In keeping with this month's tradition of posts entitled with abreviations (with a grand total of 2 now), I give you AI.
Not artificial intelligence. That might actually be useful in medicine. Like really awesome PDA's. No, AI in medicine means "Acting Intern". That's what I am this month. I think it should also stand for "Absolutely Inept". Because that's how you feel when the nurses page you for something. Not because you don't know what to do all the time (that's only like half to 3/4's of the time). It's because even if you do know what to do, your answer can only be, "We should probably do xxxxx, but I can't give you an order. Let me talk to the resident and they'll take care of it."
As an acting intern, I'm supposed to be doing all the work that interns do. Except there's billing and medicolegal implications involved, so everything I do has to be duplicated anyway by a resident. So it makes me redundant. And out-of-the-loop when things happen and people go to where they can get orders instead of to me.
The nice thing, however, is that since my upper level resident has to duplicate everything I do she tends to not give me a lot to do. I only take up to 2 patients on call and tend to be last in line every time to get patients. That means if the service doesn't cap, I get only 1 patient on call. This is glorious because it frees up all sorts of time to do other important things. Like watch every single episode of Arrested Development.
The third year medical students on my team are all taking their internal medicine shelf exam this week. And they are all blaming me for their decreased study time because I told them about Hulu.
Showing posts with label scut. Show all posts
Showing posts with label scut. Show all posts
Friday, April 18, 2008
Wednesday, April 9, 2008
AMA
I've considering posting about this multiple times over the past two years. AMA. It stands for a lot of things. Like acquired member assets, or Academy of Model Aeronautics. It's actually also a word that means "metabolic waste products and toxins that have accumulated in body and mind and which obstruct the healthy functioning of mind and body". On a related topic, it also stands for the American Medical Association.
But even more importantly, it stands for against medical advice. It's a phrase that means you took off from the hospital without being discharged. It generally conotates that you absolutely don't agree with your doctor and would rather be billed for all services since no insurance company will pay for a hospital stay that ends in a patient going AMA.
I knew going AMA existed before coming to medical school, but have been interested in its multiple faces since being on the wards. My first encounter with it was with a patient who came in for an organ transplant. If all goes well, they spend a bit of time in the ICU followed by about a week in a regular floor room. One patient during my first month had one of these kind of transplants. Everything was great and he was getting close to being discharged. To encourage this, we encouraged him to get up and walk around, as doing so has been shown to decrease length of hospital stay for most patients. Well, this patient interpreted that "going for a walk" meant leaving the hospital and strolling around, IV pole in tow, down the park across the street. The nurses caught on after about 4 or 5 hours that the patient was gone and not in the hospital anymore, so they started filling out the AMA paperwork. When the patient finally returned to find an empty room, they were clearly angry that the hospital would do that when they were just trying to do what the doctors had asked.
While amusing, other times its less so. Like the patient that showed up with **automatic admission** complaint earlier this week. They knew all sorts of details and used medical jargon in a bit of a peculiar way, sometimes seeming to feign not really knowing the right word, but then in the end getting it out anyway. Lots of patients show up and say they're in pain and sometime in the past that one that starts with a "D" helped. They then look in the corner and go "hmmmm" and then say, "Oh yeah! Demerol. 100mg in my IV." This patient was one of those. They also are ALWAYS allergic to a lot of stuff. Because if you're allergic to ibuprofen, morphine, vicodin, etc, etc, etc (add pain meds here) then you know that they can't give it to you. If you're allergic to everything but *drug of choice* then that's the only one they can give you.
Anyway, so this patient shows up following this pattern, but to a new high. They supplied medical record type information saying they'd been in the hospital recently for the same thing. Except when we called said hospital, they'd never heard of this patient. The patient also wasn't just allergic to all the other medicines, they were also allergic to the workup for **automatic admission**. No iodine. Not even xenon.
Seeing through the ploy, the patient was given no narcotic pain meds. Period. They were restricted to their room in the ED, and not allowed to leave the unit. And within a few hours, the patient demanded the AMA form. By name.
I've previously witnessed such things as punitive exams (like DRE's) and procedures (like colonoscopies) that aren't exactly necessary, but justifiable. They're done to discourage frequent flying of that particular hospital's ER. If you do enough mean stuff to a patient, they won't come back.
But what's always bothered me is what if they really are in pain? What if? There was another patient who left AMA this week that I felt bad about. They genuinely appeared to me to be in pain. And had several good reasons to be in pain. But also knew the names of a few pain meds that worked for them. But didn't get any. And left really upset. And part of me feels like they were just there for the pain meds, and part feels like we just did a bad job helping them.
Wednesday, January 30, 2008
Not So Infrequent
I was just reading through the day's "Odd News" and found an article that raised my interest, possibly because it relates directly to my current situation. The story talks about a woman who was 36 weeks pregnant and started having labor pains. She went to the hospital, was told that it was false labor, and went home. Waiting for the false labor to pass, she rested at home until she just couldn't bear the false labor pains anymore. So she tried to get to the hospital again. Except she didn't make it very far. Only to her driveway, in fact.
