The Teaching Hospital

I decided that I could no longer keep that previous piece of self-pitty as my first post. So here"s a different one!

So, I saw my gastroenterologist (GI for short) today. She"s nice. She"s a first year fellow in the GI program here, and I can tell that she feels uncertain, because she never tells me what she thinks is going on. She leaves that to the attending, who"s also nice, and appears old enough to be extremely learned. She takes an excellent history and does a thorough exam, surprising me by localizing tenderness I didn"t even know I had. She has a fairly good bedside manner, although, since I"ve been in training a couple of years longer than she has, I can tell when her level of anxiety/stress/concern/whatever affects her bedside manner. I can also tell that it threw her off when she said, "How are you?" and I said, "I"ve been better...". Which is true. If I"d realized she meant it as a conversational piece only, I would have obliged and said, "fine". :) So, anyway, I have an ok, although not great rapport with my GI doc.

Feeling a little frustrated today (partly because I still don"t feel too well in general, although resting all weekend did at least give me the energy to work today), I was considering transferring my care to a different gastroenterologist at the BigPrivateHospitalDownTheStreet (or BPH). Thinking about this lead me to think about why it is I see a GI fellow at a teaching clinic. I guess the reasons there are several fold.

1. Probably the least important reason: When I was sick in May and having a hard time getting the workup done through my internists office, I paged the on-call gi fellow (now graduated), and he really helped me out. I could have, at that point, requested to be taken care of by the GI at BPH, and nobody would have blamed me. But seeing as I got such good care so quickly, I feel like the GI division values taking good care of patients. I"ve also seen them take really good care of my patients, and that counts for something, too.

2. The more important reason: I feel like it"s all of our responsibilities to help train doctors, and that since all of society benefits from having trained doctors around, the responsibility to participate in their training should not only be borne by the poor who have no other choice. After all, we all benefit from having a constant supply of well trained doctors around. Also, I have benefitted directly from people"s willingness to be my patient. The patient who I did my first c-section on, the patient I did my first forceps on, all of the patients after that; many of whom have had other choices or could have said to the attending, "can someone more experienced assist you?", have all contributed to my education in a direct way. I feel like I owe it to them to be as accomodating as all of my attendings have been for me. Add in the fact that ulcerative colitis is uncommon in this patient population, and I am my GI doc"s first UC patient, and it"s almost like I feel like it will benefit me to have docs trained to treat UC.

So, that"s why I get my ulcerative colitis treated in the gi fellows" teaching clinic. Now... at what point do I bring it up with GI doc about the fact that I overheard her and the attending talking about putting me on Imuran (more potent immunosuppresive, used to be used commonly for transplants, also known as azathioprine) after this flare is over? I could tell that they didn"t want to worry me, because they said, "This is your third flare on Asacol, we"ll have to talk about a better long term plan when you"re feeling better..."