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SAN ANTONIO SAN ANTONIO
MEDICINE MEDICINE
My First Day

What do Patients Believe
By Daniel Rosas, MD

Finally, July 1st: I’m starting my internal medicine residency in the population at risk of infection when going outdoors more-so than with Makes a Good Doctor?
medical ICU service, on night shifts. Imagine starting a new dream job the older population.
in a brand-new place, in the middle of a global pandemic, and with a Continuing to evaluate the patients, I wrote down my findings and
new electronic health records system. This was going to be fun. started getting ready for rounds. When the attending entered the By Kalli Davis, Ryan Carbone, Justin Fredericks, Alex Basdeo and Joshua Lujan
The local surge of COVID-19 cases in the city, as well as in the hos- room, we all introduced ourselves and then we went on to start round-
pital where I was going to start, made me nervous about this great ing. Three pages of notes per patient contained random facts and lab This question was posted as a short, single-question survey on social media and encouraged people to respond and share.
learning opportunity; but finally, the opportunity to help! Until now, values written all over the pieces of paper; there weren’t enough pockets The results were submitted to the 2021 Texas Osteopathic Medical Association Midwinter Conference Student/Resident poster competition in
I had only experienced the pandemic on a television screen. Now, at on my scrubs to fit all those paper sheets. Each time upon presentation, the category of “Original Research”. The poster presentation by Kalli Davis, a second-year medical student at the University of the Incarnate Word
10:00 pm, there I was, fueled with coffee, stethoscope and pens ready, the resident and fellow corrected me on lab values, medication doses School of Osteopathic Medicine, was awarded first place.
pager on, looking professional with scrubs and badge, ready for any- and 24-hour events, among many other details I either had not found The project was developed as part of the School of Medicine Community Engagement Partnership, which is built into the curriculum re-
thing … or so it appeared. or presented the wrong number. After reporting the wrong “I/Os” on quirements for second year medical students. This scholarly project provides students the opportunity to develop research under the guidance
Upon arriving at the ICU and introducing myself to the resident, my first four patients, on the 5th one I told the attending I was sorry of experienced faculty.
he asked me why I was there so early. The answer came with a nervous but now knew where to look for that information the next time. The
and shaky voice tone; it was my first day so “early meant on time”. The attending said it was alright and, since it was July, everybody under-
resident was very kind and took me to the workroom to review the pa- stood that we were just starting and getting used to everything. This
tients to be assigned. They assigned me a total of six patients; four of was so encouraging to hear, and it was said with such a positive attitude
them were diagnosed with respiratory failure due to COVID-19. That that I wanted to show up the next day and be ready and more efficient
is scary. Immediately the images of healthcare workers seen on the news than the day before. What an example she was being for everybody
for the past months were a reality. From that moment on, I was one of there. It’s hoped that the fellows, residents and interns from that mo-
the healthcare workers, and although scared, eager to help and learn. ment on will follow this approach with their future interns on their
The resident instructed me to chart-check my patients; so, the at- first day. If it hadn’t been for this amazing group of co-interns, sensa-
tempt at navigating the new electronic health record system began. Tu- tional residents, a mind-blowing fellow, and a one-in-a-million type of
torials used during orientation had not prepared me for this. With no attending, I don’t know what would have happened to me.
idea what I was doing, after some struggle I found out how to read pre- Maybe it was just luck having those types of people around me the
vious notes; they were filled with more abbreviations than everyday first day, but I could not help but think about other interns on their
text conversations with friends. Not being sure about what details to first day who had a superior that was demeaning and treated their in-
pay attention to, almost everything was written down. I googled most terns/residents/fellows with aggressiveness and shame. That kind of
of the unknown abbreviations, wrote the word “medicine” after the behavior and medical education philosophy makes people feel bad
abbreviation, and Google almost always had the answer. The computer about themselves when they do not know the answer to a question. I
next to me showed that someone had searched “what does I/O mean?” believe this type of educational philosophy must change.
Good to know I wasn’t the only one feeling lost. Every physician should remember their first day as an intern when
Six hours later (that’s right, one hour per patient), it became clear they read this and, regardless of how that day was, be willing to help
why during orientation they had told us so many times “do not worry, people on their first day on the job. This not only gives an example to
you will get efficient reviewing charts with time”. This made so much follow but encourages us to do better every day. I hope that every
sense now. When reading patients' charts, most of the patients with healthcare worker remembers and sees how far they have come and
COVID-19 were in their 40s and 50s and were very sick. It was while how strong they have become along the way to face challenges like the
checking the chart of my 4th patient with COVID-19 that I saw some- one we have been facing for months, and probably will face for months
thing that I will never forget. The patient was only 18 years old! This to come. Thank you to the teachers that gave us good examples to fol-
shook me to my core. Although the scientific data shows that older pa- low but thank you also to the teachers that show us how we are not
tients and those with comorbidities are at a higher risk of a severe in- supposed to behave. Inevitably, the student becomes the teacher.
fection, there isn’t an age range that is immune to the virus. It has also
been shown that in the current surge, the higher number of cases have Daniel Rosas, MD is a PGY-1 in the Internal Medicine
“What Makes a Good Doctor: A Qualitative Study of Patient Perspectives”, was developed by five learners: Kalli Davis, Ryan Carbone, Justin
been in a younger population than it was during the first wave of in- Residency Program at UT Health San Antonio.
Fredericks, Alex Basdeo and Joshua Lujan; and was overseen by two faculty members, Adam Ratner, MD and Arunabh Bhattacharya, PhD.
fection. One reason is the reopening phase, which puts the younger

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