The Age Gap Trap: Young Residents Caring for Older Patients

Rosalyn E. Plotzker, MD

Disclosures

October 27, 2015

I spoke to her very carefully. I focused on each syllable ("bow-el move-ment") and every consonant ("C-aTHe-T-eR"). This was in response to what she had said to me Monday morning: "Honey, everyone raises their voice at me. You don't need to yell. I'm not deaf. I only have trouble understanding because you kids talk so fast. All the words blend together." So, on Tuesday, I tried to communicate the way I imagined she would want me to. I asked slowly about her appetite; gauged her ambulation; and examined her incision. I answered her questions to the best of my ability, with precise enunciation and upward inflection. At the end of our discussion, she said, "Sweetie, I sure do appreciate you stopping by. Now, do you know when the doctor is coming?"

I was a junior resident. Some unimpressive gray hairs vouched for 3 decades of life experience. I knew she didn't care about them. Her lifetime tripled mine. Besides, I was easily confused with other petite hospital characters—nurses, phlebotomists, and students—who wore similar scrubs, coats, and stethoscopes.

Medicine's professional ladder is sturdy, with seemingly endless rungs, especially from a trainee's upward gaze. We are all given opportunities to ascend an albeit steep incline. But, for many patients, the subtleties in rank—resident vs chief, chief vs fellow, fellow vs attending vs director vs chairman—are indistinguishable. The rungs merge and form a continuous clinical spectrum. Meanwhile, there are infinite competing ladders at the bedside. They are based, fairly or unfairly, on our appearance, how we speak, the words we choose, and ultimately the labels we are given...whether or not we ask for them.

As a result, residency can catapult a trainee into a mild identity crisis. After agonizing for years over applications and standardized exams, we are finally, finally "physicians." Nonphysicians tell us how impressive that is. We get to hear about our friends' doctor appointments, with a follow-up, "What do you think about that?" Maybe we have something valid to add. We are expected to be responsible, but the responsibility is a happy one. At the same time, inside the hospital, we are still young. In fact, we are the youngest doctors we could possibly be.

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