failures

During the first two years of med school, we went to the hospital each week and interviewed a patient. I liked the conversation and experience, and disliked never seeing them again, especially since the interaction was purely for the purpose of teaching us; we weren't involved in their care in any way. So it always felt a bit one-sided, and I mentioned a few times to people that I disliked the drop-in feel to it. I interviewed one patient who asked me to come back and say hello; he came back to the hospital regularly for chemotherapy. Given this chance, I thought I'd actually have something to offer. So I had my first (and only, at least before the wards started) second visit with a patient; we talked for a bit and planned to talk again right before winter break. But when I came back with chocolates to share for the holidays, he wasn't there; the chemo must've been re-scheduled. I checked one more time the next morning, but wasn't there. That day I went home for a few weeks, immersed in chaotic family friends and studies, and came back to more chaos of second semester of second year. In the midst of it, I kept thinking I should go back and see how he was, knowing that he was supposed to undergo an operation right after break. But I was perpetually tired and busy, and in the moments in between that I was lazy. So I never did see him again, and since his cancer didn't have a great prognosis I'm left with mostly doubts. I still have the chocolates, keeping them as both a trivial means of assuaging my guilt and a reminder of my failure to actually take the opportunity to do what I say I'd like to.

I was reminded of this today, when I saw a teenager with strep. Despite my very recent post about how we should read patients' charts, especially in primary care which is ideally continuous care, and address chronic issues at each appointment--I've already fallen into the established routine, of reading the two-line chief complaint written in by the nurse upon the patient's arrival, and checking the chart and problem list only when seeking certain information. Despite my confusion about why we don't ask about a patient's depression each time they come in, for something like back pain, I don't think to consider that each new patient I see might have similar problems. Despite my discomfort with purely focused physical exams and our school's emphasis on observation, I get caught up in the problem at hand and today, the red throat caught my attention more than other concerning findings. It's not that I missed them; I saw them, and for whatever reason, made in a half-second the decision not to inquire further. After the patient had already left, I looked at her chart again and discovered that this was a recurrent, chronic problem. To be fair, it wasn't listed in her problem list, an issue I brought up before, so I had to write that in, but it was in several notes from her previous visits. This is the sort of thing I've so recently thought and wrote so much about, the need for follow-up and detailed, wholistic care. I neglected the opportunity to address it, and not because I didn't have time--as a student the only thing I have more of than doctors and nurses is time--but just because in three weeks of outpatient care I've fallen into a habit of sacrificing depth. It's not that there haven't been models of comprehensive care; I've found the PCPs to be incredibly caring and mindful. It's the pace of things, and the necessary narrowing of things, that pervades all of current healthcare that has become practice even despite my mental barrier to it.

I hope hard that these experiences remind me not to repeat the same mistakes, and push me to try harder, because I'm disheartened that they happened so early on when we're supposedly at the height of energy and time. And it's okay, don't comfort me! I know we're all hard on ourselves; this isn't so much for the present me as the future me.

In the end I wrote out my first prescription (penicillin), asked our social worker to give her a call and follow-up, and stared at her chart for half an hour. It felt about as empty as not eating the chocolate.