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A Lame Doc


 

This is my last issue as physician editor of The Hospitalist. It has certainly been an interesting and rewarding two years. It has been an exceptional experience working with Lisa Dionne, Wiley, and SHM.

I look forward to the changes my worthy successor Jeff Glasheen, MD, will put into place. As I approach the end of my tenure, I can glimpse the light at the end of the tunnel.

I have a sense of déjà vu. I have a sense of déjà vu. I know the feeling well. I’ve noted it on the last day on a rotation, the last hour on a shift; I even remember it from the last month of residency. All of these were periods of transition, variations on the well known theme of “senior-itis.” A colleague, a one-year hospitalist named Jeremy Cetnar who is off to greener oncologic pastures, suggested his final few weeks on service were like being a lame duck president; a combination of temporizing and survival.

What is a lame duck beside the punch line for a corny joke? The term may have originated in the London stock exchange in the mid-18th century. When settlement day came, and a member was unable to meet his debt, he “waddled” out of Exchange Alley. From an avian standpoint one could also be a rook (a type of crow), which was a swindler. That was better then being a dove, which was the rook’s prey (hence the saying “They got rooked”).

It has been a great two years. We have covered stories from all over the world. … We have even looked at maggot debridement. Oh, and also some hospitalist stuff.

Perhaps better to be a mammal like a bull or a bear, than a lame duck. Lame ducks are also seen in entertainment. There is a Finnish rock band and a Norwegian ska punk band by that name. The lame duck is also a well-known tango position, but my orthopedist has forbidden me from demonstrating.

The 20th Amendment (the big XX) is called the lame duck amendment. It comes right after XIX, also known as the “No shoes, no shirt, no service” amendment. (Actually XIX is “The right of the citizens of the U.S. to vote shall not be denied or abridged on account of sex”—a biggie for sure).

Amendment XX was established in 1933 to reduce the time between the election of the president and Congress and the beginning of their terms. Having a delayed inauguration could lead to problems, as in the case of Abraham Lincoln: The Confederate States seceded before he could be sworn into office.

It is never easy to sit in office as a lame duck, whether a senator, congressman, or president. As a president, the current two-term limit creates the lame duck situation more frequently. Prior to the inception of this limit, there was always the possibility of running for a third term to add spice to those last years in office. The first Roosevelt to run for a third term was Teddy, running as a “Bull Moose.” He lost his bid to Woodrow Wilson in 1912. After FDR, there would be no more two-term-plus presidents.

There have been five lame ducks since the amendment was passed: Eisenhower, Nixon, Reagan, Clinton, and our current lame president, Bush. The last two years of the second term can be hard. For Eisenhower and Reagan their prestige and public admiration carried them through. Nixon and Clinton were significantly less lucky in this regard. How the current resident of 1600 Pennsylvania Ave. finishes his term will be of great interest to historians—and to those of us who live through it.

“How does this have anything to do with hospital medicine?” you may ask yourself, as the readers of this column frequently query.

As a resident, the last few months were never ending. The predominant sensation was being ready to move on. If it’s the last day on service after a long run, and a patient gets admitted, I still sometimes have to fight that feeling. There are unanswered questions, tests to be ordered, labs pending, but still you know that when those results come back, it won’t be you who interprets them. It creates a disconnect that is hard to avoid.

For a one-year hospitalist, spending a year on service as filler between residency and fellowship, this is a huge issue. As the transitional hospitalist nears the end, how can he or she stay involved in decision-making and maintain interest in the workings and improvement of the group? Transitional hospitalists are an important resource in many academic centers, and making their entire year a success is of paramount importance to the patients they serve.

The best recommendation I can make is to make sure one-year hospitalists are not on service their last two weeks. Let them save their vacation time and non-service time until the end, when they really need it for the transition to the next phase in their lives. This also helps avoid the creation of a malcontent and the potential for substandard care by a disengaged provider.

As physician editor—aka Grand Kahuna—of The Hospitalist, I have felt that sensation of being ready to hand over the reins. I am ready for my senescence. Nonetheless, it has been a great two years. We have covered stories from all over the world—Iraq, Afghanistan, Holland, and Brazil. We have explored medical history from ancient Greece to colonial America. We have even looked at maggot debridement. Oh, and also some hospitalist stuff.

I can’t wait to see what The Hospitalist will look like in the years to come. As the great poet-physician Oliver Wendell Holmes Sr. observed, “The great thing in the world is not so much where we stand, as in what direction we are moving.” TH

Dr. Newman served as physician editor of The Hospitalist since 2005. He’s also consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine, Rochester, Minn.

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