How Doctors Learn From Patients

I need to learn a new technique for inserting a large intravenous line. As a resident, I learned how to place these lines (used for medications and dialysis) in the groin or neck by locating the arterial pulse with my fingers, looking at the anatomical landmarks nearby, and then calculating in my mind where the vein ought to be. After a while I could reliably get a needle into the vein by “feel.”

Since then, a bedside ultrasound device has become part of the procedure, allowing you to actually “see” the vein you are aiming for—a pretty amazing difference from the way I learned. I’m told it’s awkward the first few times you try it, since you have to juggle the ultrasound and the needle while keeping everything sterile. So I asked my colleagues to teach me.

There’s an old saying in medicine about this kind of learning on the job: See one, do one, teach one. I’ll watch someone use the ultrasound. When I understand how it works, I’ll try it myself with some help. Then, before I know it, I’ll be teaching someone else how to use it. I believe this training system works pretty well for everyone involved (patients included). Like the Nike slogan goes, you have to “do it,” preferably right after you “see it,” to really get it, and then teaching it is the test to show you actually understand what the heck you just did.

But it does sound pretty scary from the patient perspective: You mean that someone is going to do something for the first time on me?

I have to admit there are situations in which I myself would prefer not to be on the receiving end of a “first time” doctor, and I am grateful to the patients who bravely held out their arms during my medical training and let me learn how to draw blood, for instance, showing me where previous attempts had succeeded. I also remember feeling “jinxed” by patients who, upon seeing me, ran through the litany of previous trainee failures and kept up a steady stream of withering comments on my technique, making me feel as if any attempt would be hopeless.

My favorite memory, though, is of one leathery old man I took care of at the VA hospital who really understood what a teaching hospital is all about. I tried to draw blood three times in one of his arms and failed. Three was my self-imposed limit. I apologized and turned to find a supervising resident. “Wait a second,” the patient said sharply. Expecting to be chastised, I turned around, shoulders drooping. “I got another arm right here, and you ain’t tried it yet! How are you ever gonna learn?”

That old man was pleased as punch when, on the fourth try, I managed to draw blood. But it is the rare individual who can, in their own time of illness, find the energy (and bravery) to be a teacher as well as a patient.

Original here