{"id":19853,"date":"2013-01-06T08:59:08","date_gmt":"2013-01-06T15:59:08","guid":{"rendered":"http:\/\/bigmedicine.ca\/wordpress\/?p=19853"},"modified":"2013-01-06T08:59:08","modified_gmt":"2013-01-06T15:59:08","slug":"vintage-big-med-b-schwartz-on-becoming-senior-germanic-terms-that-make-us-sound-smarter-than-we-really-are-jan-2008","status":"publish","type":"post","link":"http:\/\/bigmedicine.ca\/wordpress\/2013\/01\/vintage-big-med-b-schwartz-on-becoming-senior-germanic-terms-that-make-us-sound-smarter-than-we-really-are-jan-2008\/","title":{"rendered":"Vintage Big Med – B Schwartz | On becoming senior & Germanic terms that make us sound smarter than we really are – Jan 2008"},"content":{"rendered":"

On becoming senior & Germanic terms that make us sound smarter than we really are\u00a0 by Blair Schwartz<\/strong><\/em><\/p>\n

[Jan 28 08]<\/p>\n

Ok, I know\u2026<\/p>\n

It has been quite some time since I wrote anything for Big Medicine.<\/p>\n

Its not that I lost my passion for writing, nor due to the absence of several much appreciated e-notes from the editor checking up on me for signs of life. It’s just quite simply that between a ridiculous in-hospital schedule, the occasional shift on the ambulance, reading enough to ensure my patients in both domains survive and trying to maintain something resembling a life, I didn\u2019t really have the time to write a proper entry.However, thanks to the government sending me in exile for one month of community internal medicine and intensive care practice (more on this in an entry to come), I find myself with some time to spare. So I figured I\u2019d sit down at the laptop and instead of reading this week’s New England Journal, I\u2019d put some thoughts down on a *.doc file and share them with you.<\/p>\n

Since I last wrote, there has been one major change in my medical \u201ccareer\u201d\u2026 I\u2019m now a Senior Medical Resident. I\u2019d love to say that there was some kind of evaluation or examination preceding this vaunted transition, but the reality is that along with most things in academic medicine, it just sort of happens automatically on July 1st<\/sup>. Along with the nifty title however comes some responsibility. After 17h00 and on weekends, I am now the go-to guy for all things Medicine in the hospital. I\u2019m the one the medical students and junior residents come to review admissions with, discuss concerns about crashing patients, provide medical advice to the other services and lead the cardiac arrest resuscitation team. All this as a Senior Medical Resident!!! Makes you wonder if that also entitles me to have a \u201cSenior\u201d moment, but also what it means to be senior.<\/p>\n

There\u2019s an old EMS joke that goes \u201cJust because your partner\u2019s certification date is before yours, doesn\u2019t mean they know what they are doing\u201d. While we can ALL think of individual cases in which this axiom holds true, there is something to be said for real life experience. Whether it be skillfully titrating the Narcan in a chronic pain patient as Norm Rooker so eloquently described in his column, knowing that 20+ sprays of nitro to the hypertensive pulmonary oedema patient will prevent you from intubating him long before the IV is in and the Lasix and Labetalol are on board or simply knowing when to load and go. No matter how modular, problem based or dressed up we make our training programs there are still some things that can\u2019t be taught and herein lies the role of experience.<\/p>\n

Medicine is no different.<\/p>\n

People often ask me why an Internal Medicine residency is five years long and why we spend so many nights and so many hours per week in the hospital. While some of this is due to the old boy\u2019s club mentality of \u201cIn my day this is how we did it, and so you will too\u201d the simple fact remains that the only way to gain expertise in a vast array of diagnostic\/therapeutic dilemmas and acutely decompensating patients is to be there when it happens. So when you work in a domain that requires you to be an expert in rare conditions and events, if you\u2019re going have expertise in it, you had better spend a whole heck of a lot of time in the hospital and that\u2019s just what I\u2019ve been doing.<\/p>\n

Now let\u2019s be clear here. I am far from an Internal Medicine expert, but I\u2019d like to think that I am starting to acquire my own sense of Geschtalt. To many Geschtalt may sound like something most likely to be served on an Eastern European grandmother’s dining table, and to that end, my grandmother makes better Geschtalt than your grandmother. Period.<\/p>\n

In reality it refers to a gut feeling, a sort of clinical intuition that doctors get about a case. Having slugged it out in the trenches as a medical student and junior resident I\u2019ve seen my fair share of cases, seen many sick patients of varying degrees of acuity. Slowly but surely I\u2019m becoming more and more sure of those decisions I\u2019m asked to make at 03h15 as my Geschtalt comes into its own.<\/p>\n

Some personal Geschtalt highlights this past week to better illustrate this arcane term:<\/p>\n