Everything I Need to Survive in Med School I Learned in Kindergarten

1. Don't cut in line (especially for senior schedule appointments...not nice)
2. Don't be afraid to ask for help (for that IV on the Hepatitis C dude that you can't seem to get)
3. Be careful with sharp objects (like your suture-cutting scissors during a surgery)
4. Listen when others are talking to you (comes in handy with taking a history from a patient)
5. Tuck in your shirt (and don't have an attending have to tell you this)
6. Take turns (don't answer every.single.question that the attending asks, you just look like a smartypants)
7. Don't take things that belong to others (don't be jacking my gel pens! they are the best for charting)
8. Don't hit people...especially patients, even when they are annoying you. Although I must say my patients never annoy me the way my classmates do.
9. Wash your hands before you eat. And after you do a pap smear. Among other times.
10. Put things away when you're finished with them (don't leave your sponges and needles in anyone's abdomen)

Patient Autonomy

I have a patient on my current service who desperately needs a blood transfusion. For her own reasons which she has not disclosed to anyone, she refuses. Iron, Procrit, folate - she'll take these willingly and eagerly. But mention a blood transfusion and she shuts down totally. It's not to the point yet where she is going to deprive her organs of oxygen at rest, but she's bed-bound and any time she gets up she's short of breath because she has too few red blood cells in her vessels to pick up oxygen, so her body reacts by making her breathe at a faster rate.

The situation is complicated by the patient's psychiatric issues, which are incidentally not her primary reason for the current hospitalization. She has a health care proxy who has consented for blood transfusions, but the medical team is reluctant to infuse an uncooperative patient who could lash out at the nursing staff during the transfusion. Though we have orders from Psych to sedate the patient if necessary, no one wants to do that yet due to some other complicating issues pertaining to her care.

I told my fellow (doctor superior to a resident but not as senior as the attending) today that I thought I could convince the patient to accept the transfusion. She seems to like me, and I've cared for her every day for two weeks now. As the medical student I have more time than anyone else to hang around her room and chat, and in the mean time investigate her motivations and fears about her transfusion. Technically we already have a consent form in the chart for a transfusion, but if someone could get the patient on board it would be better all around.

When I mentioned this on rounds, the resident scoffed and reported that it was not our job to "babysit crazy patients" and insisted she had already tried to talk to the patient about the transfusion and she refused.

I was really irritated because the resident is lazy (the service has 6 patients under the care of 4 residents and 4 students; we have plenty of time to deal with these kinds of issues that go unattended on a busier week) and because she's writing off this patient as "crazy" because of her psychiatric issues.

This is a patient who is dealing not only with psychosocial issues and psychiatric problems, but is being worked up for a potentially life-threatening condition. She may be facing multiple rounds of chemotherapy. It is in the best interest of the patient to get her blood counts up to normal levels before the treatment begins. In this situation, the patient has been deemed incapable of making her own decisions medically, but that doesn't mean we can't try our best to get her on board with the best measures of care.

I get really irritated when I see this crap happening. Lazy residents are annoying. Dumb residents are frustrating. But lazy, dumb residents are a danger.

At least now I have extra motivation to convince this patient to accept a transfusion tomorrow.
It would look awesome on rounds to prove that resident wrong!