Just Like Someone Without Mental Illness Only More So_ A Memoir - Mark Vonnegut [29]
So it wasn’t enough that I was in medical school. I was supposed to be lining up to cure generations. And I’d thought I was crazy.
Waiting for something to happen
(Vonnegut family photo)
chapter 8
Man’s Greatest Hospital
Chance favors the prepared mind.
—Louis Pasteur
I had applied to twenty medical schools and gotten into one. I would have been overjoyed to go anywhere that had “Medical School” in its name. Four years later I was an insider, asking questions about how much responsibility interns had, whether they were supervised by fellows or senior staff, and what program graduates ended up doing.
Massachusetts General Hospital—MGH—seemed nice. I had done a couple of rotations there and done well. During my interview it was more or less settled that if I ranked it number one, MGH would be where I did my internship and residency. A happy person with decent self-esteem wouldn’t bother to have credentials as good as mine.
When I was a resident, patients were taken care of quickly, with compassion and respect. They did not have to wait for hours and hours. Their insurance coverage was something we figured out later. There was a sincere, almost naïve belief in science and settling arguments with science and data. Children with life-threatening infections had lifesaving antibiotics in their system as soon as possible after hitting the door. We were fiercely determined to do the right thing for whatever patients came our way.
The beginning of the end was when we were told we couldn’t give out advice on the phone anymore; everyone had to be told to come in and be seen. Someone somewhere thought someone might be wrongly reassured or misinterpret what we said or we might make a mistake that would end up with an injured or dead patient and a lawsuit. We were always incredibly conservative about having anyone with remotely worrisome symptoms come in anyway. There was not a single case of things going badly because of our phone advice or any study about phone advice in general that the powers that be were responding to. It was an administrative answer to an administrative concern. Giving phone advice was good for senior residents’ training and helped more than a few children get appropriate care for minor injuries and illnesses.
Having patients come into the emergency room to be seen rather than get advice over the phone seems like a small thing, but it introduced a wedge between doctors and patients. The job was no longer to do what was right for the patient no matter what. It was hard enough to figure out what was really best for the individual and obey the ancient dictum “First, do no harm.” Now we had to be in accord with risk management, HMO guidelines, managed care, HIPAA, ICD-9 coding, and on and on. Every bright idea that was supposed to improve medical care has made care worse, usually by increasing costs and restricting access. It was a better world when you could call a senior pediatric resident on the phone to help you through a diaper rash or vomiting or diarrhea. Ninety percent of what gets treated in today’s ERs at a cost of billions of dollars, zillions of unnecessary tests, and eons of waiting would go away if people could just talk with a well-trained senior resident. The point is supposed to be getting people appropriate help.
I myself didn’t like asking for help. My first night on as an intern in the ER, I faced an unprecedented barrage of twenty-plus patients, many of whom were seriously ill. The junior resident, who was supposed to be helping me, went to the library and fell asleep. The senior resident, who was backing him up, was busy in the pediatric ICU. When I was asked in the morning why I hadn’t asked for help, I explained that I’d just assumed, being new, that whatever happened was more or less normal and I didn’t want to be a complainer.