The thing that struck me about this article is that it isn't exactly a rare event for a woman to go to the hospital and be told it's false labor and get sent home only deliver shortly thereafter. I remember a few such cases in the 3 weeks of inpatient OB that I did last year. That's 1 a week. Late in the residency calendar year. At the end of the residency calendar year, in fact. One woman came in and the resident checked her. He told her that she was only 2 cm dilated and her contractions weren't regular enough. So after protesting that she had a history of short labor she left. And then nearly had her baby at IHOP over pancakes. She made it back to the hospital and was crowning within 5 minutes of getting to triage.
I'm glad I'm not going into OB. It's becoming more and more of a regimented profession in a process that is highly variable. But that's a whole different story for another post....
The thing that struck me about this article is that it isn't exactly a rare event for a woman to go to the hospital and be told it's false labor and get sent home only deliver shortly thereafter. I remember a few such cases in the 3 weeks of inpatient OB that I did last year. That's 1 a week. Late in the residency calendar year. At the end of the residency calendar year, in fact. One woman came in and the resident checked her. He told her that she was only 2 cm dilated and her contractions weren't regular enough. So after protesting that she had a history of short labor she left. And then nearly had her baby at IHOP over pancakes. She made it back to the hospital and was crowning within 5 minutes of getting to triage.
I'm glad I'm not going into OB. It's becoming more and more of a regimented profession in a process that is highly variable. But that's a whole different story for another post....
Thursday, January 24, 2008
Triage
One of the (many) perils of going to medical school is the whole concept of phone triage. That is, when someone calls you up and wants to know your medical advice for their current ailment.
The first time it happens it's almost universally so early into medical school that you have no idea what to actually say to the person. But you feel awesome that someone thought to call you. Medical school is interesting in that most people have little or no patient contact until the third year. So when you're a first year student, you can think of that one weird disease you just learned about in histo or micro, but really you don't even know what to ask next. Then you get to second year. Second year's classes are all about things that go wrong in the body. The "zebras". So when you get that call all you can think of is that rare African tribal disease that it "just might be." It never is. And of course along with second year comes the supressed hypocondria. Everytime you yourself have any symptom at all you think you have lupus or colon cancer or leishmaniasis. Never mind it's pretty unlikely. You probably have it.
Then you hit third year. Actual daily patient contact and real medicine. You start to learn the differential and actual effective history taking. That's also when "I don't know" becomes the only thing you can think of during that phone call. "Ummmm. I don't have Peds till next semester. Better call someone else." Then you finally get to fourth year. Blessed fourth year. You get to where you think you know everything. You've passed your step 1, 2, and 2CS. You've gotten boat loads of invitations to interview at residency programs. You've turned down interviews. And then you get that phone call. And all you can think is the absolute worst case scenario. "She says her neck hurts and she has a fever." "Oh my gosh - it's meningitis". "She says her stomach hurts when she eats fatty foods and now she's vomitting." "Oh man - I hope it's not cholangitis." And so your answer becomes the same for every single phone call. "Better take 'em to the ER. Just in case."
So if I've told you this year to go the ER and it turned out to be nothing, or if you called and all I could say was "Ummmm. I don't know", or if I told you that you have a rare African tribal disease that comes from eating human brains, I'm sorry. It's just the way of the med student.
The first time it happens it's almost universally so early into medical school that you have no idea what to actually say to the person. But you feel awesome that someone thought to call you. Medical school is interesting in that most people have little or no patient contact until the third year. So when you're a first year student, you can think of that one weird disease you just learned about in histo or micro, but really you don't even know what to ask next. Then you get to second year. Second year's classes are all about things that go wrong in the body. The "zebras". So when you get that call all you can think of is that rare African tribal disease that it "just might be." It never is. And of course along with second year comes the supressed hypocondria. Everytime you yourself have any symptom at all you think you have lupus or colon cancer or leishmaniasis. Never mind it's pretty unlikely. You probably have it.
Then you hit third year. Actual daily patient contact and real medicine. You start to learn the differential and actual effective history taking. That's also when "I don't know" becomes the only thing you can think of during that phone call. "Ummmm. I don't have Peds till next semester. Better call someone else." Then you finally get to fourth year. Blessed fourth year. You get to where you think you know everything. You've passed your step 1, 2, and 2CS. You've gotten boat loads of invitations to interview at residency programs. You've turned down interviews. And then you get that phone call. And all you can think is the absolute worst case scenario. "She says her neck hurts and she has a fever." "Oh my gosh - it's meningitis". "She says her stomach hurts when she eats fatty foods and now she's vomitting." "Oh man - I hope it's not cholangitis." And so your answer becomes the same for every single phone call. "Better take 'em to the ER. Just in case."
So if I've told you this year to go the ER and it turned out to be nothing, or if you called and all I could say was "Ummmm. I don't know", or if I told you that you have a rare African tribal disease that comes from eating human brains, I'm sorry. It's just the way of the med student.
