Thursday, December 5, 2013

Sleep Medicine

The most bullshit rotation I ever did in med school was Sleep Medicine. A true budding physiatrist, I selected most of my fourth year electives based on which ones had zero call and the shortest hours.

Maybe other Sleep Medicine rotations are really hardcore, but this one wasn’t. Every new patient evaluation went something like this:

Patient: “I’m having trouble with my sleep…” [describes sleep problems]

Sleep fellow: “OK, let’s schedule you for a sleep study.”

Needless to say, it didn’t take long for me to get the hang of it.

Anyway, I had been on the rotation a couple of weeks, and was seeing a new patient and was about to present the patient to one of the attendings, Dr. Roberts, after having already presented the patient to the Sleep Fellow, Scott. When Scott told Dr. Roberts I would be presenting, she seemed surprised.

“You saw the patient yourself?” she asked.

“Yes,” I said.

She gave me a disapproving look. "Don't you think Scott maybe knows a little more than you and maybe you could learn something from watching him ask questions?"

Because I am a huge wuss, I said, "Yeah, maybe."

But what I was really thinking was that this was the dumbest thing I've ever heard in my entire life. For starters, I think active learning is the best kind of learning. Any med student will tell you that watching interview after interview is boring as hell. This way I got to ask my own questions and Scott could point out to me the things I should have asked. If Dr. Roberts were right, then why do they ever assign patients to med students? Why don’t they just have med students observe for two years straight, then go release them into practice, without having actually done anything themselves? The reason is because you learn best by doing.

This reminds me, of course, of another great quote from an attending I had during residency, who was very overprotective of his patients and often made us just stand in the corner and watch procedures. He once said to me, “I don’t like residents learning on my patients.” That’s great… so what are you doing as an attending in a teaching program?


  1. "Why don’t they just have med students observe for two years straight, then go release them into practice, without having actually done anything themselves?" That is Med school in my country.

  2. The insurance companies have realized how much they've been paying for sleep studies in labs and want pts to have a home study if the pts are suspected of OSA. Even then they give you the third degree to prior auth it. The last one I prior authed the nurse on the other end went through the entire Epworth scale and asked me to relate the patient's answer. Wouldn't take my word that his score was 17.

  3. I am an M3, and I am dealing with this problem right now. My current attending does not even let me come into the room the majority of the time. I must mention he is a surgeon, and I scrub in on all his cases, but I can learn from pre & post-op appts, too. Maybe he thinks it is boring for me, but I would rather listen to him interview than read alone all day. I can do that mess at home.