Sunday, April 1, 2012

Looking over your shoulder

Right on the dot, our consultant for the Wednesday’s Consultation-Liaison (CL) rounds came into the department office.

Looking absolutely chic, and totally unruffled, she breezed into the conference room in a no-nonsense outfit of a blue and black corset-top and pants ensemble with matching nude pumps and Louis Vuitton bag.

My co-residents and I were slightly anxious, as certain aspects of the rounds we had with her from last month didn’t go that well. She had high standards, and well, that always kept us on our toes, which is always good, I suppose. Anyway, I had three patients out of the cases that we were going to discuss for the week, which was why I was on edge. I could present any of them, at any time.  

While taking out my notes from my clear book file, I caught my co-resident, Mer’s eye and mouthed, “I just want to get through this day…and then after that, I’m fine.” Mer  gave me a quick nod and a grimace (he was anxious too).  I smiled nervously. “Well, here goes,” I said, and then heaved a sigh. She was my supervisor, and she had a reputation for having high standards. I, of course, did not want to disappoint.


As it turns out, I didn’t get a chance to present any of my 3 cases.  Which was just as well…I didn’t want to do it that day, what with all the interns sitting in with us, my co-residents also concerned with their own cases.

My insides were in a terrific coil. I had to leave five patients at the out-patient department for screening because I wanted to attend these rounds. Bien, one of my co-residents, who didn’t have any admitted patients at the time, covered for me so I could sit in with this consultant.

Minutes later, when it was all done, I gathered up my papers, excused myself, and told her that I would be back for supervision by 12 noon, when all the activities were done.

Thirty minutes past 12…I got a call from one of my co-residents, telling me that my supervisor was looking for me. In the middle of wrapping up my screening interview with a patient, I could feel the familiar racing of my heart, knowing that she was really strict about time and schedules, and therefore, I had to be there immediately.

She was sitting with the others, eating lunch, with perfect poise and manners…not a hair out of place. I had to pause for a few moments so I could catch my breath.
(I suppose the only visible signs of my anxiety during that was the thin sheen of sweat on my forehead from the exertion of walking and the slight flaring of my nostrils. :-p)
She calmly told me to eat lunch first so we could talk longer about my cases.
We only had 45 minutes (as per schedule, of course), so I requested that we continued with my self-supervision during the next session and so we could talk about more pressing problems, i.e. my admitted patients. She obliged, and listened patiently while I introduced my 3 cases.

What followed was a careful critiquing of my management and how I handled my patients so far. From discussing the case with her, I learned a little more about the intricacies of how to manage my patient. She pointed out details that I had not really focused on, but were important nonetheless. My management done and medications given, along with my rationale for doing so were talked about.

“I did not want to put my diagnosis like that ma’am, because it would look like I hadn’t made a decision…” I started to say.

She smiled, and said, “It’s not about you, S., it’s about your patient…it’s always about your patient.”

And then, before I knew it, we were done with the week’s supervision.

I smiled contentedly. “Wow, “ I thought myself, “now this is what you call learning!”
In the span of just a few minutes, I learned a few techniques from experience, I learned how to look at certain things from a different perspective, and most importantly, I had more handles on how to tackle a problem that seemed simple enough at hand, but was actually a little more complicated.

I now understood what Dr. ALJ meant when learning was supposed to be done in the context of having someone “looking over your shoulder” while you dealt with a patient.

As with everything in life, it is not all about book-learning. Oftentimes, we benefit from the experiences of more seasoned teachers, who help us process our own experiences.

Note: Screening is a procedure at the out-patient department where we first diagnose a patient and then assign them to a resident-in-charge. Psychotic cases go to the juniors (i.e. first year residents), and non-psychotic, medical cases go to the seniors (i.e. second years.) Supervision is the learning process where a consultant is assigned to a resident, and they meet regularly for discussing cases. Usually, during the first few sessions, the resident undergoes “self-supervision”, where he/she gets to discuss his/her own history and process why he or she reacts to certain ways, and undergoes certain countertransferences.

The “past is prologue”, after all. :-)



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