Thursday, December 6, 2007
Questions: The Interview Process Part 2
If you know anything about me, you know I'm in the middle of interviewing all over the place for residency.
I'm not even half way done, but I don't think I can stand to hear one more person ask me, "Do you have any questions?" Because if I say no, then I look disinterested. And if I say yes and repeat the same question I just asked three other people at whatever place I am that day and then I look like a zombie totally zoned out as I hear the same answer repeated almost verbatim back to me.
Maybe I need to cancel some of these prelim/transitionals when most of the schools I applied to provide their own.
I'm not even half way done, but I don't think I can stand to hear one more person ask me, "Do you have any questions?" Because if I say no, then I look disinterested. And if I say yes and repeat the same question I just asked three other people at whatever place I am that day and then I look like a zombie totally zoned out as I hear the same answer repeated almost verbatim back to me.
Maybe I need to cancel some of these prelim/transitionals when most of the schools I applied to provide their own.
Friday, November 16, 2007
Some People: The Interview Process
I've been interviewing for residency positions over the past month all over my home state. I've met quite a few individuals on the trail, and all I can say is "Some People!"
Interviews for residency are interesting. You are there obviously bowing before the altar trying to get a job from these people - although they can't officially offer you anything outside "the match". And they are trying just as hard to sell themselves to you. I consider myself lucky in that this year anesthesia programs are doing quite a bit to woo their applicants. Most are paying for hotels the night before. Most are providing us with extravagant dinners or lunches at fancy restaraunts. Several hand out SWAG bags when you leave. I've gotten pens, t-shirts, coffee mugs (they did their research on that one, huh?), snacks, and the obligatory school folder.
Each morning there is an introductory power point slide show (if the chairman/director is tech savy enough to figure out how to power up the projector and computer) that shows off their program. One program, which notably lacked the fancy dinner/lunch and SWAG, spent most of their presentation talking about unbuilt hospitals that they are pouring money into and how great their program is going to be. Others go on and on about their benefits, which frankly is what I want out of them, while others spend the hour showing you pictures of the town and of their residents out partying together at "journal club". Then you go off to interview.
Interviews so far have ranged from 2 to 6 interviewers for about 30 minutes each. When there's just two, you pray that you get someone high up on the chain of command while with 6 you die just trying to come up with original questions to ask each interviewer and to continue to look interested as they sell their program to you by giving you the same information the last 5 have.
And the whole time you pray you don't have a situation like I had at the aforementioned school-who-sells-you-unbuilt-hospitals. I walk into the interviewers office which happens to be noticably bare of any decoration. That's a red flag that whoever this is is new to the faculty and can't tell you much or not very involved with the main faculty. Turns out this interviewer was the later. The interview starts and I notice right away that this interviewer also doesn't say much. And then the fun starts. They asked me about my step 1 score. It by no means is anything that would blow you out of the water, but it is one I'm proud of and feel like was an accomplishment. They specifically ask what I did to study for it. I tell them all about the 3 week course I took and how it helped and they start writing down details on a sticky note and then put it in their pocket. Weird. Finally they give me something to grasp at and tell me their daughter is about to take her step and they just wondered what kind of courses were available to help. Fine - I think. Then I made a big mistake. I asked what their daughter was going into. The answer was she wants to go into XX-non-anesthesia-program. Without any further interaction on my part I then get a story about how this interviewers spouse was a high up faculty for this speciality at a near by hospital and then died of cancer 4 months ago. And then the interviewers eyes started welling up with tears. Not exactly what I signed up for.
Anyway, usually while part of the interviewees are interviewing, the other half are off in a room trying to make stifled conversation. Some people are great and are people I wouldn't mind working with in the future. And some, especially those who come from big name schools, act very guarded. They ask probing questions of you and offer very little information in return. They like to hear all about every other school and even go as far to ask where you want to end up, but when you ask them in return you get a quiet, "I don't really want to talk about it." Cut throat gunners! One girl I interviewed with today was just that person. She tried very hard not to divulge any iformation even about where she had applied. What's worse is this was at her home institution so she knew all the residents and faculty well so was off gossiping with them and even had the gall to take over on part of the tour of the facilities. She was very snooty about this particular school and inferred that no other school in the state was good enough for her. I hate cut throat gunners. Fortunately none of the other residents in that program came off that way, but she seriously drove me up the wall. Some people!
Interviews for residency are interesting. You are there obviously bowing before the altar trying to get a job from these people - although they can't officially offer you anything outside "the match". And they are trying just as hard to sell themselves to you. I consider myself lucky in that this year anesthesia programs are doing quite a bit to woo their applicants. Most are paying for hotels the night before. Most are providing us with extravagant dinners or lunches at fancy restaraunts. Several hand out SWAG bags when you leave. I've gotten pens, t-shirts, coffee mugs (they did their research on that one, huh?), snacks, and the obligatory school folder.
