Free At Last?

Pretty much the whole of the time I was behind bars, I was looking forward to getting out (I'm sure I'm not the first guy to say that). But now that I'm out, there are some things I miss.

I miss the freedom. That might sound odd, but behind bars, I was allowed to practice medicine with great (and sometimes total) autonomy. I scheduled patients when I thought I needed to see them. I saw them. I examined them. I diagnosed them, and then I prescribed them medicines. I did whatever my meager medical knowledge could conjure up. If they got better I didn't see them again. If they didn't, they came back and I gave it another try.

Of course we were supervised, but it was mainly from afar, when the preceptor read through our notes on his computer screen after the patients had already been seen.

Now that I'm out, I realize the good and bad of that experience. The good was the chance to do it all, and do it myself, to sink or swim. The bad was I was probably sinking sometimes without even knowing it, without getting the feedback I needed to add some wisdom to the experience.

Now, at my new clinical rotation, I have to wait for permission to see a patient. Some of them are deemed beyond my abilities, and I never get in the same room with them. The ones I do see, I don't treat. I gather the chief complaint, do my exam, and then go find my preceptor, to "present" the patient in traditional medical student manner ...

"I have a 50-year-old white male with a history of blah-blah-blah, complaining of blah-blah-blah." ...

I make an assessment, and then offer my plan of treatment. Then the preceptor goes over my plan and its shortcomings, makes suggestions, and asks me a question or two. Then we go see the patient together to finish off the encounter. The preceptor may do some extra physical exam (or repeat the same one I did to double-check me) and ask a few more questions as I watch. Then he or she explains the plan to the patient and answers any patient questions. Then we're done. As we leave the room, I have a chance to ask my preceptor some more questions and talk about the case a bit.

It's much slower than behind bars, and I see fewer patients. But the encounters are built for learning, not for speed. I also feel a lot dumber, or more precisely, I experience my ignorance in real time.

When I present the patient, I usually realize I gleaned only a fraction of the info I needed to gather when I was in there interviewing. When I say my plan out loud, it doesn't sound nearly as solid as I thought it was. And when I get called on it, I feel just plain dumb. The preceptor doesn't intend to make me feel stupid. He's infinitely kind. I just feel ridiculous sometimes, as I should.

I gotta say, I'm learning a lot more, and the supervisory environment is way more appropriate and professional. But when I'm standing here twiddling my thumbs, waiting for someone to give me a patient (and sometimes begging someone to give me a patient), I miss the free-wheeling days behind bars, when it was just me. When I looked at that schedule that I'd made, and called in the next patient who was counting on me to make him better. I had little fear, few limits, and no chains binding me. I was doing it, and it felt great.