Fellows-in-Training: Practicing What We Preach—Being a Good Doctor and a Good Patient

Fellowship places so many demands on our time. In between balancing consults, call schedules, lectures, and family time, there's really no time left for ourselves, is there? In some ways, cardiology fellowship training transforms us from humans to super-humans. Or, at least that's what we are expected to be. Somehow, we are expected to push ourselves to the limit, and abuse our bodies, without being given the luxury of time to even go get an annual physical exam or a dental cleaning.

We are no longer subject to the same rules as regular people. We don't get our weekends off, we don't get our meals on time, we don't even get the "luxury" of a normal sleep schedule. All this abuse really wears on our physical health, with consequences that will present themselves 10-15 years in the future. And somehow, when we enter into fellowship, we succumb to these demands, agreeing to put ourselves and our health aside for the sake of our learning. So how can we ever make time for things like health care maintenance?

Is this really the right thing to do to ourselves? We are, after all, humans (much as we would like to believe otherwise), and we impress upon patients the importance of regular screenings and health care. Those who miss their follow-ups are labeled as "noncompliant" or "difficult" patients. Yet, how well do we practice what we preach? When was the last time you went to see a doctor? And why do doctors make such bad patients?

Part of it is what I already alluded to: the hectic schedules and day-to-day demands of fellowship. The other part of it is that physicians are also familiar with the challenges of being a patient, which makes us want to avoid it completely. If we do decide to go see a doctor, getting coverage to go to an appointment becomes an issue. Recently, after many months of self-neglect, I found myself in this situation. The little voice inside my head kept telling me it was time to go see a doctor, but that was much easier said than done.

First of all, the administrative hassle: I had to find a primary care doctor who would accept new patients. My UCSF insurance had assigned me to someone in Oakland (which is more than 35 minutes away, factoring in traffic), so I had to pull some major strings to get switched to someone at UCSF. Secondly, calling for an appointment only resulted in a secretary informing me of the 3-month wait to establish care. Finally, after requesting the doctor "double-book" me, I was able to get squeezed in for an appointment.

Of course, coverage became a real problem once I finally got the appointment. My chief fellow politely refused, explaining that our program only provided coverage for emergencies. If I wanted to go for a non-emergency visit, I needed to arrange my own coverage, but how could I? My co-fellows were spread equally as thin and there was no way they could neglect their own rotation to cover the cath lab for 2 hours in the middle of the afternoon. So, much as I hate to admit, the easiest thing to do was reschedule the appointment for when I have more time.

This is not a solution, though—it's the problem! Due to the demands on our time, not only do we regularly neglect our health, but we also take matters into our own hands. In 1998, a survey of 316 residents from four top-tier internal medicine training programs was published in JAMA and reported that 52% of residents had self-prescribed medications, including antibiotics, allergy medication, and contraceptives, and 42% accessed free samples from a hospital cabinet. Such practices are unsafe, unhealthy, and, in some states, illegal. But this may seem like the only option when we are not given the time or the coverage we need to access medical care.

Sadly, I don't have a solution. Until the system changes to understand that physicians may occasionally have personal demands on their time between the hours of 8 AM and 5 PM, whether it be a medical appointment, a dental cleaning, a visit to the bank, or anything else regular adults do, we are really in a bind. Although it isn't the answer, the ACGME does allow every cardiology fellow 12 days of "sick leave" annually that does not have to be paid back. This is rarely advertised, but it is certainly available to us all if we need it. So, I ask you all to take some time, no matter how busy you are, to care for yourselves and your health. Do the health care maintenance that you need to do now in order to prevent bigger problems in the future. Who knows? Just as it happened with work hours, maybe together, we can all change this super-human culture someday and go back to being mere mortals again.

Payal Kohli, MD, graduated from MIT and received her MD from Harvard Medical School. She completed her internal medicine residency at Brigham and Women's Hospital in Boston and was a research fellow at the TIMI Study Group. Dr. Kohli is now a clinical fellow at the University of California, San Francisco.

Keywords: Follow-Up Studies, Contraceptive Agents, Culture, Emergencies, Fellowships and Scholarships, Internship and Residency, Rotation, Sick Leave, Delivery of Health Care, Hypersensitivity, Internal Medicine, Primary Health Care

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