On-Call Residency

The day started at 8am with me waiting in the front of St. Vincent hospital for the on-call resident I was to shadow: Dr. Joe Aeschliman,family medicine. I was surprised the family medicine have inpatients as well as outpatients. Honestly the more I shadow Family Practice Physicians, the less I realize I know about their area of medicine.

While waiting I decided to take some pictures of the beautiful hospital. Most of the pictures were bad but this one of the nurses, symbolizes the faith based mission behind the hospital. You did know that St. Vincent was a faith based hospital right?

Anyway, Dr. Aeschliman met me and took me up to the residence lounge and we got to talk about medicine, residency, etc. Dr. Aeschliman for today is the on-call resident leader meaning that 1) he is in charge of all the residents on-call working with him and they have to report their care of patients to him 2) he assigns which resident takes care of an incoming patient 3) he reports to the Attending Staff (a practicing physician) the reports of the residents 4) he has to somehow remember to stay calm and breath during those 12 hours he's on call. 

Dr. Aeschliman listening to a MS3 giving his report on his patients before he leaves

Medicine and Residency with Dr. Aeschliman


10:30 AM By this time we have seen an obese 20 year old who is suffering from hypertension. We also so a couple with different conditions. The wife suffered gastrointestinal problems and the man had upper respiratory complications. We saw another woman with upper respiratory problems but she was doing better once she had her medicine. What was interesting about her is that she did not want to leave. She was afraid that the medication tablets would not be as strong as the medication via IV injection. The team had to come up with an effective way to convince the patient that she would be fine at her home with the medication they prescribed to her. It was decided to kindly reassure the patient that she would be fine with the medication she was given.


12:00 PM Right now eating lunch listening to a lunch lecture on infectious diseases. I'm surprised that this didn't ruin my appetite but at the same time, I didn't eat much for breakfast so I was really hungry. Before lunch there was a 11 AM staff meeting when the Attending Staff, on call resident, two other residents, a pharmacist resident, and a Physical Assistant resident all came to discuss their cases. At 11:30am we went to another meeting where all residences met to talk about another case. As you probably have noticed, application-based lectures are common in the "medical world" which I personally appreciate especially since I'm the the person who always wonders "where will I ever use this?".


2:45 PM  Dr. Aeschliman had to go attend to one of the residents' patients so I shadowed intern (a First year resident) Dr. Dana Ridderman. The case we saw was interesting. The patient was an elderly woman, 92 years old, who had fell while at home. Her daughter, who lives with her, called 911 and had her mom rushed to the hospital. The woman was very alert and knew what was going on however, the main issue shifted from her falling at home, to the fact that she stopped taking her medication because she was "ready to die". What was more peculiar was the fact that she didn't stop taking all of her medication, only her hypertension medication. The case was solved by informing the patient on the importance of her taking the medication for hypertension in order to prevent her from having a stroke and living with the physical repercussions of it. She then was going to released the next day. She seemed to understand what the doctor was saying so hopefully she won't "play doctor" anymore and continue to take all of her pills.

This is Dr. Ridderman holding up her PDA device. Residents as well as MS3 students have to carry these devices in order to download files. MS3 and residents use these in order to have faculty check off any tasks they complete

Afterward I got to talk to Dr. Ridderman about her residency experience so far as a first-year resident. She said that so far it was a positive experience and that the staff was supportive so although it was a change from medical school to residency, the transition itself wasn't bad. We also talked about the changes in technology and how that's affecting medicine. This change to e-charts and X-ray scans on computers, was a huge shock to me (particularly since I'm a bit of a technopobe--if that's a word,

This is a peek into the Family Medicine Physician room

but you get my point).  

Dr. Aeschliman met with me and I shadowed him the rest of the shift. He informed me that the case he had to attend earlier involved an elderly woman with borderline biopolarism, and everyone on the floor could tell. She wanted to sue the hospital because they didn't have the medication that she wanted for stomach pain (the one the hospital had wasn't in the right medicine bottle) and because of that she didn't feel that they were attending to her properly as a patient. I wish I could have seen the patient but Dr. Aeschliman didn't want to go back in there.  

Dr. Kedele, Internal Medicine faculty

4:45 PM One of the residents that Dr. Aeschliman is in charge of is an Internal Medicine intern on her transitional year (for some specialities such as radiology, anestelogy, etc, within the residency, the resident does a one-year transition in which they have the opportunity to interact with patients doing general care)so she reported her cases to Dr. Kedele, her attending physician for the shift which she did at this time. Dr. Kedele is originally from Erithea (next to Ethiopia) and like many DePauw University international students, came to America for college then continued on to get his medical degree. 

