2009-05-08 / Columnists

PHC Health Talk

Resident? Intern? Doctor?
Commentary by Peter A. Guiney, DO, FACOFP, DME Director, Family Practice Residency Program Peninsula Hospital Center

PETER A.GUINEY PETER A.GUINEY We've all heard the terms, of course, but do most of us really understand what a "resident" really is? or an "intern"? Are they "real" doctors? Are they there for the patient's benefit or for some other purpose?

These are questions that patients and their families have pondered over the years concerning these doctors-in-training encountered so routinely in a teaching hospital. Recent hit television shows like ER, Grey's Anatomy, House, MD and Scrubs depict these physicians through the filter of the Hollywood lens.

Yet, when you, a loved one or someone else you know is in the hospital, the television dramas are forgotten and the real world intervenes. Our culture has been fascinated with this period in a physician's training since long before the days of "Ben Casey" and "Dr. Kildare." Indeed, they have been demonized and/or idealized so often that most patients do not know what to anticipate … good or bad. And many of these myths are responsible for needless anxiety and unrealistic expectations.

Peninsula Hospital Center has been training interns and residents for well over 30 years. It is one of approximately 1,100 teaching hospitals in the United States. There are literally hundreds of established doctors in practice all over the country that have diplomas from Peninsula Hospital Center. Our programs trains physicians who specialize in such areas as Family Practice, Surgery and Orthopedics as well as podiatry and dentistry.

All residents and interns at Peninsula Hospital are successful graduates of medical school, dental school or podiatry school and are in accredited training programs. Following graduation from medical school, all physicians are required to complete one year of hospital training before they are eligible to obtain a license to practice medicine. This initial year of clinical experience, traditionally called an internship, is also referred to as the first year of residency training.

All physicians must successfully pass this challenging hurdle if they ever hope to treat patients on their own. Following this year education, nearly every one of these doctors continues on with specialty training. At Peninsula Hospital, they will serve an additional two years to become family physicians or an additional four years to become surgeons and orthopedists.

Contrary to the television myths that always seem to show residents working alone, these doctors are, in reality, under continuous supervision and scrutiny by experienced, licensed, board-certified "attending" physicians who serve as their teachers and mentors. As the intern/resident progresses, they are given more and more responsibility according to very strict and clear guidelines. Their hours are long, but even these are limited with safety in mind to prevent over-tired doctors from making mistakes. Legislation pioneered in New York State has insured that all hospitals follow these important restrictions regarding resident work hours.

Students who have not yet graduated from medical school require training in hospitals as well. The first two years of medical school are spent in a classroom learning the "language of medicine." In the second two of the four years of medical school, students serve as Clinical Clerks in the hospital. For those fans of ER, this is where "Carter" started in the first episode. Often times, this is the first exposure that these future doctors have to hospitals and, more importantly, to patients.

Clinical Clerks are strictly supervised and are not allowed to practice medicine. Clerks wear ID badges that herald their student status as non-physicians. Under direct supervision, they learn how to interview and examine patients and how to do minor procedures. Unlike television, their role does not involve "jumping in" on an operation to save the day when a mysterious alien force somehow incapacitates the more senior staff.

Many would argue that patients are the ultimate beneficiaries of this tradition and environment. Prominent medical educators maintain that a teaching hospital is uniquely able to break down the barriers between doctors and the patients. For patients with a private doctor, residents are available around the clock for on-site urgent or emergency care when their doctor is not in the hospital and seconds count. For patients who do not have a doctor of their own, the team approach of the Attending/Resident and Clerk allows for extensive discussion and consideration of patient issues in an academic environment. Such patients actually have more doctors directly concerned with their individual care.

At Peninsula Hospital, the established teaching program paved the way for the implementation of a Physician-Driven Rapid Response Team (RRT) in 2007. This new concept of hospital staff organization allows for near-immediate physician attention for a patient in distress anywhere in the hospital. Upon activation of the Rapid Response Team, a patient in distress at Peninsula Hospital can expect a board-certified attending physician and his/her team of residents, clerks, respiratory therapist and critical care nurse at bedside within minutes on any day of the week! There are few other community hospitals in the country that can make such a claim.

Because studies have indicated that such interventions have been directly responsible for saving lives by bringing the most experienced professionals in the hospital to the sickest patients at any time, we clearly count this as a significant advance in the care of our patients. By embracing new ideas and modern approaches to healthcare delivery, teaching hospitals like Peninsula have made an enormous contribution to the communities which they serve by eliminating barriers to healthcare and by bringing doctors and patients together when and where they are needed the most.

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