Volume 28 • No. 7
Death Certificates must be reviewed, signed promptly
Daylong seminar helps professionals support families facing a death
SHC offers media relations services to physicians
Wachter
talk available for viewing on
DVD/VHS
Quality and Patient Safety efforts transcend site visits
Contact Compliance if Lumetra or other official agency contacts you
Those who come, move on, and remain
by: LAWRENCE M. SHUER
On
June 18 I looked out from the front of Fairchild Auditorium at 117 young
physicians - the first of the new cadre of residents arriving at SHC.
I knew, based on logic and the many taut faces in the audience, that this
was a time when great confidence and high expectations would be tinged
with at least a few flickers of nervousness or even doubt.
As I participated in the orientation, my thoughts turned to my own housestaff experience 26 years ago, when I had my own anxieties about whether I would be able to make the right decisions on the firing line that would lead to good, safe care for my patients. At that time on one of my first rotations, a senior resident advised me that I was free to call for advice, but he explained, "It will be seen as a sign of weakness if you do."
I shared that anecdote with the new residents, and I assured them that we expect them to call on us when they had doubts or questions. "Weakness" is not even part of the equation in 2004.
Then I started thinking about how many other parts of the equation have changed, not because we are "nicer, more sensitive and smarter" than our predecessors, but because so much has changed in the past quarter century for all of us - experienced attending physicians, our new residents, and the residents who have been with us for awhile.
When I (and many of you) started in medicine, we were almost all male (or pressured to take on male values) and almost all white (or culturally prodded to take on preset values). Physicians ruled the health care world. Managed care wasn't even in our vocabulary, and referral patterns could revolve around a Wednesday afternoon golf game. In any case, referrals certainly weren't generated by Googling.
Today if one of the 677 Stanford residents calls us for advice on a Sunday afternoon (let alone Wednesday afternoon) we might just as likely be catching up on the mounds of paperwork generated by providers and regulatory agencies as on the golf course. And if we are playing golf, an ubiquitous cell phone allows us to answer a question quickly and quietly while our partner swings undisturbed.
For attending physicians or residents, there is little opportunity for acting smug about weakness when the end of the workday for male or female physician alike often means picking up the baby at daycare - not a trip to the clubhouse or pub for some macho rib jabbing about how we averted disaster in a seemingly hopeless case requiring our expert intuition (even though it was the nurse who told us discreetly what to do).
These thoughts come at a powerful time of transition. The Office of Graduate Medical Education under the direction of Ann Dohn has been busy seeing the departing residents off and helping those who are incoming get acquainted, settled and ready to start. Meanwhile, the continuing residents are showing us each day how much they are learning - and in many cases teaching us new tricks. Each of these groups offers the other marvelous lessons, and the benefit extends to those of us who have been here longer.
As mentors we garner the satisfaction that comes from working at an academic medical center where we are involved with the education and development of future doctors. And we are all involved in this process whether we participate actively in teaching medical students, interns, residents and fellows, or if our mission is to be quietly observed as a role model. I can state unequivocally that I have experienced great satisfaction in sharing knowledge and watching young physicians develop over the course of their time here at Stanford. I think most of the rest of you feel this way, too.
But the benefits are not one-sided. Our newer doctors are able to adapt to new techniques unfettered by the habits and biases that affect most experienced hands over time. For example, our trainees are fluent and take for granted the computer literacy that remains a foreign language some of us are still trying to master. Our newer physicians have helped all of us make the transition to the computerized physician order entry (CPOE). New doctors also give us a great opportunity to introduce some necessary changes in our practice, such as eliminating unapproved abbreviations. Our young doctors won't be unlearning habits, they will be learning a new shorthand language correctly from the start.
Our 205 departing trainees and those housestaff members remaining have seen many developments in the past year, including the opening of the Cancer Center and changes in our physician leadership and structure. In the past year we also seen the birth of a new Department of Otolaryngology under the leadership of Robert Jackler and many of the new faculty he has recruited. This month we welcome back William Maloney, who returns to Stanford to lead the newly created Department of Orthopedic Surgery.
Other changes will alter the equations, perhaps in subtle ways. Packard plans to open its own operating rooms, creating a tangible pediatric surgical model. A new ambulatory surgery center will also change, perhaps subtly and perhaps in unexpected ways, how we view surgical processes. And the SMILE program (Stanford Medicine Information and Learning Environment) will bring a professional educational environment to medical students and physicians. Scheduled for completion in 2008 SMILE will offer classrooms and related facilities offering high-technology communication and learning systems, simulation devices, immersive learning environments and an advanced information/library system.
By now our senior medical residents are off to start the rest of their careers. For some this means starting their "real" jobs at various sites throughout the country and the world, while others will be heading for further internships, research positions or perhaps training for another degree. We are all very proud of these physicians, and I am certain all of you join me in congratulating all of our departing trainees and thanking them for a job well done. We also will continue to support and learn from the trainees who are continuing with us. And we welcome those new to our facility and look forward to helping them grow and develop as tomorrow's physician leaders.
