First Blood, Finally

Patients want the best care possible when they’re in the hospital, and in a practical profession like medicine, best essentially equates to most experienced care. At a training hospital like NYP Cornell, there are young trainees — like me — who are the least experienced and therefore need opportunities to improve. They’re always monitored and guided by our mentors, but yes, at one point, we must perform a task for literally the first time ever. And yes, there will be a patient will be on the receiving end of that.

Two weeks in, I hadn’t gotten a chance to do a few basic tasks thanks to the dreaded question: “You’ve done this before, right?” I got this question several times, maybe because I’m a baby-faced Asian boy who can pass for a teenager or because I radiate incompetence. I don’t know. But I’m not going to lie, and when the patient is writhing in pain or worried sick about their baby, I’m not going to impose my unskilled hands on them. It’s their prerogative, and if there is a resident or attending standing by to observe, it’s not unreasonable to request for them to perform the task instead.

This applies to all sorts of tasks. Drawing blood, wound packing, fetal sonograms, vaginal exams, delivering a baby. I’ve been refused at least once on each of them. There was a patient, a lawyer, who landed in the emergency room for what was probably her period, who refused to be examined by the PA running that bay, then kicked me out on the  pretext that I was male. The line I remember best, spoken condescendingly by a soon-to-be grandma that “in a few minutes a world-famous obstetrician will be coming to deliver the baby” and that in itself was sufficient reason to kick me out. The soon-to-be mom didn’t look like she minded that well. Funnily enough, I was refused so many times on venipuncture that I actually delivered a baby before drawing blood!

Some people demand only to be seen and touched by attendings, which is an ironically ill-founded request. Who would you rather have place your epidural line, the attending anesthesiologist who while walking in mumbles “I haven’t done one in months” or the resident who wanders from room to room and places like nine in one shift? Who would you rather have draw your blood, an attending who is never present for blood draws or a young med student who is still paying attention to every little detail?

As a final comment, this problem appears to be more pervasive in a upscale medical center like Cornell. Tendency for refusal of care by medical students is highly correlated with socioeconomic status, where those with lower socioeconomic status ask fewer questions and acquiesce readily, while affluent patients are finicky. They’re the dreaded patients who feel entitled to “only the best,” and they make me feel so unwelcome. It’s a teaching hospital! I’m not going to cost you much more than a few extra minutes in the hospital! Think of the good you’d be doing for my medical experience! That’s why patients who are relaxed and happy to help are my favorite. Thanks to those kind women who have offered me their veins to stick, finally.