Does the beeper and phone rule the man, or does the man rule the beeper and phone? Dr. Aeschliman's question of the day.

After this meeting, Dr. Aeschliman and I went into the doctor's lounge for a quick snack. I'm not going to elaborate on the doctor's lounge,but in short,the lounge is a nice perk for being a doctor. For the next hour and half (so up to 6pm)it was relatively quiet (which translated to boredom for me since I did'nt have any patient charts to fill out) however for some reason Dr. Aeschliman's beeper and phone repeatedly went off but when he tried to answer the call, it went to a machine and this continued consistently for 30 mins. It was a bit funny but at the same time annoying. 

At this time,my legs started to hurt. I was wearing 1 1/2 inch heels and I was starting to feel it so the break was nice for my
feet. 

Fashion tip for you ladies interested in medicine, whether clogs or 6 in high heels, the only rule is, if you can work it, you can wear it!

We did see another patient, an elderly woman with COPD due to emphysema. She was in the hospital because she wasn't given a transportable oxygen tank so when she had to go out, she was unable to take the tank with her and, you probably can guess what happened. Dr. Aeschliman was doing a follow up making sure she was okay and then ordered a transportable oxygen tank for her.


6:30PM Dr. Aeschliman checked in his unit's last patient of the day, a homeless man who had a psychological disorder (burned down his house as well as parts of his own hair)who came in because he had passed out drunk. After the patient was revived and went through tests, the resident in charge of him found out that the man was suffering from liver sclerosis. Dr. Aeschliman was checking up on the patient and confirmed the resident's diagnosis. 


7:30PM The shift is officially over so Dr. Aeschliman and his unit are no longer responsible for incoming patients. Now all they have to do is paper work. I could have offered to help but since it's probably illegal for me to look patients plus the fact that I rather wait until I'm actually a resident before taking part of this "experience" I decided to head home and write about all I have experienced.

Summary of On-Call Residency
 Residency is no joke. You have to be on your feet for many hours at a time, be calm in an environment that at times is anything but calm and be able to apply all the knowledge that you spent four years in medical school learning on each patient, remembering that no patient's diagnosis will be textbook perfect. From the TV shows we've seen on residencies: Grey's Anatomy, ER (1990s), etc one truth that these shows do reveal to the audience is that residency is a time when post medical students see the reality of healthcare and patients. You are also always learning whether through case study presentations with your staff or through the lunch lectures more knowledge on better treatments, diagnosis, diseases, etc are continuously thrown at you. 


 From my brief experience, I found residency to be a doctor's first realization of the fact that you can't help everyone. That sometimes a patient will be less than grateful for all the hard work you put into treating them and you have to let it go.  That sometimes the phone won't stop ringing, the pager won't stop going off, patients will keep on being administered into the hospital under your care and you can't do anything to stop it. All you can do is deal with it and remember why you became a doctor in the first place. It takes patience, dedication, and focus on one's final goal to be a practicing physician (in case you're wondering, yes there is one more test residents have to take before they are official practicing physicians. It's called USMLE 3 .Bet you didn't hear about that on Grey's Anatomy) as well as really comfortable shoes.


Residency has also gone through many changes in the recent years. Primarily to help residents be able to administer care to the best of their ability. Talking to Dr.Byrant and doing some independent reading           (Treatment Kind and Fair: Letters to a Young Doctor by Dr. Perri Klass) I was able to learn more on the controversy behind the changes. Part of the controversy is the idea that young residents are being spoiled and by reducing the required hours they have to work, it's believed that the training they need to have (which they can only have by being in the hospital) is being compromised. Another factor is the fact is that by reducing the time a patient is in the hospital, there is less continuity for patient care so instead of one patient seeing one doctor throughout their visit, they are now seeing two or three separate doctors at different times giving probability of miscommunication between these doctors concerning proper treatment for the patient. However, proponents for the recent changes is that overloading residents on patients to the point that it deprives them of sleep to the point that they are unable to do their job and administer care to the patients effectively is not helpful or beneficial to anyone and with a patient's life at stake is not worth the risk. What's even more interesting is the fact that as medicine, technology, and healthcare continues to change, they will affect how residency programs are run. So the residency program that I was able to have a glimpse into now, will probably become completely different once it's my turn to take part of it as resident. 


In short, residency is one's first glance into the reality of medicine and the joys and not so happy times that as doctors we will all go through. As Dr. Aeschliman stated in his interview, you do have faculty with you to help you with any question or concerns so you don't face the 3-5 year challenge alone. Although it can at times be the hectic step on the road to being a practicing physician, after my brief experience, I understand its importance in shaping post-medical students into doctors.