Friday, November 20, 2009

Halstead is Dead!

I was called to see a patient urgently. Of course I got there and started to take care of the emergency and once things had calmed down, I went to the chart which of course meant logging on and slowly making my way through all the HIPPA screens and then the whole thing crashed. About this time the resident of the service of whom the patient was on came in and I started asking him what her labs were and her past history. I got a shrug and he said that he would get the intern as he might know. It was all I could do to no take his head off right there. (It is the kinder more gentle era of medical education where incompetence is met with, please do better next time and I hope that your feeling were not offended!) This is the new"team" way of teaching medicine. You only have to work a certain number of hours and no one is really the boss or responsible, the patient is "the teams" not a specific doc.

I know I am dating myself but we trained under the halstead principles. We were expected to know everything about our patients and be able to recite their labs, history etc from memory. We drew their blood, we pushed them to the OR and got to know their families like they were ours. For all intents and purposes, we lived at the hospital. Everything about our pateints was our responsibility. If we failed in that responsibility, punishment was harsh and instant. We weeded out surgical residents with only a few surviving to the top of the pyramid.

Now we have a scary trend of shift workers and a mentality of not being totally invested in patients that is slowly creeping into medicine. The Halsteadian code of ethics and responsibility is being eroded by "its not my responsibility or someone else will do it". We cant reprimand or even fire bad residents because they can claim to be ethnically, sexually, intellectually discriminated against. When I am sick, I want an old school doc, not one of these time card pushing, Union docs.

2 comments:

SeaSpray said...

That IS scary Throckmorton! It does not instill confidence for ever going to a teaching hospital for critical care and yet that is exactly where patients HAVE to go.
And on top of that if one has to ..I suppose if they could choose their surgery times..they would not want to have the new residents until maybe the following winter..early/late spring?

Actually..if you don't mind answering this..What is the optimum time for getting surgery in a teaching hospital? I have heard..you never want to do it in June or July... because they are too new.

Back to what you are saying...WHY are things going this way? I knew about the hours being cut.. but what about responsibility? Makes NO sense.

I think we learn the most when we make it through the tough experiences. I would think that in your profession it would be counterproductive for the good of all to be a coddled resident.

I agree with you.. old school doc for sure!

The surgeon that works on my case is amazing for so many reasons.. but then I've already said that here. But, he impresses me as the type you talk about..the dedicated, invested doc and no doubt trained under the Halstead principles.

I am so tired of the discrimination stuff when used wrongfully. High expectations/standards HAVE to be met because human LIVES are involved.

I got a much needed laugh when I read "It was all I could do to no take his head off right there. (It is the kinder more gentle era of medical education where incompetence is met with, please do better next time and I hope that your feeling were not offended!)" and appreciated the much needed laugh. :)

Hope you don't mind because I know it's a serious matter..just the way you said it. :)

Chrysalis Angel said...

Amen!