{"id":2580,"date":"2019-01-30T12:14:54","date_gmt":"2019-01-30T17:14:54","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=2580"},"modified":"2019-01-30T12:14:54","modified_gmt":"2019-01-30T17:14:54","slug":"im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/01\/im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation\/","title":{"rendered":"I’m Sad That Interns Don’t Want to Do a Palliative Care Rotation"},"content":{"rendered":"
\"Justin<\/a>

Justin Davis, MBBS, is a Chief Resident at Barwon Health in Geelong, Australia.<\/p><\/div>\n

It\u2019s an exciting time for final-year medical students in Australia. Exams are over. They\u2019re in their last-ever clinical rotations, and they\u2019ve finally found out in which hospital they\u2019ll be starting their careers. Most are happy. Perhaps some aren\u2019t, I dunno. But most\u00a0are simply excited to finally start their intern year as doctors,\u00a0having\u00a0spent 8 or more years\u00a0in\u00a0college\u00a0and medical school. Finally getting to practice\u00a0medicine. I suspect the fact they\u2019ll be getting a regular wage is also something they\u2019re looking forward to. I was surprised when, all of a sudden, I could afford a bigger tv after a few weeks of work as an intern.<\/p>\n

\"\"<\/a>

The final day of my own medical school time. Cricket on the right, Mario Kart on the left. And beer, of course.<\/p><\/div>\n

Of course, finding out which hospital you’ll be working at also comes with finding out about rotations. These are definitely more varied than hospital choices \u2014\u00a0your new hospital\u00a0will often offer a gajillion different rotations. (I wonder how many zeros a gajillion is? *looks it up* \u2014\u00a0Oh, it\u2019s an unspecified large number. OK, so a gajillion is correct.)\u00a0 Here in the Land Down Under, our interns\u00a0are required\u00a0to have an emergency medicine rotation, a\u00a0surgery rotation, and a general medical rotation in order to satisfy their intern training requirements, so those\u00a0are not optional. The others could be anything. Perhaps even rotations you wouldn\u2019t necessarily choose.<\/p>\n

So, I was chatting with intern friends about their rotations. Overall they were pretty happy with their particular list of rotations for next year, but several people noted that their colleagues who were assigned palliative care rotations were trying to swap them out. And they wondered why anyone would agree to swap anything for a palliative care rotation.<\/p>\n

This really saddened me. It made me muse and reflect on my own experiences as a palliative care intern and how good that rotation had been for my medical learning and growth. Why wouldn’t our newly minted doctors want to experience the personal improvement that working in palliative care could provide?<\/p>\n

Of course,\u00a0 there is a story behind all of this (like most of the blog posts I write, I\u2019ve come to realize). I was quite happy with my own intern rotations: with the aforementioned emergency, surgery, and general medicine already allocated, I was given palliative care and orthopaedic rehabilitation as my optional ones. My own intern year started in emergency medicine.<\/p>\n

The next\u00a0paragraph\u00a0is tricky.\u00a0Emergency medicine\u00a0was a\u2026 difficult<\/i> rotation. Outside of intensive care, which I would experience later as a registrar (have you ever felt the dread of standing alone at 2am staring at an ECMO machine while your patient has just crashed, having never seen\u00a0an ECMO before\u00a0or had anything to do with one and wondering what the next steps are? I have.), emergency medicine was, by far, the most challenging experience I have had as a doctor.\u00a0I think everyone, when they start out,\u00a0has an existential crisis when they realize\u00a0they have\u00a0the responsibility of, you know, caring for sick patients. But,\u00a0if you start\u00a0in general medicine, you have ward-based registrars to run decisions through, which lessens the brunt of that responsibility.<\/p>\n

\"\"<\/a>

Palliative care is about endings, but endings can be beautiful. I love sunsets, so putting nice ones into this blog goes with the spirit of palliative care.<\/p><\/div>\n

There is a different culture to emergency medicine. Cold neon lights\u00a0illuminate that place, no matter what the time\u00a0or weather is outside. Like all of medicine, it\u2019s a grinding wheel that never stops, but the relentless pressure<\/i> there is something else. I remember walking down the corridor one day, with monitored cubicles to my right that continually beep and alarm like every patient is going into VT (they aren\u2019t) and my second-favourite staff base to my left (you can have favourite staff bases. Don\u2019t look at me like that), and thinking I had just wasted the last 8 years of my life. I should have stayed working at Dan Murphy\u2019s (Uncky Dans is a liquor store chain in Australia, and I have to admit, if you\u2019re going to have a part-time job to support yourself through university, you couldn\u2019t ask for a better one). And all that excitement about working? Starting out? Finally being a doctor? Gone. Extinguished under the cold neon lights, while another category 2 comes into resus 3, and the monitored cubicles alarm for no good reason.<\/p>\n