Each morning there is an introductory power point slide show (if the chairman/director is tech savy enough to figure out how to power up the projector and computer) that shows off their program. One program, which notably lacked the fancy dinner/lunch and SWAG, spent most of their presentation talking about unbuilt hospitals that they are pouring money into and how great their program is going to be. Others go on and on about their benefits, which frankly is what I want out of them, while others spend the hour showing you pictures of the town and of their residents out partying together at "journal club". Then you go off to interview.
Interviews so far have ranged from 2 to 6 interviewers for about 30 minutes each. When there's just two, you pray that you get someone high up on the chain of command while with 6 you die just trying to come up with original questions to ask each interviewer and to continue to look interested as they sell their program to you by giving you the same information the last 5 have.
And the whole time you pray you don't have a situation like I had at the aforementioned school-who-sells-you-unbuilt-hospitals. I walk into the interviewers office which happens to be noticably bare of any decoration. That's a red flag that whoever this is is new to the faculty and can't tell you much or not very involved with the main faculty. Turns out this interviewer was the later. The interview starts and I notice right away that this interviewer also doesn't say much. And then the fun starts. They asked me about my step 1 score. It by no means is anything that would blow you out of the water, but it is one I'm proud of and feel like was an accomplishment. They specifically ask what I did to study for it. I tell them all about the 3 week course I took and how it helped and they start writing down details on a sticky note and then put it in their pocket. Weird. Finally they give me something to grasp at and tell me their daughter is about to take her step and they just wondered what kind of courses were available to help. Fine - I think. Then I made a big mistake. I asked what their daughter was going into. The answer was she wants to go into XX-non-anesthesia-program. Without any further interaction on my part I then get a story about how this interviewers spouse was a high up faculty for this speciality at a near by hospital and then died of cancer 4 months ago. And then the interviewers eyes started welling up with tears. Not exactly what I signed up for.
Anyway, usually while part of the interviewees are interviewing, the other half are off in a room trying to make stifled conversation. Some people are great and are people I wouldn't mind working with in the future. And some, especially those who come from big name schools, act very guarded. They ask probing questions of you and offer very little information in return. They like to hear all about every other school and even go as far to ask where you want to end up, but when you ask them in return you get a quiet, "I don't really want to talk about it." Cut throat gunners! One girl I interviewed with today was just that person. She tried very hard not to divulge any iformation even about where she had applied. What's worse is this was at her home institution so she knew all the residents and faculty well so was off gossiping with them and even had the gall to take over on part of the tour of the facilities. She was very snooty about this particular school and inferred that no other school in the state was good enough for her. I hate cut throat gunners. Fortunately none of the other residents in that program came off that way, but she seriously drove me up the wall. Some people!
Saturday, November 10, 2007
"Ambulatory" "Medicine"
This month I'm on a 4th year required core rotation - ambulatory medicine. Essentially what that means is I'm supposed to be at just a regular run of the mill internal medicine clinic. Not in the hospital.
So I entitled this post the way I did because of what I'm actually doing. "Medicine" because it's actually more like "interventional cardiology". The attending I'm working with is a cardiologist, and a pretty well respected one at that. My friends are all treating diabetes and hypertension and "chronic pain" and whatever else it is regular doctors do. I'm seeing people who have all sorts of crazy messed up heart disease. SVT of pregnancy, s/p quintuple CABG (coronary artery bypass graft, or "cabbage" as we lovingly call them for short), or nectrotic foot ulcer limb slavage (necrotic = dead tissue). It's also interesting considering the number of health care professionals we see and treat. Nothings stranger than doing a history and physical exam on a patient who also happens to be a doctor at the school you attend.
"Ambulatory" because >50% of this month we're actually in the hospital and not in clinic. We have clinic two mornings and two afternoons a week. The other 3 days worth of time is actually hospital time. We round on patients in the CVIMU, CCU, and CVICU. We do lots of endovascular procedures in the cardiac cath lab. I think I've been wearing lead in the cath lab more time this month than I've spent in the clinic. Procedures after all is where the money in medicine is.
Oh yeah, and I think on average I'm working 3 days a week for the whole month. 4th year is everything I dreamed and more.
So I entitled this post the way I did because of what I'm actually doing. "Medicine" because it's actually more like "interventional cardiology". The attending I'm working with is a cardiologist, and a pretty well respected one at that. My friends are all treating diabetes and hypertension and "chronic pain" and whatever else it is regular doctors do. I'm seeing people who have all sorts of crazy messed up heart disease. SVT of pregnancy, s/p quintuple CABG (coronary artery bypass graft, or "cabbage" as we lovingly call them for short), or nectrotic foot ulcer limb slavage (necrotic = dead tissue). It's also interesting considering the number of health care professionals we see and treat. Nothings stranger than doing a history and physical exam on a patient who also happens to be a doctor at the school you attend.
"Ambulatory" because >50% of this month we're actually in the hospital and not in clinic. We have clinic two mornings and two afternoons a week. The other 3 days worth of time is actually hospital time. We round on patients in the CVIMU, CCU, and CVICU. We do lots of endovascular procedures in the cardiac cath lab. I think I've been wearing lead in the cath lab more time this month than I've spent in the clinic. Procedures after all is where the money in medicine is.
