Saturday, June 15, 2013

Invisible Consequences, The Fall Of The Clinician/Teacher

It was just like every other email I had gotten in the past.  A young student at a local university was interested in primary care, and wanted to shadow me for a month between his second and third years.  I responded swiftly.  I was delighted to bolster the interest in my speciality.  Over the years I had helped train students, residents, nurses, and nurse practitioners.  By exposing them to the office, hospital, nursing home, and hospice and palliative care, I felt I gave them a window into a nontraditional view of Internal Medicine.

He showed up on a Friday for clinic.  His excitement was palpable.  He jumped out of his seat, and trailed behind me from room to room.  But something was off that afternoon.  The patients were elderly and difficult.  Their problems were amorphous and complex.  I could see the fatigue and consternation after each visit, though he said little.

This is not how a student glamorizes the specialty when daydreaming about their future.  Eventually those that learn from me, however, realize this is a small part of the job.  They also experience the thrill of the diagnostic process, the humility of human interaction, and the privilege of becoming a part of your patients lives.

The student's gaze seemed especially trained on me when I was being distracted: the cell phone call from a nursing home in the middle of a visit, or the unending overhead pages pulling me away from what I was doing.  Time and again, though, his eyes glazed over most when I was typing on the computer.  The strain of meaningful use had altered my most intimate interactions.  As my patients were bemoaning their newest symptoms, I was busy clicking, making sure to print the after visit summary and patient education.

Meaningful use has been the tipping point, the beginning of the avalanche.  I was able to keep it together before.  Now, I have become a befuddled, frazzled, ball of stress instead of cool and in control. And this student saw right through me.

It's not that I don't enjoy teaching.  I encourage any who want to spend some time in my office.  But the number of emails has decreased dramatically. 

And like this student, those who do show up once, often decline to return again.

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