…trying to present a complicated neurological case to a neurologist while sounding like I know what I am talking about.
From the thorough neurology-centric history and physical to synthesizing region and tract-specific differentials of what might be going on, it was madness considering neurology is most definitely not one of my strong suits.
It would be my first case conference. The doctor I was working with suggested I go take a look. I had no idea what to expect. I arrived too early. It was ten to four and the conference room was quiet. Only a technologist and a doctor sat in a corner, huddled by the computer as they busied away with preparing files and scans. They looked up at me briefly and seeing my hospital tags, went back to working. Though I had already been given permission to participate, I still felt relieved.
The room lights buzzed in the background as I crept into a seat in the rear of the room. It was set up like a lecture hall. Chairs of different styles and sizes faced forward at the large projector screen. On it, files continued to populate the canvas, a miniature version of which reflected on the glasses of the doctor behind the computer.
Slowly, people began to trickle in. First one, then two, then a number of doctors shuffled in. Some looked bright and energetic as though it was the start of their shift; others looked tired and exhausted as though coming in after their shift was done; the rest fell somewhere in between. Though everyone was in different states of mind, it was clear from their conversations that they were all interested in seeing the cases that would be presented. Like the room’s arrangement had let on, this was a learning environment and the cases a learning opportunity.
"I think we’re about ready." Said the doctor sitting behind the computer. With that, everyone got seated and the first case went up on screen. The doctor attending the patient got up to present the case to the rest of us. She gave a quick run down of the history and the developments thus far. CT scans and other test results were presented. Having learned some of the material, I was able to follow some of what she was saying but quickly got lost in the jargon and other diagnostic features. "For now I’ll just sit back and observe the process," I thought.
Once she was done presenting the facts of the case, it was time to brainstorm. This was the purpose of these conferences: to bring to the attention of other physicians difficult or rare cases in order to discuss how to manage the patient’s care. One by one, the experts in the seats gave their recommendations, discussing what information was still missing that would be needed and what could be done now. I watched as some of the resident doctors madly scribbled notes into their notepads as the older, more experienced physicians gave their reasoning and their thought process; the presenting doctor did the same.
And so it went on for two more cases. The whole time, I just sat and watched as the doctors discussed and poured their knowledge together. It was teamwork at its best; it was learning at its best. For me to observe the process was definitely worth the visit.
Shifting gears for a day, we received a local lecture from a geriatrician. He came to talk about the state of geriatric care in the context of rural medicine.
"A very underserved population," he said. There was no question about that.
With the current state of understaffed facilities, an aging baby boomer population and large disparities in care between different regional health districts, the presentation he gave was a reminder of just how far behind we are in this area of medicine. It left me feeling scared about getting old.
He gave a brief history of how the care facilities have evolved and how people admitted used to be healthier and as more and more people required beds, they began to admit sicker and sicker patients. Now, the onus will be on us to do better. I feel like this is a catch-twenty two: you need to restructure and change the way we practice health care to address this issue but without showing a working model and having cooperation between various districts, the geriatric problem in more rural areas will continue in its current state; without the agreement you cannot get restructuring and so on.
As our presenter noted, a part of the problem is that the required care is lost in a bureaucratic nightmare. Until we can all work together on this, this is not going something that will go away soon.
Slide 334 of 345.