Residency Protection Program

This is dedicated to all the new private attendings who are seeking escape.....

A former co-resident and I were recently discussing some of the differences between residency and private practice (or in my case - locum work).   We found ourselves commiserating about some of the very difficult patients we had had to care for recently.  Difficult not because of perplexing health issues, but due to sometimes overwhelming social and "other" issues.

Take my patient: a woman in her mid-twenties with 45 medical allergies and a history of 15 or so previous surgeries, now complaining of pelvic pain.

The words "pelvic pain" can truly strike fear into the heart of any gynologist.  As real as this entity can be, it is often confounded by physical abuse, social and emotional factors and other health problems.  Not to mention malingering or secondary gain.  It's frustrating for patient and doctor allike and sometimes requires a trial and error approach. 

It made me think back to the days of residency and how - subconsciously - we often tried to "run the clock down" on these patients.  "Get an ultrasound and see us back in 2 weeks."  Which often meant - "I will be on vacation then," or "Maybe the next person will have some clue what the heck is going on." 

In the post-residency world - there is no hiding, no evasion maneuvers.  You are responsible for your patients for all their good and bad attributes.  You can't give them to your partners, you can't avoid them by cancelling office or being on vacation.  They will find you.  If you practice in a small town - they will probably find you in Wal Mart.  :0)

Likewise, you are their physician, whether you have the answers or not.  If you don't have the answers - and sometimes you won't! - at least know where to look it up.  And who you can call later to share the good and the bad.

So, a bit of advice to all my readers who are still in residency: beware the consequences of hiding from your patients.  Learn well how to deal with the difficult patient, the depressed patient, the abused patient and the patient with pathology.  Learn now - because these patients will soon be looking for you.....