I need to learn a new technique for inserting a large intravenous line. As a resident I learned how to place these lines (used for medications and dialysis) in the groin or neck by locating the arterial pulse with my fingers, looking at the anatomical landmarks nearby, and then calculating in my mind where the vein ought to be. After a while I could reliably get a needle into the vein by “feel.”
Since then, a bedside ultrasound device has become part of the procedure, allowing you to actually “see” the vein you are aiming for—a pretty amazing difference from the way I learned. I’m told it’s awkward the first few times you try it, since you have to juggle the ultrasound and the needle while keeping everything sterile. So I asked my colleagues to teach me.
There’s an old saying in medicine about this kind of learning on the job: See one, do one, teach one. I’ll watch someone use the ultrasound. When I understand how it works, I’ll try it myself with some help. Then, before I know it, I’ll be teaching someone else how to use it. I believe this training system works pretty well for everyone involved (patients included). As the Nike slogan goes, you have to “just do it,” preferably right after you “see it,” to really get it, and then teaching it is the test to show you actually understand what the heck you just did.
But it does sound pretty scary from the patient perspective: You mean that someone is going to do something for the first time on me?
I have to admit there are situations in which I myself would prefer not to be on the receiving end of a “first time” doctor, and I am grateful to the patients who bravely held out their arms during my medical training and let me learn how to draw blood, for instance, showing me where previous attempts had succeeded. I also remember feeling jinxed by patients who, upon seeing me, ran through the litany of previous trainee failures and kept up a steady stream of withering comments on my technique, making me feel as if any attempt would be hopeless.
My favorite memory, though, is of one leathery old man I took care of at the VA hospital who really understood what a teaching hospital is all about. I tried to draw blood three times in one of his arms and failed. Three was my self-imposed limit. I apologized and turned to find a supervising resident. “Wait a second,” the patient said sharply. Expecting to be chastised, I turned around, shoulders drooping. “I got another arm right here, and you ain’t tried it yet! How are you ever gonna learn?”
That old man was pleased as punch when, on the fourth try, I managed to draw blood. But it is the rare individual who can, in their own time of illness, find the energy (and bravery) to be a teacher as well as a patient.
Comments (13)
Glad to see someone addressing this side of things. As a patient I make sure to inform my team about things they are unaware of many times such as prescription costs with and without insurance, unusual side effects because they need to know. But there is no doctor out there who can learn it all themselves, it’s our jobs as patients to help them as well.
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“one leathery old man I took care of at the VA hospital who really understood what a teaching hospital is all about.” — Thank God this patient understood what his purpose was – to make the Doctor’s life easier. My understanding of ANY kind of hospital is that it’s a place to take care of patients first and foremost. I understand that this article was intended to be a nice little piece on how Dr’s are human too and need to learn things just like the rest of us mere mortals, but this kind of language scares the hell out of me and backs-up the out-of-sync culture of hospitals where the needs of the Doctors are paramount to those of the patients.
Im a senior med student in Scotland, and its just as hard for a student to try to take blood as it is for the patient to experience it. Physically, its a simple task: needle, skin , vein, blood, boom; But mentally, ur thinking of the patient ” will i hurt them? ” ” I cant do it .. ” “Too many people watching ” etc.. its the nerves that get to us, and I thankfully learned during my GP placement from a young man who stuck his arm out bravely during my cries of ” are u sure? this is my first time!” ;p
Its a learning experience .. and im thankful to every patient, and colleague, who helps me through such times :)
I liked this article. I’ve been in hospitals constantly for the last four years, and finally I convinced a nurse to let me draw my own blood – fun! Ok, sadistic. But I have so much chronic pain, that I could care less about a needle. Is there a way in which to volunteer to be practiced on for procedures like this, in the US? I do some clinical trials, but that’s different than med students getting practice and learning.
@justiin
so your idea of the ideal system is that the current generation of doctors will be the last, as it is not in the patient’s best interest for doctors to learn new skills?
doesn’t sound like a great idea to me. unfortunately there are quite a few idiots like you who make training junior doctors difficult by refusing to let them learn new techniques. in my view you shouldn’t get the choice.
wow, @mike & @chris S, your bile is a little unsettling. My point was not that Dr’s shouldn’t learn nor was it that dr’s shouldn’t learn through a hands-on approach. I am not that much of an idiot. My point is that Dr’s need to be aware that it’s not the patient’s obligation to ensure the Dr they are dealing with is getting a good education. Patients do not exist for the benefit of Dr’s. My issue is that this last statement seems to be the norm rather than the exception in health care and that the author’s language is rhetoric that supports this bias. I agree that patients who are “cool” enough to help a new doctor out are good people, but I am not comfortable with any expectation that this should be the norm. Patients are in the hospital because they are sick/injured/in need of care. They are NOT there to teach you things. While very, very important, it should NEVER be the primary focus of a health care facility. I will ask you this: if you want patients to be the “teachers”, would you (assuming you are MDs) be comfortable if the same patients also graded you on your performance and that grade actually counted toward your ability to practice medicine? My guess is that you wouldn’t. Lastly, you don’t know crap about me or my experiences. I have spent plenty of time in teaching hospitals and I have been VERY happy to allow medical students, nursing students, whoever participate in my care and the care of my family. So please reconsider statements such as “quite a few idiots like you who make training junior doctors difficult”. I hate to say this, but for every story I have heard about patients making things difficult for doctor’s, I have about 10 where the exact opposite situation is true.
