Outside of Seattle Grace…

… medical residents see patients who actually look sick, and not just actors with slightly pale complexions and overly dramatic spouses. For the last day of my most recent hospital volunteering gig, I shadowed a group of general medical residents on their morning rounds. As much as I suppressed the images of rounds I had from Grey's Anatomy and St. Elsewhere, I still pictured a semi-orderly series of patient visits, interspersed with questions about what conditions the residents would consider with certain findings. Though my Pathophysiology course this spring only covered the most common diseases, and skipped over some key systems (the GI system and reproductive system), it was rewarding to be able to follow some of the residents' discussions and to see a variety of non-surgical patients. (I had spent months seeing all sorts of hernias, hearing about colonoscopy preparations, and learning about hysterectomies - it was good to have some new sights).

When I worked in the preoperative clinic, I found that one of the anesthesia residents was fond of pointing out "interesting" details in a patient's history or showing me what physical findings were abnormal (such as a loud systolic murmur whose "whoosh do whoosh do" I can now distinguish from the moderate, even "lub dub lub dub" of a normal heartbeat). During rounds, I noticed that some of the general medical residents made a point of talking to me about cases that to them illustrated a major clinical issue. One such case was a person who had a serious allergic reaction to a prescription drug. The resident mentioned this case not only as an example of a serious immune reaction, but also to make a point about how unnecessary prescriptions of antibiotics can raise the risk of an allergic reaction.

While the practice of pointing out clinical curiosities may seem like it reduces people to abnormalities, seeing the manifestations of a disease (or a combination of conditions) in a real person broadens the sometimes narrow image of an illness that one gets from a textbook description. Even reading a person's lab values does not always give a complete picture. One resident noted that a sick person "looks sick." That may sound obvious, but it does highlight the importance of looking at the patient and talking to him/her. We can learn a lot from lab values and vital signs, but every person's body responds differently, and some people do not follow "textbook" patterns or our preconceived expectations. One of the preoperative patients I remember best was a man in his 80s who I assumed (based on his medical history and age) led a fairly quiet, less active life than in his youth. He proudly announced that he still did household renovation work. That certainly taught me the value of a thorough physical activity and occupational history!