Posted Oct. 21 

Being in inpatient medicine reminds of being a medical student again. With doubt creeping in, I have to constantly remind myself to be gentle. Each day, I make it a point to provide compassionate, effective, efficient, and informative care to my patients in the wards. Quite honestly, it has been a tough juggling act.  I have to be gentle with myself because I can easily find fault in my own lack of timeliness, thoroughness, patience, knowledge, and communication.  I remember this feeling well as a medical student, fumbling through new departments each month like a tourist lost in translation. Alas, residency is about training and mentorship. I have to remind myself to be gentle with my own sense of inadequacies and find humility in the pursuit of competency. 

Most of my patients have problems larger than their illness - financially, socially, and psychologically.  I try to talk through their problems and find their humanity, find the health within them and help them identify it. This takes time, as well as vulnerability - theirs and mine.  But it is this connection that makes doctoring rewarding. Even if the connection is slight and fleeting, this partnership could mark the beginning of a long road towards well-being. 

Yet, a frustration lingers in the wake of my inpatient interactions.  This is not the place to have a medical home. Though for many of our "frequent flyer" patients, the hospital is their fragmented and broken medical hotel.  If I could, I'd have a village of ordinary citizen volunteers, social workers, rehab facilities, innovative family support networks, and mental health services to help our most vulnerable populations.

There are many social innovators who are taking on this task of building stronger safety nets in resource-limited communities.  It can be done.  A doctor in Rio de Janeiro created a network of support for poor children after discharge from 17 public hospitals.  According to David Bornstein, author of How to Change the World, Dr. Cordeiro's organization, Renascer, helped bring the percentage of "at risk" children from 42 percent to 10 percent, while increasing family monthly incomes by 58 percent.

So my frustration with our health care system and with the revolving door of our hospital for our most vulnerable citizens is serving its purpose: motivation.  I need motivation to seek out alternatives, to question the status quo, and to research solutions.

I have spoken to Rachel Friedman, a fellow intern, about starting a think tank.  We planned to meet over tacos and salsa to talk about our vision for social change.   About a month ago, our think tank of residents met. Twenty or so idealistic residents showed up to talk and hash out ideas to change their community for the better.  The more I get frustrated, the more I want to do something about it.  This think tank is a start. It is a beginning.