Sunday, December 4, 2011

The Parallel Worlds of the House of God and Södersjukhuset

sunset - now before 3 pm
After finishing Stieg Larsson's Millenium trilogy, I started reading the American classic The House of God. Although the book is a little over-the-top in cynicism and is more like Grey's Anatomy if it were on HBO or showtime as far as the sexual escapades of the hospital, there are a lot of truths behind the emotional turmoil of the American medical education system and some more universal truths to some of the types of patients seen on an internal medicine hospital service. Since I have been on internal medicine for the past two weeks, I have started to see what Samuel Shem meant by the gomers and the LOL in NAD (little old lady in no apparent distress). One of the other people on my team - Sara - has recently finished medical school and is doing a working year before starting an internship. She has also read The House of God and throughout the week, we have shared many inside jokes about the book and how it relates to our current group of patients. I think our shared interest in the book has also helped us to become friends during this past week. 

Next week I switch wards which I am kind of sad about especially since I feel like I had kind of found my place in the team and had made some friends with my fellow medical co-workers. As I leave my current ward, I look at our patients and find that many of them have been there for the majority of the two weeks I have spent on the service. We have several people who are old and frail and somehow stroke after stroke continue to make it although they seem to lose a bit each time. We have several elderly patients in varying stages of dementia. This causes an interesting problem when trying to plan for medical interventions. There is no formalized system of informed consent in the hospital and I asked how it worked with patients that had dementia and clearly did not seem competent to make medical decisions for themselves. Especially when the same 30-40 minute conversation would take place day after day about the same intervention. The patient would not really answer questions directly and in fact seemed to be having a different conversation altogether. I suggested that it might be more useful to have this discussion with her family and asked who in fact was responsible for making the decisions for a patient who was not competent to make their own decision. Like our patient, my mentor seemed to answer around the question so I am not sure what the answer is. 

In addition to our elderly, mostly demented population of patients, we also had quite a few that seemed to be at the hospital for socializing more than anything else. The idea of a care plan does not seem to be a part of hospital management of patients and neither does making specific goals for discharging a patient from a physician standpoint. For one patient in particular, I would ask what were the specific goals that would allow her to go home. I listed the one that I could identify and my mentor said yes, and that she needed to be ready to go home. I am really not sure what that meant. She never seemed to be ready to go home because everyday she would say she wasn't ready and asked to stay longer. Even though she probably could have left the hospital on Friday, she is staying the weekend. Who knows when she will actually leave. 

I have also noticed several positive things about this system over the past couple of weeks: the physicians spend a lot of time with their patients and seem to have quite good relationships with them. There is definitely a care team that manages the patients and we do sit-down rounds with the nurses in the morning and in the afternoon to make sure that the things that the patient needs are being taken care of. Everyone seems to have their role (my role seems to be to ask a lot of "why" questions and give suggestions about management of patients as well as provide some comic relief for the team) and it seems that everyone leaves the hospital by 4 or 430 everyday. 

On a tangential note - we drink a lot of coffee at the hospital and so I have found myself going through quite a lot of chewing gum. In fact, I have chewed through the 5 or so packs of chewing gum I brought with me and had to buy some in Sweden. They package gum differently here - I haven't seen the sticks of gum like we have at home. Mostly it's the shell-coated gum and it comes in either re-sealable bags or a medicine-bottle-like container. 

Next blog - Helsinki trip. Hard to believe that two weeks from Tuesday I will be flying home! Hej då!

No comments:

Post a Comment