As promised, highlights from our Stanford tour:
- Weather: the sky in Palo Alto was blue, temperatures were in the 50s and 60s, gentle breezes blew constantly, and sweet flowers perfumed the air. The weather permitted several outdoor meetings, strolling the grounds and absorbing the sun.
- Buildings: The medical school is building an earthquake-proof hospital on the main campus, designed to roll back and forth by up to six feet if tremors strike. The older buildings remain functional. I’m jealous of the education group’s office suite, which includes space for the PD, staff, and Chief Residents, as well as a large conference room. The hospital has an elegant dining room, featuring crisp, white table cloths, gleaming silverware, and a fresh, healthy buffet. Just a brief shuttle ride away, residents see outpatients in sunny offices on the third floor of their primary care building (I’m hoping for something similar when the PCC moves to Long Wharf next year). The spectacular Palo Alto VA is another shuttle ride away, replete with large picture windows, generous offices, and a gleaming Starbucks, where one of the Chiefs treated me to a doppio espresso.
- Learning: rounds pause at 10A for report, which all but the MICU team attends. Residents, interns, and students are welcome. Max and Chris led vigorous discussions, featuring impressive imaging and blood smears. The residents were smart, vocal, and opinionated, just like our own. They slot 30-45 minutes for noon conference. I gave a session on managing agitation, which it’s about time I gave in New Haven.
- Clothes: it seems like everyone wears Stanford swag, not just in hospital, but on the streets and in restaurants. They gave me a black Stanford Medicine baseball hat. Dare me and maybe I’ll wear it to Yale Grand Rounds...
- Rounds: in the MICU, the teams are multidisciplinary and include Anesthesiology and Emergency Medicine. They present by system, dividing the history, exam, studies, and plan by organ (brain, heart, lungs, etc). I felt this approach creates artificial divisions that could make it difficult to address systems interactions and overlapping problems. We’ll stick to what we do now, limiting the systems approach to the assessment and plan. Floor teams follow a more traditional SOAP format, like ours. On the team I joined, one of the interns remained in the workroom while the other rounded, which helped efficiency kept the intern left behind from seeing interesting patients, including a man with epididymitis, a woman with bullous pemphigoid, and a woman with influenza A. I prefer rounding together as a whole team if possible. At the start of rounds, the resident was called to the ED to admit a patient and, unfortunately, he missed the rest of rounds, which the attending and intern did together. While I see the potential benefit of having residents see patients in the ED, I imagine the resident regretted missing work rounds.
- People: The residents, chiefs, staff, and faculty were warm, bright, and friendly, reflecting an environment that was stimulating, creative, and energetic. Very much like ours.
- Perspective: I left with special appreciation for our sunny MICU, affordable cost of living, housing near the hospital, our block system, specialty services, New Haven pizza, and four seasons (though I’m ready for Spring), as well as renewed appreciation for our own talented team.
I’m grateful for the Stanford exchange and the opportunity to make new friends. We learned a ton, and I’m sure both programs emerged with fresh perspectives and ideas to try in the weeks ahead.
And now it’s on to visit to my family in New Jersey, final ranking decisions, and maybe a hike in the melting snow before starting a two week stint on the MICU Green Team.