient workloads? Does the quality of the weekly conferences make a difference? Should they inquire about how many research papers are published by the program's residents? Or for the truly crass, should the students ask about the vacation schedule and salary?

I was walking through the hospital the other day and passed a whole gaggle of medical students coming for residency interviews. As they were being led by a current resident, she asked them if they had any questions. One intrepid interviewee then boldly asked, "Do you guys have a gym?" I almost stopped in my tracks as I heard that. It took all of my self restraint from reaching out to slap that idiot upside the head. The resident guide kept her cool and gamely replied that the hospital does not have a gym for the residents but that there are plenty of gyms nearby they can sign up for.

The gym question is so wrong on so many levels. First of all, while the ACGME has relaxed the rules for residency hours, it is still a total grind. You will be exhausted like you've never been exhausted before. You think you're tired during medical school but you haven't experienced total and complete mental and physical fatigue until you've gone through residency. What makes that person think he will have time to go exercise on a routine basis?

Second of all, if you did have the time to work out, you probably should be spending that time more wisely doing medically related activities, like reading and research. With restrictions on work hours, residents have even less time during their three to five year residency commitments to gain all the knowledge they should to become competent physicians afterwards. With the vast explosion in medical information, it is almost incomprehensible that anybody can adequately prepare to become a doctor in such a short amount of time. Going to the gym four times per week? Forget about it.

Finally, what does the gym question say about the priorities of that particular student? He is advancing his career to better understand the human condition and help sick people. But one of his main concerns is how the residency program will help him maintain his big guns and six pack abs. Though maintaining one's health is important, that is not the responsibility of the residency program. Find your own time to exercise in residency. Don't expect a program to offer five star hotel amenities. Remember, if the programs had their way they would still make residents work one hundred plus hours per week with every third night call. They couldn't care less if by the time you finish training you've shrunken down to a pale and ghostly 120 pound weakling.

Sure I knew some residents who could have it all. One of the smartest residents I ever met was in my residency class. She just blew everybody away with her intelligence and wit. She knew every question the attendings threw at her during grand rounds. She seemed to write up papers and abstracts on a monthly basis. And she always had great stories to tell about her latest activities, like kayaking around Catalina Island or surfing in Costa Rica. But I also think she was hyperthyroid and a bit manic. She only needed four hours of sleep each night, if that. So unless you plan on cutting your sleep by half during your training, don't plan on having much time for your workout regimen unless you don't mind being a mediocre resident. But at least you will look fabulous in the naked selfies you post on Snapchat.

Tuesday, December 1, 2015

I'm Already A Relic

If you know what this is, you are old.
At the age of 47, I am now officially an old anesthesiologist, a relic. I had an illuminating conversation with one of our anesthesia residents about the monitoring of patients while under sedation. Now mind you this resident is a CA-3 and smarter than a whip. He'd already easily passed the early board exam required by the ABA nowadays for anesthesia residents. We discussed the role of capnography, the physiology behind the pulse oximetry, and the indications for arterial lines.

Then I asked him about the precordial stethoscope. All I got was a blank stare. I asked him if he knew what a precordial stethoscope was. He replied that he thought he had read about it in a textbook once. Did he ever see an anesthesiologist use one? No. Not even during their rotation through Children's Hospital? No. Oy!

I then fished out my precordial stethoscope from my bag, which for some inexplicable reason I still carry around. He held it and gazed at it with befuddlement and amusement. He asked about how it worked. I explained that we used to have round double sided tape that fit over the bell of the stethoscope which was then affixed to the patient's chest wall. The earpiece was custom made for each of us with an actual mold of our ear canal. I showed him how my candy apple red device fit snugly and perfectly into my ear. With this stethoscope, I explained, the anesthesiologist can hear instant changes in the patient's respiratory and cardiac status without relying on electronic devices.

The resident just looked at me with bemusement and a little sadness. It's the pathetic look you give somebody who still treasures their old eight track tapes or AMC Gremlin. When we have so many electronic wonders at our disposal that precisely measure every important body function then automatically inputs the data into the electronic anesthesia record for permanent archiving, why would anybody still use an old analog stethoscope? How can a simple rubber tube connected to the ear possibly be of any worth to the modern anesthesiologist?

While the precordial stethoscope may not be "better" than all the electronic gizmos that we attach to patients, the level of intimacy we attain with our patients by actually having be physically close to them is itself informative. By sitting or standing next to the patient, we can derive information that is is not picked up by our electronics. Important things like the color of the patient's skin, pressure points that may cause injury, how a patient starts developing increased airway resistence.  Important information like this is easily missed when the anesthesiologist is only staring at his computer monitors or, worse, cellphone.

It makes me wonder about where the future of anesthesiology is heading. Are we all destined to become mere observers of the events unfolding in the operating room, like a security guard watching over a bank of video monitors in a department store? Or is there still a role for us to become more actively involved in the care of the anesthetized patient?