The Three A's of Medicine

Once again another July has come and it’s time to welcome the newest class of medical students, residents and fellows to the next step in their medical career.

Part of being a resident or fellow is to be on call overnight and on the weekends. As any new resident, you’ll be nervous the first time because you think you don’t know anything.

Overtime, you’ll gain the knowledge and expertise to be able to ask the right questions, improve your exam skills and make the right clinical decisions. Trust that you know more than you think you do.

Throughout your career, especially if you’re a specialist, you will be asked to perform consults. As you gain experience, you’ll be tempted to triage patients away as your comfort level increases.

Just remember, no matter how trivial the consult seems, don’t blow it off.

One of the important things you can be while on call is to be available. And it continues after graduation. I’m in my eighth year of clinical practice as a retinal surgeon who also takes call at several of our local hospitals.

Just the other night, I was asked to see a patient who was admitted to the hospital because he fell and broke his back.

Upon admission, he complained that had vision loss in both eyes over the past several weeks, but more noticeably over the past few days.

He also had multiple medical problems such as high blood pressure, diabetes, a prior stroke and the all reasons in the world to have poor blood flow to his eyes leading to vision loss.

I wasn’t the first ophthalmologist the hospital intern had called.

In fact, just a few days prior, another eye doctor who was on call before me decided it wasn’t urgent enough and that he didn’t need to come in but rather have the patient follow up as an outpatient.

After a few days in the hospital, the patient’s wife got angry and urged the hospital housestaff to reconsult and I happen to get the call.

After a busy clinic day, I went in. Sure enough, upon examining him, he had retinal detachments in both eyes, one of which appeared to have only recently affected the center of vision. We operated the next day and he is doing fine.

In the family consultation room after surgery, the wife asked why didn’t the other doctor come in. I didn’t have a good answer, only reassurance that the problem was fixed.

I believe in karma.

Can you imagine if you or a loved one who was hospitalized and one of your main complaints was blown off and later to be found to be an emergency?

In this case, his poor vision may have contributed to his fall leading to a broken spine.

Be a doctor and take care of the patients you are fortunate to be given the opportunity to see.

My attending physician Dr. Paul Tapino once taught me while I was a first year resident at the University of Pennsylania, “You’ll never be faulted for coming in and seeing the patient.”

That advice 12 years ago has stayed with me ever since.

The simple fact of being available to your colleagues and referral network will go a long way. You’ll develop trust amongst your referring doctors AND your patients.

In your mind, it may not be a life threatening emergency, but most doctors just want to get the patient out of their exam chair and into yours.

I’m not sure who said this first, but my fellowship mentor Arthur Fu taught me that every good doctor should follow this sage advice:

“Be Able, Be Affable, and most importantly, Be Available.”

These are the three A’s for success in medicine.

This blog is part 6 of the best pieces of advice in medicine that I've learned in my career. To read the previous blog part 5: "A simple phone call goes a long way" click here.

#medicaleducation #residency #medicalschool #eye #advice #ophthalmology #medstudent #acgme #dellmedschool

Robert Wong, MD
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