See one, do one, teach one.
A recent blog post on KevinMD (a really great resource, check it out) brings up a very important point that I think would be useful for my readers to understand. It is regarding “trainees”.
A “resident” is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything. An MD is just a piece of paper saying you did your time in the lecture hall/lab. Residency is where you learn how to be a doctor. The term “resident” originates from the old days in which newly-minted doctors were actually living at hospitals in designated housing and caring for patients essentially 24/7. That doesn’t happen anymore but residents still work the equivalent of 2 full-time jobs and do all of the basic grunt work that actually helps you get better. If you go to an academic medical center for your care, you WILL be seen at some point by a resident. That is a large part of what academic centers do. They teach new doctors how to be doctors. Medicine is really learned more on an apprentice model than anything else.
Residency can last anywhere from 3 to 10 years, depending on the specialty. So a doctor training to be a surgeon will do maybe 4 years, plus maybe 2 years of research and then another year or so of specialized training in one area of surgery. An anesthesiologist does 3 years, plus an optional fourth year of specialization. Medical doctors do three years and then specialize with one or two more years.
So, if you see a resident, that person could be: a) straight out of med school; b) have a year of experience; c) be three days away from finishing residency; d) really really really tired. If you want, you can ask them what year they are. The less experience they have, the more supervision they will have; please don’t doubt this. It might not look like it, but the newbies are getting the close eye from an attending somewhere. The only way for them to learn is to do. So you the patient have a choice: you can roll your eyes and look at the poor guy with distrust and demand a more senior person, or you can be patient and allow yourself to be a teacher. Within reason of course – no one is asking you to let the first year do surgery on you. But let them interview you, try an IV maybe. When I gave birth to my kids I had people in various levels of training taking care of me. I had a med student interview me, I had a student nurse put my IV in (she missed once, but no worries, she got it the second time). I was happy to have a resident put my epidural in – I know they’ve done hundreds of them in the last week. If you go to an academic medical center for your care, you WILL be seen at some point by a resident.
There was an article in the New York Times a few weeks ago about a woman who used to be a nurse who was dying of cancer and, as a last act, called her alma mater and offered herself as a practice patient for nursing students trying to learn how to take care of dying people. An extreme example maybe, but instructive of the role patients have to play in teaching doctors how to do their work in the best and most patient-centered way possible.
You absolutely have a choice. You do not have to be cared for by a trainee. If you don’t want residents, go to a community or private hospital. If you go to a teaching hospital, in a way it’s understood that your job is to help teach. The attendings will make sure you are well cared for, and maybe you can help make a new doctor a better doctor.