Countdown to July 1: Attending

The last July 1st with any significance is after the last year of residency. At that point, a resident (AKA house officer, physician in training, indentured servant, scut monkey, etc.) completes his training and is board eligible. If you ever wondered what BCBE stands for, it's 'board certified / board eligible.'

Uniformly, residents discover that they have a limit to the amount of residency they can take. After a certain point in time, residency becomes intolerable. It is a continual nightmare having your judgment questioned continuously, and having your clinical decision making process derailed by someone who potentially knows less than you. In fact, most residents in their final year may know as much if not more factual medical knowledge than their superiors.

But practicing on your own is a different beast. There's no one questioning what you're doing, but there's also no one to offer advice or reassurance. There's no superior to appeal to.

It is an intensely isolating experience, and all those years of medical school and residency suddenly feel very empty. I thought that I was ready to be an attending when I was done with residency, but what I discovered was that there is no preparation for being your own doctor. At some point, you have to trust that you are right, and that can be hard to come by.

Advice to the new attending:
-Sometimes making any decision is more important than being right.
-Never let them see you sweat.
-Do not pull the 'Who's the doctor? You or me?' card unless you really mean it.
-Most importantly, trust no one.

Graduation!

Freedom! by Noeluap

One of my patients said something funny in the clinic. She has survived breast cancer. Five years ago, she had her left breast cut off, lymph nodes taken out, chemotherapy done, and she lived with the sword of Damocles over her head for five long years. When she came to see me, a glow was about her. She could barely contain her excitement that it was time for me to order a mammogram. I had never ordered a mammogram for her. Her oncologist had been dealing with mammograms this whole time.

She had graduated oncology, as if oncology was some sort of perverse high school where the hazing of freshmen involves surgery and chemo, and graduation is accomplished simply by being alive after five years. The dropout rate is so atrocious that if it truly was a school, it would've been shut down long ago.

Now it was time for her to be followed by her PCP once again for the routines of life. She had spent five years thinking that the cancer would come back, that her days were numbered. She didn't think that it would be five years. She did not think she would graduate. Now, her joie de vivre was renewed.

"Dr. IFinding, when was my last cholesterol level? Do I need one? Because I'll be damned if I'm going to survive breast cancer just to die from a heart attack." I love my patients so much sometimes.

By the way, I've been putting up flickr pictures to accompany my posts. If you want me to stop, let me know. I think the pics add a little character to the posts, but I can certainly understand if you think they're a detraction.