Well, I was so excited about the changes we had made when we went to the orphanage, with the residents making rounds in 2 small groups so they could hear about some of the other patients that their colleagues were seeing (https://chopstixplease.wordpress.com/2010/06/09/orphanage-team-rounds/).
Some good discussion and learning was going on, with principles that apply to many more patients than those we just laid eyes on that day.
Then last week my colleague brought 3 residents (one by one) from the main orphanage building to see a child with some congenital birth defects, in the “clinic” building for sick kids and new arrivals.
That was apparently the last straw for someone, and we were told (via a second or third party) that we “have too much teaching” going on.
Why? What’s wrong with teaching, for crying out loud?!!!
I could get really defensive and say: We are happy to see the patients, just bring them to us (instead of us never hearing about children with problems but just hunting them down on our own, uninvited).
Or I could say, frustrated: We are aching to help the children, just talk with us and we can come up with some good ideas.
Or, I could be sarcastic and say: Teaching is what is really needed here.
But those are all my human emotions fighting to be at the head of the ranks, to lead the way and lead all the other bad attitudes.
That is not what we’re about.
So how do we respond?
Ask more questions, for one.
Who is upset?
It sounds like partly, the ayees (caregivers).
Maybe they’re not happy with residents or attendings taking a long time with their child during feeding or naptimes.
We are, after all, encroaching on their turf, uncovering problems when we spend a long time with the kids.
The orphanage doctors? Maybe. We’re still gathering more info on their view of things.
For one, the Chinese system of educating doctors is: the attending sees the patient quick quick quick (partly because there are 1.3 billion people in this country and they all use the hospitals for medical care), and the resident watches.
In fact, most residents here (from what I’ve been told) pretty much spend their entire training period watching.
Once they become an attending, they can actually lay hands on their own patients.
Radically different from the US, where your entire medical school and residency training is focused on gaining more and and more independence and seeing patients before reporting to the attending.
The lay public is not used to a setting where the doctor-in-training first extensively questions the patient and caregiver, examines the kid, and reports back to the attending (and team of other residents).
The unfamiliar is always a little frightening and threatening.
Try to find out what they want, how we can support them in their felt needs and what they think we can offer.
One of our Chinese colleagues spent yesterday with us and will continue to go for the next few weeks to be eyes and ears.
We are already tenuously in the orphanage–not exactly invited in (who wants outsiders, especially foreigners, tromping all over a carefully controlled setting and messing things up?).
Back off, compromise.
We resumed 1-on-1 teaching this week, and saw twice as many patients, whipping through developmental screening discussions, failure to thrive and cerebral palsy just like that.
Arrogance, anger and pride only feeds the negative stereotypes, so I am learning to dump those.
I am a guest here, and wish to act accordingly.