Posted by Dr. Vollmer on April 8, 2015
Another rant about how the world of medicine has changed. In my era, we saw inpatients, which meant that we saw the same patient every day. That patient expected Shirah to show up, and not the “doctor.” Some patients would track when I was on call (sleeping in the hospital, resulting in a 36 hour shift) and they would have the nurses page me in the wee hours, because they wanted to talk to ME, not the doctor on call. I would have seen that patient hours early, during “business hours” but as we developed a bond, he began to see how talking to me relieved his anxiety, as we developed a trust which grew out of spending many daylight and nighttime hours together. Seeing these patients was more than my job, it felt crucial to the well-being of these hospitalized patients. I, like my colleagues at the time, would never think of “leaving early” or “coming late” as we understood that specific patients were counting on us to be there. It was as much my personal integrity, as it was my professional duty to show up and work my grueling hours. Fast forward thirty years and inpatient psychiatry has dwindled, making the Resident’s experience, mostly outpatient. As a result, the Psychiatry Resident never sees the same patient every day, nor does he/she see them every week. Patients are shuffled like cards and they may or may not see the same doctor, at a frequency of once a month or longer. Consequently, Psychiatry Residents do not have the same work ethic, as it is not as critical that they be on time, or show up for a particular patient. The environment changed, and so did the working style. I do not blame the Residents, as I would be just like them, if I were working in today’s environment. Patients depending on you is different than a clinic depending on you. The problem is not that millennials were raised with entitlement, although that may also be at play. Rather, the problem is that the work is no longer personal. If you change the game, then you change both the people who want to play, and how the players approach the interaction. Duh?