Nevada Drug Card Media Center

One of the most common complaints in health care involves people not getting enough time with their doctors. Patients often feel rushed without having their questions answered or conditions addressed.

The Clark County Medical Society can't promise more time with your primary care provider, but the group's Mini Internship Program offers so much access to a physician you'll feel worn out by the end of the day. By shadowing doctors, participants witness the delivery of health care from an insider's perspective and the multifaceted world of those who have taken the Hippocratic oath.

The program tries to show people all the pressures a doctor goes through each and every day, said Dr. Keith Brill, the Medical Society's immediate past president. The face time with patients is only part of it. I wish I would only see patients all day.

Patient interaction represents only part of a doctor's day. Consultations, charting, preparation time, phone calls: Mini interns learn what goes in the back office. The program, offered twice a year for either a day or half-day, is designed primarily for people who have a connection to the health care industry insurers, lawyers, judges, lawmakers or other government officials but the general public also can apply. Participants can choose from a range of medical disciplines from cardiology to infectious diseases to urology.

Suzanne Domoracki, program director for Nevada Drug Card, a free statewide prescription assistance program, interned with Dr. George Alexander, a Las Vegas plastic surgeon. She spent the day shadowing Alexander as he completed several procedures at the Surgical Center at Tenaya, an outpatient clinic near MountainView Hospital. Domoracki's professional life revolves around medicine, but she never had such a glimpse behind the scenes. She chose to spend a day in an operating room because she wanted to challenge herself.

I didn't even know whether I was really up for it. I get squeamish, and I wanted to know whether I could handle it, Domoracki said. Working with Dr. Alexander, everyone felt very comfortable, very calm, and there's no frenzy whatsoever. He's got the greatest bedside manner.

Domoracki's experience was similar to other participants who frequently express wonder at the physicians' attention to detail and breadth of knowledge. Domoracki also was impressed with patients' willingness to let an observer participate in the process.

"I was amazed there was no opposition to an outsider participating in a procedure that's so personal," Domoracki said.

The program is not for the faint of heart. Interns don gowns and gloves, and have a front-row seat to examinations, surgeries and other invasive procedures. A day with a cancer specialist probably will include a biopsy, the removal of tissue for diagnostic study. If you intern with a gastroenterologist, you might witness your first colonoscopy, the examination of the large intestine's inner lining.

"Some of the procedures are a little more intense than others," said Dr. Daniel Burkhead, a Las Vegas pain specialist who once had an intern quietly leave the room because she saw more than she could handle.

Patient safety and consideration are paramount.

"My priority is always the patient," said Dr. Souzan El-Eid, a Las Vegas breast cancer specialist. "If anything is going to jeopardize that, I block it."

Burkhead and El-Eid were co-chairs of the program this year for the Medical Society, a professional organization with 1,437 members serving the needs of physicians, their patients and the Clark County community. The intern program has existed for about 15 years and averages from seven to 15 participants. A record number of interns - 21 - took part in March.

The program changes course in the spring to include students considering medical careers from valley prep schools including Rancho High School and West Career and Technical Academy. The Junior Mini Internship Program will run March 9-26, and community and business leaders still will be included.

Spending a day with a doctor could be a defining moment for young people weighing career options, galvanizing their decision to enter medicine because they have the firsthand experience, Burkhead said.

"If given the chance to spend a full day with a physician in a completely spontaneous and unscripted setting, it will really open the eyes of someone looking to go into the profession as a career choice," he said.

The doctors plan their days with the interns as much as possible, but like any endeavor involving human interaction, they must adjust to the situation. Burkhead's day with his latest intern, Bonnie Wallen, an administrative assistant with the Nevada State Board of Medical Examiners, was interrupted when a staff member said one of the patients harbored thoughts of self-harm.

Burkhead's full focus then turned to the patient.

"When he mentioned to my staff that he was thinking of hurting himself, I reconfirmed with him about having an intern participate, and he said he was OK with that," Burkhead said. "He and I then proceeded to have a very detailed conversation about his suicidal thoughts and whether he had the means to hurt himself."

Burkhead conducted the in-depth assessment required of all medical professionals in such situations to detect warning signs in the patient's words, behavior, posture and attitude. Burkhead determined the patient did not need emergency psychiatric treatment, but the incident is an example of how a doctor must expect the unexpected.

Structure is key in operating rooms. Surgeons train extensively for any circumstance, but the goal is carrying out a well-defined plan for all the experts involved in the procedure. Dr. Michael Edwards, a Las Vegas plastic surgeon and this year's Medical Society president, admits to running a very tight ship. From his anesthesiologist, Dr. Scott Boman, to the rest of his surgical team, Edwards knows exactly what to expect.

Several outsiders have watched Edwards during his 18-year practice in Southern Nevada, but his main worry always is the observer. He participated in the Mini Internship Program for the first time in October taking on Kim Friedman, an investigator with the Nevada State Board of Medical Examiners.

"My only concern was whether the intern would faint or pass out because I run a very tight ship," Edwards said. "Whenever an outsider comes into the operating room, there's always a little bit of an orientation."

The elimination of the unexpected begins with the first contact a doctor makes with a patient. Interns who shadow El-Eid, also a breast cancer surgeon, will witness among the most extensive health-history inquiries of patients. Investigating the family tree for any form of cancer and other illness is vital for an oncologist.

"If I'm going to take care of a patient, if I'm going to need to do surgery, I don't want to have any surprises," El-Eid said.

The Mini Internship Program provides an authentic look at how health care is delivered and gives participants a view from a doctor's perspective without going to medical school. The Medical Society's doctors await, eager to show Southern Nevadans the quality of medicine available to them.

"I have such a strong sense of what great medicine is being practiced in Southern Nevada, and I'm frustrated more people don't have the chance to see just how exceptional their health care can be," Edwards said.

Contact Steven Moore at 702-380-4563 or smoore@reviewjournal.com.