@justiin
fyi… over the past 5 years, all teaching hospitals (those that have residents and medical students) are REQUIRED to have patients grade those in the learning process.
Good to read this, I am one of the cool patients who have now had so many blood tests that it’s a joke to me and they let the new drs have try – some of them are terrified. They’ve got to start somewhere and I’m happy they want to be a dr, have had one chap shaking so hard I had to hold his arm still for 2 minutes because the needle was flying about and he could have lacerated both of us. Once i’d assured him that it wasn’t the end of the world if it hurt a bit, he calmed down and did fine. Another tried to push air into me and had to be grabbed by both supervisor and me shouting pull the syringe don’t push!
What matters most to patients is that old word RESPECT. I would far rather a newbie scared of hurting me than a cynic who thinks he’s HOUSE M.D and that i am taking up a bed.
Some patients are already frightened and want to be ministered to be an omnipotent being..most just don’t want a dr who thinks we are incidental to their career.
Play nicely with Justiin,he might have had a really bad experience.
My son is just finishing his third year in med school. This was his first year of rotations. He and I talk a lot about what happens. Mostly philosophically about what it means to the students, the patients, and society.
Funny thing is, all you trashing Justin, my son has views which tend to agree with Justin, not you. He is at times rather upset at the view that patients exist only to help doctors or students learn.
He has to do things the first time, and with real live humans. But, he never forgets it’s all about the patient, not his learning. If the needs of the patient contradict his learning for any reason, he believes he should wait until a more appropriate patient is available.
He was especially touched at his training pelvic. In the past, students did their first pelvics on women who were, frankly, unconscious for other reasons. It was finally realized this is unethical. (Yeah, duh!) His school went the new route, which is to pay volunteers. I think they were told the women got like $250 for each student, and were trained to tell the student if anything hurt or was uncomfortable.
He said his volunteer looked as if she were ashamed she had to do this for money. It is usually said the women are paid prostitutes, and he did not think his volunteer was, but a woman who needed money and felt this was a relatively good thing, unlike prostituting herself sexually. But, she still seemed a bit ashamed or embarrassed by it. He both apologized for his need, and thanked her when they were done.
Good for you, Justin. And, boo hiss for those who called him names.
I think all doctors can learn from their patients. BY LISTENING! Not everything is in a text book. And just cause a doctor hasnt come across something doesn’t mean it cant be possible or really true.Patients can teach their doctors alot,if they would take the time to listen to them. Not everything works the same on all patients. And all patients are not the same. So listen to what your patients is trying to tell you, you might learn something new.
I find it interesting how strongly some people react to what I have said here and in other forums on this topic. I must admit that while I am somewhat proud of being able to elicit such a response, I am pretty sure that I did a terrible job of making my actual point which was NOT that teaching hospitals are bad and should be eradicated and was NOT that residents are bad and NOT that all doctors are bad and, finally, NOT that new/junior Doctors shouldn’t practice on actual patients. These were all things that other asserted, either directly or indirectly. Not me.
My issue was with this particular phrase of the author’s rhetoric “one…man I took care of at the VA hospital who really understood what a teaching hospital is all about”. I ask you this: is a teaching hospital REALLY all about teaching new doctors? If you answered “yes”, then I would say that you forgot something: the care of the patients. I would make the dramatic (and from what I gather from the nastiness I have encountered, offensive) claim that ALL hospitals are REALLY about caring for sick/injured people. Everything else is secondary. Important, indeed, but secondary nonetheless.
The author wraps up her article with this statement: “rare [is the] individual who can, in their own time of illness, find the energy (and bravery) to be a teacher as well as a patient.” How true! This is indeed rare and it is a reality of dealing with people who are sick and afraid. When training our new Doctors, shouldn’t we be preparing them for this reality rather than hoping that the patients themselves will have some mass attitude adjustment? I would like to see that idea embraced and be so pervasive that a blog entry like this one is simply pointing out the obvious.
One last thing – @marylin – your bedside manner is lacking. I understand your anger, but I hope you reserve that for anonymous internet postings.
i m girl i m 14 years old i like to be a doctor when i grow up if god say inshallah god wish
Thanks for the great article. I know that physiotherapists in training have to spend some time (as part of their training) being “patients”. For example, to spend a day in a wheelchair to see and feel (at least a little bit) how their patients see and feel.
I think there is something like that in medical schools, but I am not sure. My personal opinion is that until healers will understand what patients feel and become patients themselves, they can not be true healers. Cheers!
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