Training grounds



The hospital is the training grounds for interns.

I was confused.  It started in the emergency room, and it continued after Christopher was admitted.  Different doctors all claiming to be "Christopher's doctor" kept showing up in his hospital room wanting to exam him and offer a diagnosis.

Sometimes they came alone or with a buddy, or sometimes they came in groups.  They all wore white lab coats with the letters "MD" emblazoned next to their names.  It all seemed legitimate to me.  Each one of them said they were working on Christopher's case, but the funny thing was they often disagreed with one another and were quite hostile with each other.  For example, at one point a doctor came in and announced that Christopher was going to have surgery and then left.  I, of course, was quite upset, but then the next doctor came in.  He asked me what was wrong,  I told him, and then he proceeded to tell me that it was not true.  He said the other doctor didn't know what he was talking about.  I remember thinking...that might be true (actually in this case I hope it is), but I don't get it.  How can two doctors working on the same case be so diametrically opposed to each other about something pretty serious- whether or not my son needs surgery!?!  Who do I believe?  What is going on here?

As you can imagine I started to get a little "worked up" again.  I felt that inner "momma bear" getting a little uptight.  Now what do I do?  I decided to ask the only person I had met that I felt like I could trust, the GI doctor.  I asked to have a meeting with her, so that I could find out just how this hospital worked.  No more wondering and guessing.  I felt silly and stupid for not knowing how hospitals worked, but my baby was really sick.  There was no room for error.  Besides, they didn't seem to be able to agree on anything.  Maybe she could shed some light on the problem

It turns out, that the meeting was just "what the doctor ordered" (pun intended).  She explained that this was a teaching hospital.  That meant that doctors in training would be helping with Christopher's care.  There would be medical students (not real doctors yet) and residents (real doctors, just very new) helping  work on his case.  Okay...so I asked her if there was some kind of doctor totem pole here?  She said there was.  The medical students were at the bottom.  The residents were in varying degrees of residency.  Each resident was some where in the midst of a 3 to 7 year program.  They ranked according to what year and what type of specialty they were involved in.  There was also a senior resident or "doctor in charge".  This person was the leader of the resident "gang", and answered directly to the attending.  An attending was a full-fledged doctor who was post residency, and was responsible for managing and training all the residents. The attending was definitely the top of the totem pole.

The next question that came to my mind was...who is Christopher's attending doctor?  I want to talk to that person!  She said she was the attending doctor under the Pediatric GI specialty team.  Here came my next question...is there more than one team?  She told me there was.  It all depends on the type of care your child needs. There were doctors on all sorts of teams including: pediatrics, surgery, infectious disease, cardiac, oncology, and on and on. 

Then I asked if the residents were allowed to make major decisions (like doing surgery on your baby) without the consent of the attending.  She said that under NO circumstances were they allowed to make decisions on their own without consulting and getting permission from her.  She reassured me that she understood my concerns, she would address them, and that she was in charge!

Now I understood how all this worked, and I felt much better.  The halls of this hospital were their training grounds.  It makes sense.  I guess they have to learn somewhere, but do they really have to learn on my child?  I wondered why they don't explain all this to people when they are first admitted.  It seems like it would help to avert a lot of misunderstandings.  It certainly explained a lot about that "ping pong doctoring" in the emergency room.

I was glad I had talked to the GI doctor.  I was VERY glad she was Christopher's attending doctor.  It's good to know someone at "the top".


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More tomorrow...