BACK of the BOOK
know what to do. Throughout training,
we’ve learned to trust their opinions over
our own, then – seemingly all of a sudden – there’s just us.
Frankly, my Gen Y colleagues are
probably just as terrified of the older generation retiring or leaving medicine as
they are of us taking over.
We are only as good as our mentors;
when the umbilical cord of mentorship
is yanked after three years of fellowship,
we start to begin to build the experiences
that will allow us to become that lifesource to the next generation of doctors.
However, we still need the nurture of our
senior colleagues until that time.
protocols and evidence in the literature
in the place of that experience – making
us more rigid in our approaches. Older
generations, having had time to develop
and practice “the art of medicine,” are
more comfortable exercising the exceptions to every rule.
Us, though? We look like young,
nervous Doogie Howsers who think they
know it all because we have our precious
protocols, but not the life experience to
back it up. One day we’ll get there.
A Shifting Work Ethic
With the recent movement toward “shift
work” and stricter work-hour restrictions, our work ethic
has been called into
question. Any change
has its pros and cons.
Obviously, the “pro”
is humane work
hours for residents
and fellows: Qualityof-life in training is
improved and the
threat of fellowship
enslavement isn’t as
scary as it used to be.
The “con,” though,
is when those rules
become an excuse
for skirting around
patient care.
Rest assured, that
concern is not unique
to the older generation.
Supposedly, the
work restrictions
were put in place to
improve patient care and protect against
medical errors. But the truth is, we all
know that there are major quality “disprovements” that can do more harm
than good. The shift-work model comes
with unwanted side effects: increasing the number of patient hand-offs,
complicating physician–nurse communication (a century-old issue), and
promoting the “softness” that results
from work-hour restrictions becoming
an excuse for good patient care. These
are the conflicts that the new millennial
doctor has inherited.
The shift-work model forces us to
practice medicine by the clock, rather
than by our patients’ needs: Should I stay
past the 16-hour mark to perform an
urgent bone marrow biopsy? Or, do I go
over my work-hour limit and lie about it
to maintain the accreditation of the fellowship program? The obvious answer is
to save the patient’s life.
Gone are the days of seeing a patient
diagnosed with acute leukemia through
tumor lysis and DIC. Instead, we sign
out a patient in the middle of his initial
work-up and only learn the results when
we start our shift the next day after the
treatment has already been initiated. The
Just as the younger
generation has to be
teachable and moldable,
so must the older
generation. Be open to
new evidence-based
protocols, be willing to
try something different.
Trust us; we learned
from you.
Experience Versus Evidence
I suspect that older doctors think that the
junior generation of physicians are more
rigid in their management of medical
practice. I can’t argue with that perception. The younger generation’s medical
practice is primarily protocol-driven and
evidence-based.
In the past decade, medical training has become so compartmentalized
that the millennials are armed with very
focused clinical knowledge. Physicians
before us had a much broader medical
training, and, therefore, their medical knowledge covers more depth and
breadth than the newer trainees. Rather
than relying on the report of a pathologist, for example, older physicians can
make clinical decisions based on physical
examination and peripheral smears.
During residency education, much
of the focus is on research, quality, and
standards of care handed down by the
governing bodies. Yet, when you ask
older physicians why they do things a
certain way – even though it may deviate
from the prescribed standard of care –
their answer is, “It just works. Trust me.”
Younger physicians, obviously, lack
that base of experience. We stick close to
ASHClinicalNews.org
process doesn’t unfold in front of our
eyes – and that puts us at a disadvantage.
The amount of pushback and the
number of residents who play the “workhour excuse” card to leave while the floor
is in disarray is pretty horrific, I have to
admit.
I know I’m not painting the rosiest
picture of our work-hour restrictions and
how the millennials potentially exploit
them, but I do believe it’s the minority of
young doctors who fall into that category.
Many young physicians let their desire
to do what’s best for their patients guide
them, working around the restrictions
when necessary – a trait we likely picked
up from observing our mentors.
The Tech Crunch
Another common critique of millennials: We’re addicted to technology. It’s
true, to some extent. If you were to tell
trainees and residents to put away their
smartphones, you might as well tell
them to come to work naked. And, let’s
face it, you can tell who the attending of
the residency clinic is by sound alone:
The slow-and-steady tapping of senior
physicians typing up their notes, broken
up by long pauses as they search for the
backspace button, versus the piano concerto that the millennials are tapping out
on the keyboard, seemingly without even
moving their fingers.
These days, it’s not about how much
we know, but if we know where to look
it up. There’s drug indexes, PubMed
searches, and, of course, Drs. Google and
Wikipedia when we get desperate – or
when we want to know what our patients
are reading.
Of course, that’s oversimplifying the
use of technology. We are still the brains
behind the typing a