The rotation is called malignant hematology, but between Thanksgiving, Christmas, New Year’s, and everyone being away for ASH, it was a joke. The only memorable part were the first two weeks—the oncology consults at Georgetown—which reminded me that the NIH was indeed an ivory tower. This is compared to a well-known academic center. Compared to a community hospital—my last employer being a good example, though you may find much better—the Institutes in general and the Clinical Center in particular are a tower of crystalized angel tears sitting high on top of a mountain range on Mars. This is neither criticism nor praise, but a statement of fact2.

Having only spent four days on Georgetown consult service, I would rather not comment1. But here are ten things about the inpatient side of my home institution that might interest the outside world:

  • There is only one EMR and no paper charts;
  • Someone else, most commonly the research nurse, will obtain the outside records and have them scanned in—so the EMR is the only place you need to look for anything;
  • There are usually no medical students, interns, or residents—it’s the NP/PA, fellow, and the attending running the show;
  • Remember the 3am page from the nurse asking for a Tylenol order? If it is for someone on a phase 1 trial, you’d better check the protocol and call the attending before giving it;
  • Patients can be “out on pass”—meaning they can leave the campus for up to 20-something days and still count as an inpatient, without needing to be discharged and readmitted;
  • If a patient needs to stay an extra day or two because of transport issues, nobody blinks an eye;
  • For three to to five days you will get weird looks if it is your patient, but there will be no passive-aggresive emails about the hospital not getting reimbursement;
  • If it is six days or more it is likely they are homeless—social work will be on it;
  • Ordering most imaging—ultrasounds, CTs, MRIs, etc—requires two steps: getting a time-slot from central scheduling, or the tech on call if it is a same-day scan, and putting in the order. Think about the implications and let it sink in;
  • All discharge medications are dispensed from the outpatient pharmacy free of charge to the patient. Yes, all of them;

Most people treated at the Clinical Center are trial participants who are sick, rather than “just” patients. There are no administrative or financial pressures, no dealings with insurance companies, and not much concern with disposition. As you can imagine, this makes for a beautiful work environment.

  1. This makes it sound worse than it was. I don’t want to comment because n=4, not because I’m holding back the criticism. 

  2. Angel tears are a pain to clean up when they melt.