Oh yeah, and I think on average I'm working 3 days a week for the whole month. 4th year is everything I dreamed and more.
Tuesday, October 23, 2007
They're Watching You
This month I've been working in the surgical ICU. One thing I've come to notice is that ICU delirium is a very real thing. One patient on our service developed quite florid delusions and delerium. He rants about nurses having sex near his room and hospital staff stealing his credit cards and perseverates on the idea that the hospital staff is trying to keep him from communicating with his son. His delusions are so strikingly paranoid that if they were in almost any other context I'd think schizophrenia. Or cocaine abuse.
Anyway, he reminded me of my stint at the county psychiatric hospital. While there I saw many patients who had all sorts of bizarre and non-bizarre delusions. People would confide to you such things like their mother is really satan, or that their bones are disintegrating or that their doctor is conspiring against them.
It's interesting dealing with these patients because you have to build their trust, but at the same time cannot foster their delusions. You have to reassure them that you believe them, but at the same time let them know what is actually real.
The reason I am re-blogging about this (you'd have to have access to the old blog to see the original post) is that I saw the below video at The Onion. I wasn't quite sure what to think of it. They bring up some of the most common delusions that schizophrenics have, but make a mockery of it in a Steven Colbert style comedy. While some of the delusions people have can certainly be entertaining is this video going too far?
Anyway, he reminded me of my stint at the county psychiatric hospital. While there I saw many patients who had all sorts of bizarre and non-bizarre delusions. People would confide to you such things like their mother is really satan, or that their bones are disintegrating or that their doctor is conspiring against them.
It's interesting dealing with these patients because you have to build their trust, but at the same time cannot foster their delusions. You have to reassure them that you believe them, but at the same time let them know what is actually real.
The reason I am re-blogging about this (you'd have to have access to the old blog to see the original post) is that I saw the below video at The Onion. I wasn't quite sure what to think of it. They bring up some of the most common delusions that schizophrenics have, but make a mockery of it in a Steven Colbert style comedy. While some of the delusions people have can certainly be entertaining is this video going too far?
Thursday, October 11, 2007
P = MD
Today we ate lunch with one of the pharmacy students and a pharmacist. While eating, the pharmacist said, "There are people who were in my class I just thought shouldn't be pharmacists. Do you see the same thing in medical school?"
Sadly you do. Medical education is interesting. The admissions criteria are difficult. There are lots of hoops to jump through. You have to look good on paper and in person. You have to weigh competing offers or pray that you are at the top of the wait list. But once you are in, you are in. Atrition from medical school, at least my medical school, is remarkably low. I can think of only one person who has actually been kicked out. I can think of at least 5-10 others who probably should be kicked out. But doing so is a death sentence to a career in medicine. After acquiring so much debt to get through school, it seems like the school bends over backwards to get you through to the end.
Some people pick fights with ancillary staff. Some people let their egos supercede their training. Some people just don't have what it takes to survive effectively in the system. Some people are just plain not mature enough to handle hearing the proper terms for certain anatomic regions without giggling. Somehow all of them become doctors.
Every now then urban legends crop up about so-and-so who did such-and-such on the wards. Hearing those things second hand through the grapevine make them hard to believe, but almost all gossip and rumor are seated in at least a little peice of truth. And what's even more incredible is the fact that almost universally everyone seems to have a story about one person they rotated with that did something so incredibly stupid that you wonder how that person ever got into medical school. What's funnier is that sometimes the entire class knows how that yahoo got into medical school. It's so prevalent it just leaves you wondering - was there ever a day that it was me who gave someone else something to talk about? I know when I hear stories about people, or witness it for myself, I don't really have the guts to bring it up to their face (i.e. coumadin anyone?). Am I the gunner that just makes people look bad without knowing it (you couldn't tell from my non-AOAness)? I'm that guy who left all the scut work for someone else to do? I'm I the class idiot who doesn't see what everyone else on the team sees?
I try to not be any of those things, but sometimes you just have to wonder. Am I?
Sadly you do. Medical education is interesting. The admissions criteria are difficult. There are lots of hoops to jump through. You have to look good on paper and in person. You have to weigh competing offers or pray that you are at the top of the wait list. But once you are in, you are in. Atrition from medical school, at least my medical school, is remarkably low. I can think of only one person who has actually been kicked out. I can think of at least 5-10 others who probably should be kicked out. But doing so is a death sentence to a career in medicine. After acquiring so much debt to get through school, it seems like the school bends over backwards to get you through to the end.
Some people pick fights with ancillary staff. Some people let their egos supercede their training. Some people just don't have what it takes to survive effectively in the system. Some people are just plain not mature enough to handle hearing the proper terms for certain anatomic regions without giggling. Somehow all of them become doctors.
