Savage.MD Blog

Yesterday I saw a new consult patient in the GI oncology clinic. The patient has a treatable GI cancer, but also had a history of a traumatic brain injury. I listened to the patient's cancer history intently and then asked "How did you get your brain injury?" The patient told me the story and I again listened, taking notes periodically.  After I asked all my questions and did a physical exam, I told the patient what to expect next. I told him/her that I'd discuss his/her case with my attending, and that the two of us would come back to talk about a plan to treat this patient's cancer.  Before leaving the room I asked, "Are there any other questions you have before I go get my attending?" The patient's eyes started to tear and he/she said, "I just want to thank you. I felt listened to today, and I don't always feel listened to."  It was an acknowledgement of the many ways big and small that our health system falls short when dealing with...

July 13, 2020 was my first day of continuity clinic at my new residency at UC San Diego. I was pretty nervous. I had gotten so comfortable at my continuity clinic in Cleveland, OH and I knew the routine there well. This new clinic served a totally different population of patients. The faculty members, the staff, and the residents were all new faces to me. The very first patient I met in San Diego in my resident clinic was Mr. G. He had a lot of health challenges and was a complex first patient. He had just been discharged from the hospital. He had heart failure, COPD, diabetes, and cancer. When my faculty member asked how soon I'd want him to follow-up with me again, I proposed "2 or 3 months." My faculty member knew better. She said, "No, I think you should see him in one month. He's pretty sick." So that's what I did. About once a month for the remainder of my residency I saw Mr. G and tried my best to keep him out of the hospital. I was not always suc...

Last Friday I moonlighted working overnight as a hospitalist doing admissions and cross-covering patients. It was a 12 hour shift (7 pm - 7 am). During that stretch we had 14 (!) admissions. I had the help of a fantastic intern and resident. They cap out at 8 patients total, so I had to supervise their care and do six admissions on my own. This was one of the hardest nights I've ever worked. In general, I did not feel like I was doing a satisfying job with the care I was providing. We kept getting "boluses" of 3-4 patients from the ED all at once. I just barely learned a patient's story, put in admission orders, and wrote a cursory note when I had to move on to the next patient. In the early hours of the morning it became hard to keep the patients' stories straight. Each of these patients were very complex, so to admit them properly really requiring doing some chart biopsy to find out about co-morbid conditions and home medications. There simply was not time to do...