Thread by @ethanjweiss

I guess I graduated from medical school 25 years ago. It got me thinking about what’s changed & what hasn’t.

In the past 25 years in medicine:

1) What has changed that you never expected to change?

2) What hasn’t changed that you expected would by now?

I’ll start:

There are some obvious ones like communication. Cell phones barely existed in 1996. Email was just getting traction. Pagers were ubiquitous. We interacted with paper charts way more than we ever touched a computer. Video visits were some kind of Star Trek concept

And of course data in the hospital. As students and interns we still went on daily X-ray rounds which included walking to radiology to view films, to path to see specimens, to the echo lab to see echos. We interacted with the people there and learned from them

We did not have a term to describe work hours. You worked till you were done and then you went home and came back. If you were tired and needed help, your colleagues would notice and pitch in (or so it seemed)

There was no distinction between service and learning. It was all considered learning

What hasn’t changed?

The basic structure of the inpatient teams is mostly the same

The basic structure of the outpatient office visit is the same (before March 2020). Sure, we use computers a lot more, but patients still come in the front door, they still get the same vital signs and ECGs on the same machines. They still change into and out of a gown

There is still the same template for visits. New patients get more time than established patients but that amount of time is fixed whether the patient has 1 problem or 10

Not surprisingly, patients and clinicians still mostly feel that they don’t have enough time

This is obviously not meant to be a comprehensive list. It’s just a start. And it’s also not meant to judge what is good or what is bad. It’s mostly a way to calibrate how things are relative to how I expected them to be 25 years ago

Lastly, I’ll mention briefly that the one thing that has really changed the most is me. I’m much more confident. I’ve seen a lot. I have gotten good at pattern recognition. But at the same time I am also much more humble about what I/we don’t know

I’m much more likely to say “I don’t know”. I’m much less likely to argue with or to cajole a patient. I see myself as a resource more than a decider

Whereas clinic was a burden when I was young, it is now my favorite experience in medicine. And my joy in seeing patients has nothing to do with solving puzzles or saving lives. It is nearly entirely about connecting with people

Just yesterday, I went to lunch at the home of one of my patients. It was amazing

A lot of my favorite patients have died. I’ve gone to multiple funerals. It’s incredibly sad but it’s also oddly beautiful that I have been a part of their lives and for so long

I definitely see myself in a much different light as a physician today versus 25 years ago. That said, I still have trouble calling myself Dr. Weiss