But, something happened that changed my perspective. That \u201csomething\u201d was my palliative care rotation,\u00a0my second rotation after the battering and brutal introduction that emergency medicine gave me. Instead of having to move patients to somewhere, anywhere, as long as it\u2019s out of emergency, quick! Quick! And the relentless pressure<\/i> … palliative care was a completely different experience. We had time for patients and their families. To sit down and talk with them about the issues they were having and what we could do to make their lives better.\u00a0We didn\u2019t\u00a0need to investigate everything to make sure it wasn\u2019t dangerously lethal, or to do things quick! Quick! Instead, the focus was on comfort, dignity, and making people\u2019s lives better in what time they had left. Focusing on their needs and how we could best address them. Time. Empathy. Compassion.<\/p>\n

It changed my outlook on wanting to work as a doctor and my enjoyment of the job. It was a liberating experience to be a part of a team of doctors and nurse practitioners (whom I cannot thank enough) who simply made people\u2019s lives better without investigating, referring, testing, or moving patients. Just talking, focusing on essential medications that would take their symptoms away, and having the time to spend with patients and their families, listening to their concerns. You could tell it was a valuable experience for the people whom we consulted on, and it certainly was for me as well.<\/p>\n

\"\"<\/a>

And another sunset, taken one night on the three and a half hour drive to my rural hospital placement.<\/p><\/div>\n

The business that is specialist medicine has the potential to draw\u00a0out the worst qualities of the medical grindstone. Sometimes,\u00a0we simply have\u00a0too much<\/i> to do in one day. This is why I was saddened to learn that others wouldn\u2019t want to experience a rotation like palliative care during their own intern years. Perhaps they\u00a0won\u2019t\u00a0come\u00a0to it\u00a0from as low place as I did, but the experiences\u00a0and the satisfaction of just making people feel better\u00a0is something that\u00a0new doctors shouldn\u2019t miss out on.\u00a0When I fnd myself having difficult discussions with patients and their families, I\u00a0 often reflect on the conversation skills that palliative care taught me. But mostly, it was nice to do so much for people by doing so little.\u00a0A palliative care rotation is\u00a0definitely\u00a0worth swapping into.<\/p>\n


\n\u201cWith time, every epilogue extends into a sequel.\u201d
\n
\n<\/b><\/p>\n

\"NEJM<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

It\u2019s an exciting time for final-year medical students in Australia. Exams are over. They\u2019re in their last-ever clinical rotations, and they\u2019ve finally found out in which hospital they\u2019ll be starting their careers. Most are happy. Perhaps some aren\u2019t, I dunno. But most\u00a0are simply excited to finally start their intern year as doctors,\u00a0having\u00a0spent 8 or more […]<\/p>\n","protected":false},"author":1292,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[49,29,31,40],"class_list":["post-2580","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-art-of-medicine","tag-internal-medicine","tag-patient-care","tag-student-experience"],"yoast_head":"\nI'm Sad That Interns Don't Want to Do a Palliative Care Rotation - Insights on Residency Training<\/title>\n<meta name=\"description\" content=\"Dr. Davis describes his own intern year experiences and hopes that new doctors make some time for the art of medicine.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/01\/im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"I'm Sad That Interns Don't Want to Do a Palliative Care Rotation\" \/>\n<meta property=\"og:description\" content=\"Dr. Davis describes his own intern year experiences and hopes that new doctors make some time for the art of medicine.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/01\/im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2019-01-30T17:14:54+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2018\/07\/AU000_jdavis-125x150.jpg\" \/>\n<meta name=\"author\" content=\"Justin Davis, MBBS\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Justin Davis, MBBS\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/01\/im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/01\/im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation\/\",\"name\":\"I'm Sad That Interns Don't Want to Do a Palliative Care Rotation - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2019-01-30T17:14:54+00:00\",\"dateModified\":\"2019-01-30T17:14:54+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/f009a6f8df8a0f4d9cfb1110486780c9\"},\"description\":\"Dr. Davis describes his own intern year experiences and hopes that new doctors make some time for the art of medicine.\",\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/01\/im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/01\/im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2019\/01\/im-sad-that-interns-dont-want-to-do-a-palliative-care-rotation\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"I’m Sad That Interns Don’t Want to Do a Palliative Care Rotation\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/f009a6f8df8a0f4d9cfb1110486780c9\",\"name\":\"Justin Davis, MBBS\",\"description\":\"Justin was born and raised in Geelong, a city in the southern (less-warm) part of Australia. 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