Bedside

When I was an intern, there was a big push for better bedside medicine. The fear was that with greater technological advances and widespread use of the electronic medical record, we would forget how to be a doctor: how to hold a child and look in the ear or clasp a hand of someone who was dying or listen to a patient's story and tease out the details that would make the diagnosis. We were taught to make the history and physical the cornerstone of our care.

Strangely enough, I find that now as an anesthesia resident, I spend much more time at the "bedside" with a patient than I ever did as an internal medicine intern. True, I spend little time when they are awake, but when I do, I engage in it deeper than I did as an intern. Information-gathering is no longer the primary aim; instead, I want to build trust and rapport, get to know the patient's fears and anxieties, and confirm those relevant medical details. It takes work, and I can tell you, if I miss that first IV, I work twice as hard to keep the patient's confidence.

Sitting at the bedside in the operating room with an asleep patient is an odd way to get to know someone. I learn their sensitivity to drugs, where their blood pressure lies, how compliant their lungs are. I can discern whether they really took their blood pressure medicines this morning and guess whether they really quit smoking. I know the patient's height and weight by heart. I know where their largest veins lie. I look at their teeth. I see a patient's scars and tattoos, indirectly examine their heart and kidneys. At the end of a surgery, I really know someone's physiology, even if they are asleep the whole time.