It’s getting to be that time of year again.

An intern called me today for a psychiatric consult:

“So I was wondering if you’d see this guy…”

(Side note: Why do we all slip into past tense when we’re actually currently wondering if a consultant will see a patient?)

After telling me the patient’s demographics and reason for admission, but before telling me the reason for consultation, the intern slipped into a tirade:

“… and this guy was originally on the [other] service and [other service] oversedated the patient and once the patient’s [presenting problem] resolved, they dumped the patient onto us.”

He was exasperated, but clearly not finished expressing his displeasure.

“And then the patient developed [minor medical complication], which is another excuse [other service] used to get him onto our service.”

This intern and I had spoken a few times over the past month and I had never heard him so agitated before.

“So now I’m calling you and hoping that you can help out.”

Winter is coming and the interns are getting tired… and some interns (perhaps all interns, some of the time) begin to resent patients and view them as problems, not people.

It isn’t a zero-sum game, but for every patient that is transferred off of one service, that means the patient ends up on another service. Think of “buffing” and “turfing” from The House of God (an engaging, brutally honest, and occasionally disturbing read—written by a psychiatrist, incidentally). The work of medicine becomes less about caring for a patient and more about solving a problem and getting the problem patient out as fast as possible!

This is where mentorship becomes hugely important. The language used to describe patients is hardly forgiving: admissions are referred to as “hits” and people who are often hospitalized are called “frequent flyers”. Patients who sustain long hospital admissions are described as “rocks”. Good mentors model professionalism and help physicians in training, even if only indirectly, reflect on their reactions to situations and refocus on the “bigger” picture of medical care. They remind their trainees that these are opportunities to provide a meaningful service and that, indeed, the clock never stops moving.

I do not mean to invalidate the frustration of physicians in training. It’s true: That patient who shows up in the ER at 2:00am may be the individual who interferes with the two hours of sleep the intern may get for the entire night. Sometimes, other physicians do engage in “buffing” and “turfing” tactics. It’s hard to feel compassion towards others when it seems like no one—not the system, not the staff, not your peers, and not even your patients—demonstrates compassion towards you.

Winter will pass and the interns will soon become residents. They will realize how much they learned during that seemingly endless year and, with this growing knowledge base, hopefully provide support for their interns when they become irritable and angry with work.

And, sometimes, as the psychiatric consultant, the best thing to do is merely listen—sometimes the doctor needs to vent more than the patient.