Every now then urban legends crop up about so-and-so who did such-and-such on the wards. Hearing those things second hand through the grapevine make them hard to believe, but almost all gossip and rumor are seated in at least a little peice of truth. And what's even more incredible is the fact that almost universally everyone seems to have a story about one person they rotated with that did something so incredibly stupid that you wonder how that person ever got into medical school. What's funnier is that sometimes the entire class knows how that yahoo got into medical school. It's so prevalent it just leaves you wondering - was there ever a day that it was me who gave someone else something to talk about? I know when I hear stories about people, or witness it for myself, I don't really have the guts to bring it up to their face (i.e. coumadin anyone?). Am I the gunner that just makes people look bad without knowing it (you couldn't tell from my non-AOAness)? I'm that guy who left all the scut work for someone else to do? I'm I the class idiot who doesn't see what everyone else on the team sees?
I try to not be any of those things, but sometimes you just have to wonder. Am I?
Thursday, September 20, 2007
Et-AOK revisited [update 1]
Those of you who have been reading my blog since its previous address may remember my EtAOK post. Without reposting it, a quick summary is that despite its many ill effects and the huge cost it creates within society, alcohol (a.k.a. EtOH) is consistently and preferentially ignored throughout medical education. I like to therefore call it Et-AOK because despite the huge medical burden it places on society, since most doctors seem to enjoy drinking more than the average individual it is passed off as being totally OK, or EtAOK.
We all know smoking is bad. It causes cancer of many kinds. It causes significant decrease in lung function. It causes birth defects. It even carries a surgeon general's warning that using the product will cause these problems.
Alcohol can cause cancer, specifically hepatocellular cancer and stomach cancer. Alcohol can cause you to die from just about any organ system failing. Alcohol is the #1 cause in America of birth defects. Nobody seems to care.
Not only does alcohol cause all these things, it also causes a lot of trauma. You might remember my ER rotation posts "Life Lessons" and "Chief Complaint". A lot of those people also came in with pretty notably elevated blood alcohol levels. Anyway, the whole reason for me revisiting this post is I spotted this article in the news today. You might notice a few things about this guy. Like his use of a mixture of "stupid stuff" right before inserting the snake in his mouth. A poisonous western diamond back rattlesnake. Into his mouth. Because it was a "nice snake". Not that this one case report among many would change the fact that in medical school you will hear more about "the beneficial effects of drinking one glass of red wine daily" than anything other consequence of drinking alcohol.
Oh yeah, and this case is double awesome because it's anesthesia related because his tongue was so swollen as to totally occlude his airway requiring an emegency trach.
[update 1]: Who could ask for such luck in a single day?! Not just one story of inibriated madness, but two. This one is the story of a 54 year old drunk man who got in trouble with the law for throwing an onion at his 27 year old wife. I'm sure there's more than one story of "night's I can't remember" in that family. Your first clue might be that when the man was his wife's age she was but an embryo.
We all know smoking is bad. It causes cancer of many kinds. It causes significant decrease in lung function. It causes birth defects. It even carries a surgeon general's warning that using the product will cause these problems.
Alcohol can cause cancer, specifically hepatocellular cancer and stomach cancer. Alcohol can cause you to die from just about any organ system failing. Alcohol is the #1 cause in America of birth defects. Nobody seems to care.
Not only does alcohol cause all these things, it also causes a lot of trauma. You might remember my ER rotation posts "Life Lessons" and "Chief Complaint". A lot of those people also came in with pretty notably elevated blood alcohol levels. Anyway, the whole reason for me revisiting this post is I spotted this article in the news today. You might notice a few things about this guy. Like his use of a mixture of "stupid stuff" right before inserting the snake in his mouth. A poisonous western diamond back rattlesnake. Into his mouth. Because it was a "nice snake". Not that this one case report among many would change the fact that in medical school you will hear more about "the beneficial effects of drinking one glass of red wine daily" than anything other consequence of drinking alcohol.
Oh yeah, and this case is double awesome because it's anesthesia related because his tongue was so swollen as to totally occlude his airway requiring an emegency trach.
[update 1]: Who could ask for such luck in a single day?! Not just one story of inibriated madness, but two. This one is the story of a 54 year old drunk man who got in trouble with the law for throwing an onion at his 27 year old wife. I'm sure there's more than one story of "night's I can't remember" in that family. Your first clue might be that when the man was his wife's age she was but an embryo.
Monday, August 27, 2007
Life Lessons
So by popular demand*, or rather at least one person's demand, now at the end of my ER rotation I have more to blog about my actual ER rotation.
I'm sure everyone reading this has seen that awesomely cheesey poster that lists like a million things that you learn in kindergarten that make you a wonderful person. Well, this month in the ER I've compiled a similar list that will help make you a healthy person. At least as healthy as luck and/or stupidity will permit.
I'm sure everyone reading this has seen that awesomely cheesey poster that lists like a million things that you learn in kindergarten that make you a wonderful person. Well, this month in the ER I've compiled a similar list that will help make you a healthy person. At least as healthy as luck and/or stupidity will permit.
- Don't wear flip flops while mowing the lawn. Don't put your hand under a stalled lawn mower that is still turned on. Don't try to take a riding lawn mower out of the back of a pick-up truck all by yourself. All are really good ways to lose body parts. If you know the neumonic - it's usually a body part that you wouldn't use lidocaine with epinephrine on that you lose. If you don't know the neumonic, well, I'm not going to post it here because while I do like the attention from random google searches, that's not the attention I want.
