Cardiology

I did cardiology in December and need to catch up on the blog. This has been by far my least favorite rotation. I really like the subject matter (I find the heart to be fascinating), but I think I didn’t like the way my preceptor (Dr. A) conducted his practice.

Let me explain how the hospital system works (italicized words are medical jargon). In a big hospital like the medical center, when a patient gets admitted to the hospital, they are assigned what we call a hospitalist: an internal medicine physician that will coordinate the care of this patient during his/her stay. If the hospitalist has a complex patient (one that has several health problems or risk factors), they will consult a specialist (cardiology, psychiatry, pulmonology, etc.). The specialist then meets with the patient, obtains a history, and prepares a plan of care for the patient within their specialty (for example, a cardiologist only prescribes and writes orders for medications that will affect the heart). After the first day, the specialist will round: stop by every day, read the notes left by previous doctors, talk to the nurse about their progress, visit with the patient, perform a brief physical examination, and adjust medications or care as needed. I personally think that care could be much better if the physicians would actually meet with/talk with one another about each patient (because their handwriting truly is terrible and sometimes it seems that each does their own thing without taking into consideration what the other “teams” plan on doing). So a patient in the ICU (Intensive Care Unit) probably has several teams (heart, lung, infectious disease, etc.) coming to visit them daily (normally in the morning).

In cardiology, Dr. A is an interventional cardiologist, meaning that he will do cardiac catheterizations (where they stick a wire in an artery in your groin, lead it up to your heart, and visualize the arteries of the heart using a dye). If he finds that your arteries are 80%+ blocked, he will place a stent, or a narrow tube to keep your arteries open. Arteries that are 100% blocked result in what is called an Acute Myocardial Infarction (AMI) or heart attack. So he does this to prevent heart attacks or fix them if you come into the ER. This is a much less invasive surgery than a cardiac bypass (which is open heart: a stent placement results in a 0.5 cm incision that is not even big enough to need stitches, whereas in open heart they saw your chest in half). This procedure does not require assistance and takes maybe 15-20 minutes to do, so I observed a few but opted to go round instead. [We also did stress tests (running on a treadmill while checking the electricity of the heart) and echocardiograms (ultrasounds of the hearts), but those aren’t interesting enough to go into detail about.]

So in the morning I would go round with his PAs. I started to see my own patients (no worries, they would go back with me and read my suggestions and write orders if they agreed: I don’t have power to write orders as a student) and I LOVED that. I just love people and they were all very respectful and nice and I loved being able to teach them about their hearts (some physicians and even hospital-paid education counselors do a terrible job explaining medical conditions in layman’s terms).

In the afternoon, we would see patients in the outpatient clinic (inpatient = hospital, outpatient = clinic). Dr. A scheduled his patients for every FOUR minutes! I personally would call this poor medicine: what can you possibly learn in so little time? He has a skill to keep encounters that short without making it seem so short, but I imagine the patient leaves with several questions about his/her health. He also has an incredible memory about his patients (their professions, even the dimensions of their stents!), but his appointments consisted of a brief greeting, inquiring if they have had chest pain lately, checking the heart and legs (looking for swelling), refilling meds, and that’s it. So we would often get behind and things would get stressful.

I know I could never work for him because he works way too much and so does his two PAs. Dr. A works around 14 hours a day (thankfully he didn’t make me stay past 6) and his PAs work 12 hours days every day except Saturday, which is a 6-7 hour day. His family? His wife is doing additional training in periodontics in Ohio and their son lives there too (his wife is a dentist). He’s from a different country where I don’t think families and spending time with them are valued very much (I mean, he made his PAs work on both Christmas and New Year’s!). Anyways, one of the purposes of pursuing high education is to have enough marketable skills to work reasonable hours while providing a decent income. Considering that his PAs are on salary, they probably make less than minimum wage in hourly pay.

The other thing I didn’t like about this rotation was, well, my preceptor. I admire his intelligence and skill, but he was a mean pimper (pimping is asking questions). He told me that I don’t think fast enough and several other demeaning comments about my intelligence. He had a clear preference for a male student who spent a few half days with us who blurted out the first thing that came to mind, which was commonly incorrect. I tend to be more conservative in my answers: I like to think things through and make sure I’m right before answering, but it seems that my preceptor prefers speed over accuracy (but if I were a patient, I would prefer accuracy over speed). I had several discouraging days during this rotation in which I would question my intelligence because Dr. A clearly was less than impressed by me. In the end, I don’t think I dislike cardiology, I just don’t like the way my preceptor practices medicine. That rotation couldn't end soon enough.

I just completed my Pediatrics rotation and start Geriatrics today. I’ll write again soon!