One of my colleagues, who is my vintage, told me how, as an intern, he became overwhelmed on a grueling every-other-night service. Tired and frazzled, he went to his chairman to confess his worries about his lagging ward work.
“I’m exhausted all the time. I don’t sleep and I’ve lost weight. What should I do?” he asked.
“Get your thyroid checked,” the chair said, looking disdainful and dismissive.
Of course, some of this macho attitude is nuts, but at its core it can represent a drive for achievement. In athletics, this drive makes champions and is rewarded royally.
MD Coaches Who Inspired Awe—and Dread
Sports and medicine are different universes. Unlike sports, where the coach is omnipresent—prowling the sidelines, barking orders, stomping his feet—the chairmen of medicine coach episodically, contacting trainees at grand rounds, chief-of-service rounds, or at morning report.
At the time of my training, morning report was a stressful occasion, ranking with an M and M (Morbidity and Mortality) conference as a time when patient care would be put under a very public microscope and unmercifully critiqued. Morning report can be analogized to watching game film in sports. Both endeavors involve dissection of previous work with the goal of discovering flaws. Whether the team wins or loses, mistakes are made and they have to be found and analyzed for immediate correction. Indeed, in sports, victory can be deceptive and—unless the film is broken down—the mistakes become ingrained and losses loom.
I occasionally give morning report now. It is quite pleasant because I am presented a case about something I know and the house officer gives an evidence-based medicine (EBM) review. I usually complement the management of the case and the EBM discussion. There are sometimes delicacies from Panera and a steaming urn of their finest house blend, making a most enjoyable interlude.
How I wish morning report was like that when I trained. My morning report was a time of reckoning with the chairman. For the chairman, think Joey Dorsey with a white coat and stethoscope. Every case that came in the night before would be ripped apart. Even if the outcome were a resounding success—paroxysmal atrial tachycardia instantly banished with carotid massage, Addisonian crises reversed with a squirt of Solu-cortef—the chair would find something amiss.
“So, Dr. Pisetsky, what did the EKG show before you ran potassium on the diabetic ketoacidosis patient?” the chairman would ask, his steely eyes drilling into mine.
