Taking Ownership of Your Patients

In many ways, residency is not too different clerkship. You rotate through different specialties, you try to learn how to take care of patients from your teachers. Sometimes, I feel like I knew more medical knowledge when I was a medical student than I do now. During clerkship, I saw fewer patients, read more and spent a lot of time in my studies. As a resident, educational activities take a second seat to clinical duties, often consists of a lot of scut work.

However, the biggest difference you face as a resident is the responsibilities  you are given and how you handle them.

I remember in medical school I had several preceptors tell me to “take ownership of your patients.” At the time, I thought this meant I should see my patients daily, know their medical history inside out, have all their lab work and investigations checked obsessively and write comprehensive daily notes. To me, taking ownership was knowing everything about my patients..

But looking back now after being a resident for half a year, I think taking ownership is more than just good patient care, it’s a philosophy where you learn to be the most responsible person to your patients.

Last week’s NEJM had an excellent perspective on medical hierarchy and how when we don’t take responsibility and ownership, patients get harmed.

We realize that, each of us unsure, we gained confidence from the perceived assurance and expertise of the other. We unearth the other specialists who participated in the patient’s care. The oncologist had wanted the infected effusion drained so he could safely commence chemotherapy. The respiratory physician had recommended referral to a larger center for drainage. The infectious diseases physician had no more antibiotics to offer. The general internist bowed to the others, and the surgeon was approached as the next service provider in line. Tragically, no one person looked beyond the effusion to the whole patient. Although he saw myriad specialists in his last week of life, he died lacking holistic care.

It’s hard to really understand this concept until you are on your own, on call in the middle of the night looking after sick patients. As a medical student, you were always supervised either by your resident or attending. Whenever patients got sick or there was some obstacle, there was always someone you could defer to.

To me now, taking ownership means assuming you are the most responsible physician looking after this patient. Although as a resident I am still supervised by a staff doctor, I think having this mentality of being the most responsible person will ultimately make me a better doctor and provide better patient care. It means not assuming that other people will order proper investigations or check lab results. It means advocating on behalf of your patients. It means doing that DRE that everybody has avoided doing or taking extra time to talk with family members.

However, assuming responsibility comes with a cost. It can be emotionally draining. You become invested in your patients. You experience their joys but also their sorrows. You end up working more and your efforts are not always appreciated.

And as I head into the second half of my intern year, finding this balance between being your patient’s doctor and personal wellness will be a continued challenge. But Residency is exciting. If medical school was learning how to be a doctor, residency will determine what kind of a doctor you will become.

One Response to Taking Ownership of Your Patients

  1. Josh says:

    Really excellent post. Much of the “bad” care I’ve seen has come when a service punts serious decisions or, in your terms, fails to take ownership of the patient. The worst example was a CCU patient that I saw on nephro consults – 85, demented, EF 15% or thereabouts, rising Cr, consulted ?dialysis. The staff was absolutely clear that no dialysis would be offered while we were running the list one morning. Around noon we find out the patient had a PEA arrest, and was resuscitated but was now unconscious without sedation and intubated. And when we get down to CCU, the attending staff had written a brief note still saying “Nephro to consider dialysis”.

    Long story short, since the CCU attending had left, it fell to us around 7pm to have a meeting with family we’d hardly met before to establish the goals of care and explain that there was no role for dialysis. There was nothing unpredictable about that, but I felt it was extremely unprofessional to have left that kind of thing to a consulting service.

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