How to get good healthcare, Part V

The Bottom of the Hierarchy

Previously I made reference to med students, interns, residents and attendings. Let me explain something about hospital hierarchy. Medical students have all finished college. They may have masters degrees or PhD’s. Unless they’re some kind of Doogie Houser, they will be at least in their mid-twenties or much older. It can take years to get your resume in shape and numerous trials to get into medical school not to mention the divergent paths that lead folks into medicine. While plenty of these people are normal, some are intellectually and emotionally entitled requiring constant affarmations of their good work. This is probably why they do what they do in the first place.

Once graduated, the med-student gets an MD and goes on to become a resident. While they can now call themselves a “doctor,” they will be practicing under a temporary medical license as an “intern.” The internship, the first year of residency, can be the hardest year of a young doctor’s life. They frequently will work in excess of a hundred hours a week and may be severely sleep deprived. They will look tired, disheveled, their pockets may be full of papers, they probably have more than one pager on their scrub pants and they may be freshly fucked having just emerged from the broom closet with one of the nurses or better yet, nursing students. They are the nuts and bolts of a hospital doing the jobs that no one else has the energy to do at all hours.

How to Get Good Healthcare, Part IV

Your Team

This team is your team. Let them work for you. So many patients refuse to see students and residents. What a huge mistake! There is plenty of evidence to suggest that you might get better care at a teaching hospital. It’s not because the attending (boss) doctor at the university/teaching medical center knows so much more than somebody else at the community hospital (where they too may have residents). Rather, it’s because you have so many people taking care of you! Your little 25 year-old med student may be the person who knows your case best. Shit, they might be the only one who got any sleep last night. Try to let them take care of you.

In no way am I saying you should let a med student do complicated procedures. If you’re headed to surgery, make sure you know who’s on the team and who is doing the surgery! Unless you are in rural Africa (and then you’ve got other problems) you will not have a med student doing surgery on you. The chief resident, however, might be taking care of you. Try your best not to insult the resident by calling him or her a student.