- Don't cuss out homeless men with knives who ask you for money. They might stab you. A couple times.
- Don't zip your pants up too fast without looking to see what's still in the zipper. I didn't think that this actually happened, but as I discovered this month, it does. And it looks very painful.
- Don't lie to the doctor about what happened to you. For example, don't tell the doctors at 2 different hospitals that you fell off a swing if you actually were bitten by a cottonmouth snake. Some of them might believe you and your treatment might get delayed 6 hours and you might risk loosing body parts.
- Don't punch glass windows. Don't jump through glass windows. Don't lean all your body weight on glass windows. Don't push really hard on glass windows. Glass breaks. Broken glass is sharp. It will cut you. Deep. There will be blood. Lots of it.
- Don't insert objects PR. P stands for "per". R stands for a word that starts with R and sounds like "wrecked 'um". It might just disappear on you. And that's a really embarrassing story to have to tell the doctor.
- Don't think that you are too good for eye protection. Especially if you are breaking up concrete (it might just end up inside your eye) or working with methyl chlorobenzene (it might just burn your corneas right off).
- Don't think that vizine eye drops is all you need if you get methyl chlorobenzene in your eyes. And don't wait 2 days to go to the hospital.
- Don't do drugs. Especially fry (marijuana dipped in embalming fluid). It will make you crazy. Irreversible-forever-for-the-rest-of-your-life crazy.
- Don't think you no longer need your psychiatric anti-psychotic meds. You will go psychotic if you stop them.
- Don't think you don't need a seatbelt. Unless you are curious what it's like to break a steering wheel in half with your chest or go through the windshield.
- Don't put your feet over the passenger air bag. It will come out very fast and it will hurt you very badly.
- Don't accept unscreened blood transfusions from Mexico.
- Don't beat your child to death. The police are pretty good at figuring that one out.
- Don't let your kid ride a broken bicycle outside after 11 PM. It might just be asking for disaster.
- Don't come into an ER and ask for a pain medicine by name and dose. You won't get it, or much of anything else after that.
- Don't stop coumadin all of a sudden because you think it's not doing anything. If you had a stroke before and they put you on coumadin, it's pretty likely that you'll have another if you stop the coumadin.
- Don't get 20 tattoos and then be a cry baby about getting stitches. Or about getting shot by your father-in-law with a shotgun.
- Don't change your tire on a too-narrow shoulder of a busy 6 lane freeway. Unless you want to get hit by a car.
- Don't jaywalk and think you can beat any car. You can't. And cars weigh roughly 10 times what you do. And don't break as easily.
- Don't shoot at the police. They shoot back.
- Don't eat like an American.
- Don't think that you don't need pre-natal care. You do.
- Don't think that if the doctor told you to be on bedrest that this means don't go to work, but spend all day out and around town doing a million things.
- Don't bring all your personal belongings to the ER with you in a cardboard box. And then drop it all over the trauma bay as they are taking you out to a bed.
- Don't come to the ER and say you have a spider bite unless you saw an actual spider on you and saw and felt it actually bite you.
- Don't eat batteries.
- Don't come to the ER in a busy academic hospital unless you want some random medical student to anonymously blog about your stupidity.
So there you have it. Real convential wisdom for your bathroom wall.
*I say this is by popular demand, but I have no actual way of confirming this since apparently the popular demand all read this site previously via an RSS aggregator and never actually came and visited my site nor did they artificially inflate my self importance by raising my site visits counted by sitemeter.
Wednesday, August 15, 2007
Welcome 1st years!
Although I doubt a single one of them will read this, here's a big fat welcome to all the new first years who I saw today at orientation. They looked so innocent, naive, and excited to be there. We'll see about that once their first block of tests rolls around.
I had a good time sitting with my born-a-radiologist friend labeling the newbies as they walked by. Like the nerdy, quiet looking foriegners - aka "pathologists". Or the guys overflowing with testerone as the pretended not to be flexing for the bleach blond barbie dolls - aka "orthopedics". Or the bleach blond barbie dolls - aka "OB/Gyn". Or the totally lost and clueless guys wandering around - aka "Medicine". Or the super white, never seen the sun before - aka "radiologists". Or the hardcore shaved headed giant - aka "emergency". Or the not so nerdy or quiet looking foreigners - aka "family practice". Ok, I'll quit being so, um, specialty-ist there before I alienate everyone. (TS, notice there's not a single psych joke there - just making up for that aggie dig earlier!)
Anyway, it reminded me of how far we've come and how different things seem now. It strange how 3 grueling years of med school can change the way you see things. It's also funny to think they've never experienced the joys of pimping, or scut work, or guaiac cards, or noon conference, or M&M, or grand rounds; yet here they all stood excited as ever to dive head first in.
Here's to those with the cleanest white coats in the school!
