Jonathan L.

Ventigan, 08-87008 FCH 251 Ambu Reaction Paper

Aug. 21, 2011

I can definitely say that my ER rotation in the ambulatory clinic was my best ER rotation so far (and probably will be)? Why? Well, to be honest I liked it because it didnt feel like I was in the PGH ER. It did not smell like the PGH ER. The room was open and there was fresh air, no foul odors. It was relatively cool during the day, really cool during the night. It was probably the only place in the ER I didnt sweat a lot. Duties only lasted 10 hrs, not 24 hrs like elsewhere. This allowed me to get much needed sleep after my duties, essential for a properly functioning mind. The kiosk was only a few steps away so you could always grab a bite without worrying about being out of post. The best thing about it was that it never got as toxic as any other place in the ER. In short life was easier in the ambulatory clinic than anywhere else in the ER. Now dont get me wrong, Im no lazy bum so let me explain. Some people might be put off by the benigness(sic) of the place but Im not one to rush after a difficult life. They say the more toxic you are, the more you learn. Well, whoever said that never heard of the law of diminishing returns. As Wikipedia says: in all productive processes(say learning), adding more of one factor of production(patients, cases, referrals), while holding all others constant( say ones intelligence, talent, energy though energy can hardly be constant), will at some point yield lower per-unit returns(in the form of learning, knowledge, skills). Obviously, those in the brackets are mine but the point is you can only learn a little more with so much toxicity, after which, you learn almost nothing more and you might even learn less than you could be learning (by for example, studying rather than being hassled by a hundred patients, a case of negative returns). And thats the highest praise I can give to the ambulatory clinic: it never throws too much work at you but only just the right amount. One can really take time to study ones patients cases and learn by both doing and reading, not just doing. One never really gets rattled but you are always on your toes. It seems patients in the ambulatory clinic come to you at a rate of about one ever one to two hours. And thats necessary because you never really know what kind of patient is going to walk through the door. Fever is the most challenging chief complaint to handle because it can have many causes. Psychiatric patients too although I did not encounter any this time but past experience has taught me to be patient and thorough with psychiatric patients. And perhaps best of all, you can really get to spend time with your patients. I had this mother of an infant patient who badly wanted to have her child admitted and I had to explain to her why her child didnt need to be admitted, explained to her the nature of the illness, how it can be managed at home and all the while, I never had to raise my voice or be rude because I was feeling rattled and had to do a million other things. Only in the ambu can you find this. Another thing I like about the ambu is that duties last only 10 hrs, not 24 hrs or more with other rotations. The department says that this is more physiologic and I agree. In fact, I believe duty times are now being limited in other countries, including Europe and at least for 1st yr residents in the US. I have always wondered why is it that doctors still insist on pushing the human mind and body to function

beyond what is optimum when the task at hand is one of the utmost urgency. May I ask for example: would you feel safe if you ride a plane and suddenly your pilot tells you that he hasnt slept for 24 hrs? Or would you ride a bus where the driver is sleepy? Many accidents have resulted in such cases. Even the doctor would get off that plane yet he treats patients even when he hasnt slept for more than 24 hrs. Perhaps we think its because of the lack of medical personnel in a place like PGH but one doesnt really hear this argument for 24 hr duties. I do suspect sometimes that it is a matter of pride, that doctors feel they have to act like supermen. (Or the same case applies that they have to act as if they are infallible.) If so, then kudos to the department for recognizing this very human weakness: that we need sleep. This is being implemented in other countries and I believe it will catch up here in the Philippines, though that may be in the far future yet.