This week, I covered for one of the chief residents. I was the attending physician for about 25 patients in the hospital during the space of a few days. On 1 of those days, I still had scheduled my regular outpatient clinic; the entire day became a way to experience the contradictions inherent in the practice of medicine, crossing the street again and again between the hospital and my clinic like a shuttle on a loom.
How many contradictions, or rather, pairings that we see as contradictions, confronted me with each patient I saw, comparing in my mind the medicine I practice every day in clinic with the kind of health care delivered in our hospitals!
• Providing each person the care that works for her uniquely, while uniformly assuring best practices for safety to hundreds of patients at a time.
• Getting the tests and treatments that are needed as fast as possible, while deliberating appropriately on the evidence base of every intervention.
• Treating pain, but acknowledging the dangers of opiate addiction.
• Enabling the patient to make decisions, while recognizing they need the support of a treatment team in an alienating and scary environment.
• Discharging as soon as medically possible, while aiding the patient in their convalescence.
• Hewing to principles of safety and organizational efficiency, while being unafraid to venture out of the box when changed situations demand it.
How can we treat patients while on the very knife-edge of these contradictions? Treating both inpatients and outpatients makes me more sensitive to the edge, but I'm not sure I can dance any better … yet.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.