A Day in the Life of a Boston Doctor
Internist Dr. Joshua Liao chronicles exactly what happens in a day in the life of a first-year doctor.
Hospital interior photo via Shutterstock
5:45-6:15 a.m.: It’s still pitch dark outside when I awake. On my walk to the hospital, light begins bleeding through the clouds, painting the sky gray.
6:30 a.m.: I hit the ground running. I record vital signs, examine my patients, and apologize for waking them so early. I locate their nurses, which is probably the most important task of my hectic morning, to ask for input or questions. My first patient has blood in her stool, but she is stable and I have seven other patients to see. I will swing by again later.
7 a.m.: The overnight physician and I meet to communicate updates on my existing patients and discuss new patients in more detail. He asks if I stayed late to do paperwork the night before, and I smile and pat him firmly on the back in response.
7:20 a.m.: Several nurses page me asking for medications. I order one quickly but defer the others until I have personally evaluated the patients in question.
7:30 a.m.: I introduce myself to my new patients and review their medical information. “It must be hard remembering all the different doctors you meet,” I say as I fish in my pockets for a marker. They laugh affirmatively as I explain that I will be their primary doctor and pen my name onto a whiteboard. “Liao, like a cat’s meow but with an ‘L’.” They laugh again and repeat my name slowly, but accurately. Leeoow. I feel confident the memory aide has helped.
8:15-8:25 a.m.: Four pages arrive in rapid succession. The last is from a nurse who leaves no message. I return her call but I’m placed on hold as the secretary tries to locate her.
8:30 a.m.: I am still holding when my supervising physicians page and ask to “round” (discuss and decide plans for each patient) with me. I reluctantly hang up and jot down a reminder to touch base with the nurse later.
8:45-9:15 a.m.: My supervisors begin by asking about my new patients. I search for answers in the stacks of paper that are jutting out from my coat pockets, and think to myself how I wish I had more time to familiarize myself with their conditions. As we talk, I receive several more pages, which a colleague handles for me so I don’t break the flow of rounds.
9:30-10:30 a.m.: We migrate through the hospital so the entire team can greet my new patients together and recap treatment plans. Afterwards, my supervisors leave to round with another physician, and I stuff my papers back into my pockets and head back to the hospital floor.
10:45-12 p.m.: Retracing my steps to my patient’s rooms, I add my daily notes to their paper charts. Then I retreat to an alcove to order diagnostic tests, request consultations, and initiate therapies.
12:10 p.m.: I circle back to my patient with blood in her stool, and we agree on additional testing to guide the treatment plan. As we talk, nurses begin paging about discharge paperwork, which I am glad I completed the night before.
12:30 p.m.: I meet to pass-off patients to the responsible day coverage physician while I’m away at my outpatient practice. Afterwards, I stop by the noon conference (a daily academic lecture) to eat quickly and jot down notes on interesting learning points before heading to my practice.
1:30-5 p.m.: I treat a college student with lip blisters, conduct screening exams for several retirees, clear an athlete for physical activity, and counsel a businessman about diabetes control. Between patients, there are letters to mail and outside medical records to reconcile with my chart. A patient’s wife calls frantically asking if I can find time in my full clinic schedule to see her son and husband together. They are driving in from out-of-state. I agree, and she offers to bring me fresh northeast scallops as a thank you. I decline profusely, but she insists. They are delicious.
5:05 p.m.: After seeing my last clinic patient out the door, I touch base with my secretary and leave several files with her. She wishes me a good night, and I joke that it won’t even begin until I’ve finished my clinic paperwork. She sympathetically offers me a candy bar.
5:30 p.m.: After arriving back at the hospital, I make my daily trip to my patients’ rooms and address their concerns, speak with their families, and order medications required overnight. I explain that I will be back in the morning and bid them goodnight.
6:15 p.m.: The on-call physician and I huddle around my papers to discuss my patients. I highlight details, trying to simplify without omitting crucial facts. After asking some questions, he tells me to enjoy my night. I joke that it won’t even begin until I finish several more hours of paperwork. He doesn’t laugh because he knows I’m serious. He simply squeezes my shoulder and smiles knowingly.
6:45 p.m.: After finalizing several notes, I update discharge documentation for patients who will likely go home tomorrow. Revising this information daily is tedious but crucial. It requires repeated synthesis of laboratory tests, imaging, and clinical decisions. I will admit up to four new patients tomorrow, and I can’t afford to hold up morning workflow with paperwork.
7:30 p.m.: I see my reflection in the work room window and rub my eyes. It has been pitch dark for more than two hours, and I have one more patient to go.
8 p.m.: I finalize my work, grab my coat, and text my significant other on my way out of the hospital.
8:45 p.m.: After a quick bite to eat, I spend the next hour with my significant other. I apologize for getting home later than expected. It’s okay, she says, while smiling into the webcam. She’s proud of me for working hard to be there for my patients. I smile at the computer screen and feel thankful for her understanding, especially from 3,000 miles away.
10-11 p.m.: I read medical textbooks and journals to better understand my hospital patients’ conditions.
11 p.m.: I manage a few minutes of non-medical reading (currently Open Veins of Latin America by Eduardo Galeano) before calling it a night.
Dr. Joshua Liao is an internist at Brigham & Women’s Hospital.
Source URL: http://www.bostonmagazine.com/health/blog/2012/11/15/day-life-boston-doctor/