By Susana Vargas-Pinto
Sign out. Rounds. Run the list. Check labs and images. Do the orders, start the notes and check my ‘to-do-list’ boxes for the day. Done! A series of events perfectly orchestrated during years to take care of our hospitalized patients and begin a new relationship with those coming in for their operations that day.
As an intern I had my checkbox list to fill so I could make it to the OR on time. I thought of myself as the guardian of our floor patients and prided myself on “getting everything done” for the day. I spent countless hours with the electronic medical record (EMR) but not as much with our patients. A recent observational study using direct time-motion observations of interns from 6 mid-Atlantic internal medicine training programs, participants of the iCOMPARE cluster trial showed that first-year residents spend 10 hours over a 24 hr period on indirect patient care. Most of this time was spent working on EMR and multitasking. While surgical residency programs were not included in this subgroup analysis, and the study could not determine if this had a positive or negative effect, if you ask any surgical intern what do they dislike more about their job many will say the number of hours dedicated to EMR documentation and other aspects of indirect patient care.
As a junior resident I devoted many hours to studying and learning the operations for the day, seeing all the consults and getting the patients ready for surgery so I could “earn” the privilege to do the case at my chief residents’ discretion. How irritating were the times when a chief will show up after I have been working hard and staff it with the attending physician and “take” the case from me… I certainly didn’t understand well their responsibilities at the time. Throughout the years, residency felt to me as a series of steps you methodically follow according to your post graduate year level, like a ritual or a standardized protocol to become an independent surgeon.
Then, chief year happened. Neither Sabiston nor Cameron taught me how to run a service with different and at times very conflictive personalities. There was no chapter on paying attention to your interns, identify the areas where they struggle and come up with a plan to help them improve. Nor any guidance on how to organize the week so everyone can have a fair amount of operative time appropriate for their level, ensure no one breaks duty hours, and keep things going when someone gets sick or their children are sent unexpectedly home from daycare and the babysitter can’t make it.
Having discussions with the attendings and consultants in regards to differences in patient management in a respectful way and to earn their trust while taking care of their patients was important to me. I began to see patients more as fellow humans whose fragility have placed them in my path rather than cases. They had a need and I had something to offer. I started to inquire more about their wishes, their understanding of the procedure they were about to undergo, and spent more hours on the phone with a family relative who was worried to death about their loved one and could not be there for them. My junior residents may continue to complain our morning rounds may take longer but I feel we need to listen more to the patients. Chief year has enriched my life in many ways which are not described in the textbook. In a sense, I feel I am becoming human again. In a sense, that passion I felt when I got my first white coat placed is growing back and I love it.
Dr. Susana Vargas-Pinto was born and raised in Puerto Rico. She obtained a Bachelor’s Degree in Industrial Microbiology from the University of Puerto Rico at Mayagüez, Puerto Rico. She then earned her Medical Doctorate from Ponce Health Sciences University in Ponce, Puerto Rico. She is a Chief Resident at the General Surgery Residency Program at the University at Buffalo, in Buffalo, New York, and will train as an Endocrine Surgery Fellow at Yale University School of Medicine. She enjoys teaching and mentoring medical students. Dr. Vargas-Pinto is also a member of the Gold Humanism Honor Society, a wife and mother of a 3-year-old.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.