From clinic to the operating room

A new patient was referred to the gynecology clinic from an outside community clinic that serves a low-income population. She was at the end of her rope dealing with symptoms from a condition that she allowed to progress for so long because she couldn't afford to fix it.

I was working with the chief resident, who is essentially almost a "real" doctor; even she was taken aback. "I'm going to go talk with the supervising doctor, and we'll see what we can do for you." The attending was equally impressed with the patient's history and physical exam and scheduled her for surgery the very next day.

My resident invited me to watch the surgery. "It'll give you a chance to follow a patient from start to finish." Thank you so much! This kind of continuity, as a medical student, is not the norm. I had to play hookie from afternoon clinic (with the chief's permission) in order to see my patient's surgery.

During the first two weeks of this clerkship, I saw many surgeries on women whom I had never met and never examined. The only history I knew of them is what I read in their chart and what the resident told me beforehand. Occasionally, I'd have a few minutes to chat with these patients immediately before surgery. But the whole experience felt disjointed.

That's why I'm incredibly grateful to have experienced the kind of continuity of care, from clinic to surgery, that the residents and attendings enjoy. The attending even stepped back allowing my resident to operate and leaving me to first-assist! And she invited me to accompany her to talk with the patient's family afterward! The experience felt complete.

I think more effort should be made to give medical students this kind of patient continuity. In terms of teaching and learning, I personally find that such continuity is especially effective: I will never forget this patient.