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Resident Physicians. Uh, what are those?!

July 29, 2009

Daily, I find myself explaining who I am to patients. Who is this young, inexperienced, excessively thorough, very slow-to-get-things-done but has-a-lot-of-time-to listen person standing before them? I’m a Resident Physician. I’m “the future face of medicine.” This video explains some of what I do.

Many residents work longer hours than their attending (supervising) physicians, so you may find us at all hours of the night, roaming the hospital corridors on our way to assess a new patient or with our pager beeping incessantly, warning us that we’d better run to Obstetrics to “catch a baby” or that someone needs our help in the Emergency Room. On Scrubs, resident interns are bleary-eyed, sarcastic, self-doubting, dependent and righteous creatures. On Grey’s Anatomy, we are ethics-violating, emotional hardcore nymphomaniacs who get lunch breaks at lunchtime. But what are we really?

A resident physician is  a person who holds an MD but who has not yet completed qualification requirements for either the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC). We need to have a certain amount of hands-on technical and patient experience as well as passing written and situational qualifying exams. Fully licenced physicians supervise us at all times. Depending on the speciality, residents will do 2 to 6+ years of training in addition to their medical school and undergraduate work. Wikipedia has a lot more on the topic.

In residency, physicians in training rotate through various specialities, with the focus being on their chosen field. For example, in Family Practice, we spend a certain proportion of weeks in our Family Practice community clinic. We might spend a month doing a surgical rotation, but the emphasis is on pre- and post-operative management and practising basic surgical skills, rather than learning about complicated surgeries that we will never be performing as CFPC-certified physicians. This prepares us for real-world management of our patients who are preparing to have or are recovering from a surgery, and to do small surgical procedures – such as the excision of a mole – in the office.

Generally we have, in our medical school years, seen patients of all kinds, but we lack the experience to make the judgement calls that seasoned doctors are able to. Likewise, we may have never met someone with a certain condition, though we’ve probably read about it in a textbook. The problem is, the diseases don’t read the textbook. Rashes never look the same as they are supposed to. Lab values often don’t correspond to what we would expect in the case of such-and-such disease. But developing heuristics, pattern recognition, and a collection of experience is exactly what we are working at. And we are profoundly trained in how to find the answer to a problem and knowing when to ask for help.

As a new member of the Professional Association of Residents of BC (PAR-BC), I’ve started thinking more about my role as an advanced learner, a new doctor, and as a patient in this province. That, and the fact that our contract is up for re-negotiation in the spring and there’s room for improvement. I’ll be writing about these three perspectives in coming posts, and how each will impact the nature of our new contract.

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9 Comments leave one →
  1. July 30, 2009 6:55 am

    Very nice post. I just forwarded it to my wife and her fellow residents.

    • July 30, 2009 6:59 am

      thank you! I hope they enjoy it too.

  2. Mark permalink
    August 3, 2009 10:06 pm

    I would add that resident physicians hold a licence to practice medicine from the College of Physicians and Surgeons of the jurisdiction in which they work, and are bound by the rules and ethics of that college.

    Also residency is not an observership and there is no lack of responsibility. We independently make decisions affecting patient care and are responsible for the results of those decisions. Sometimes they are simple decsions. To give tylenol or not? Sometimes a senior resident will, if it is within their level of competence, see a patient, do a complete assessment, arrange treatment, and may not involve the attending physician until morning.

    To me the progression of graded responsibility is the key to residency.

  3. August 5, 2009 8:19 am

    My Mom had pancreatic cancer and ended up in emergency when her stent came out and caused a massive infection. When we saw the first doctor he was so thorough, caring and explained everything so carefully…I kept thinking, thank god, finally someone who really knows how hard it was for her and her family to go through all the emotional and physical turmoil and pain of this awful illness. He was exactly as you described, thourough, and had a lot of time to listem…something that we hadn’t really encountered in her family doctor or a few of the attending physicians we had had to deal with.

    Please, when you become an attending, try to treat your patients with the respect and thoroughness of a resident;>) Your patients will appreciate it. Great blog.
    …aqua

    • August 5, 2009 8:30 pm

      Wow, pancreatic cancer is one of the toughest things a person (and their family can go through). I’m glad that you had an excellent resident caring for you. Though I hope to be more ‘efficient’ with time, asking more focused questions and completing the physical exam more smoothly, I too hope I don’t loose the thoroughness and respect that I have now.

      Unfortunately even residents don’t always have time to listen. When that pager goes off, we’ve got to run, but if we’ll make the time when we know it’s important.

Trackbacks

  1. A Cracking Grand Rounds! // Emergiblog
  2. Resident physicians, as learners « Dr. Ottematic
  3. How old am I?: Being both ancient and youthful in medicine « Dr. Ottematic
  4. How old am I?: Being both ancient and youthful in medicine « health care commentaries from around the world

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