They say 95% of treatment happens outside of the hospital. Having rotated through psychiatry and OB/GYN so far, I couldn’t agree more.
We pursue a career in medicine because we want to help others. It’s truly a profession of service. Patients come to us not only sick but probably anxious. I imagine that for most situations (unless you’re having a baby), people don’t look forward to going to the hospital.
So when we interact with patients, and we want to help them get better, it’s important to think about long-term treatment. We don’t want to keep patients in the hospital longer than they have to be. How do we set up a treatment regimen outside of the hospital that a patient is willing to able to follow while we aren’t there monitoring them directly? I’ve seen this in psychiatry, where much of the treatment requires connecting patients to therapists and strong social networks. In OB/GYN, it’s working with pediatricians and GPs to help with the overall health and well-being of the patient.
The past two weeks I was working in our labor & delivery unit, I thought the only thing I would be doing was delivering babies. And while that’s a significant component of the work, I realized through my interviews that there were multiple other factors I had to help patients create a treatment plan for. Hypertension and diabetes were two of the more common occurrences, mostly because they have an impact on the developing infant.
One case stands out where a patient came in for preterm labor but was in excruciating pain because of a tooth abscess. Having no dental insurance, she had little access to a dentist and the pain became intolerable. Not only did she have significant pain, but other complications meant that it was time to deliver the baby. Working with the residents, the plan was created not only to address postpartum care, but the residents spent hours outside of the busy schedule to find a free dental clinic that could take the patient as soon as she was discharged from the hospital.
Specifically, it was the ED intern on the team (ED interns their first year here spend about half of the year rotating through various services) who initiated the workup. It was incredible to see the commitment to a patient’s care outside of the direct care of OB/GYN. My initial instinct was that the ED physicians focused on acute care, but this intern demonstrated care above and beyond that instinct. It’s really making me consider pursuing emergency medicine. At least I’ll do an elective in it to start.