I had a good time sitting with my born-a-radiologist friend labeling the newbies as they walked by. Like the nerdy, quiet looking foriegners - aka "pathologists". Or the guys overflowing with testerone as the pretended not to be flexing for the bleach blond barbie dolls - aka "orthopedics". Or the bleach blond barbie dolls - aka "OB/Gyn". Or the totally lost and clueless guys wandering around - aka "Medicine". Or the super white, never seen the sun before - aka "radiologists". Or the hardcore shaved headed giant - aka "emergency". Or the not so nerdy or quiet looking foreigners - aka "family practice". Ok, I'll quit being so, um, specialty-ist there before I alienate everyone. (TS, notice there's not a single psych joke there - just making up for that aggie dig earlier!)
Anyway, it reminded me of how far we've come and how different things seem now. It strange how 3 grueling years of med school can change the way you see things. It's also funny to think they've never experienced the joys of pimping, or scut work, or guaiac cards, or noon conference, or M&M, or grand rounds; yet here they all stood excited as ever to dive head first in.
Here's to those with the cleanest white coats in the school!
Monday, August 6, 2007
Chief Complaint
I just finished my first night shift this month and am having trouble sleeping so I thought I'd say a word or two about E.R. Really, E.R. boils down to those two words - Chief Complaint. You are responsible for finding out why the patient is at the hospital and then figuring out if said chief complaint is worthy of hospital admission or worthy of a trip back home.
One of the coolest features of the EMR (electronic medical records for you lay-people) software our ER uses is that you can pull up a list of all the people in rooms, in waiting, and inbound and it tells you their name, location, how long they've been waiting or roomed, and what their chief complaint is. This is the absolute funnest tool in the ER. By far. Because if you happen to have a short break in the action, you can log on and see who's coming and why. I guess the other super cool part about it is that the people in triage are instructed to list the chief complaint exactly in the patients' own words and not to translate it into medical terminology.
So, from two nights worth of working, here's a short sampling of what came through.
One of the coolest features of the EMR (electronic medical records for you lay-people) software our ER uses is that you can pull up a list of all the people in rooms, in waiting, and inbound and it tells you their name, location, how long they've been waiting or roomed, and what their chief complaint is. This is the absolute funnest tool in the ER. By far. Because if you happen to have a short break in the action, you can log on and see who's coming and why. I guess the other super cool part about it is that the people in triage are instructed to list the chief complaint exactly in the patients' own words and not to translate it into medical terminology.
So, from two nights worth of working, here's a short sampling of what came through.
- I broke a window and am bleeding - (Pretty accurate assessment I thought. I put 25 stitches in that person's arm. 24 beers + nagging spouse + glass = disaster waiting to happen)
- My parts are huge - (to clarify, those were man parts he referred to, and indeed they were perhaps the largest man parts I have ever seen.)
- bicycle in foot - (this was actually EMS's words since it was a small child who was crying. She really did have a bicycle impaled through her foot.)
- I chainsawed my leg - (disappointed I didn't get to meet this one)
- broken skull s/p jumping from moving vehicle - (this one was cheating too since the chief complaint actually came from doctors at another hospital. S/P means "status post" and is doctor-ese for "after".)
- broke my arms - (Yup. We didn't do much diagnosing past that one)
- woman problems - (enough said)
- f%$# you - (this guy wasn't too happy with being at the ER. He also said that was his wife's name. And his name. And his address. I guess that makes it all easy to remember)
Anyway, on a totally seperate note, I just wanted to give a nod to a not so average family for mentioning me in their blog. Sitemeter tells me that in the past 3 days I've doubled in traffic from people linking in from their page. Despite one of their members leaving deceptive comments on one of my posts.
Wednesday, August 1, 2007
Crushing
I suppose starting off with the title "crushing" on my first day of ER might imply some sort of intense physical trauma, but it's the only word that describes the horribleness I saw today.
It's more of an emotional horribleness.
So imagine this. You are a new 4th year medical student and your first rotation is an ER elective. You absolutely fall in love with it and decide, "This is IT! This is what I'm doing." You talk to lots of people and find out it's a really good idea to get at least one away rotation if that's what you're going into. Great. So you get on the ball trying to find one. Turns out the only ER program in a city you want to go to has a couple openings. You try as hard as you can to get it set up and are even told when and where orientation is the first day. So you DRIVE from Tennessee across the country to get there in time to start on August 1st.
So you get to orientation just as its starting. Some big burly guy at the front is counting people and says, "There's one more person here than there should be." You say that it's probably you because you've been trying to get all the paperwork ironed out still.
"I'm sorry, but you have to leave. We don't have you on our roll and so you can't be here for orientation."
What do you say? Well, how about, "All my stuff is at student affairs. They're getting it together so I can be here."
"No. I'm sorry. We don't have your stuff yet from them and so we can't enroll you, so you can't be here."
"Can I pick my shifts and do all this after I get it worked out."
"No. You can't be here. We don't have you on our rolls so you can't be in orientation and if you miss orientation you can't rotate this month."
"But I drove from Tennessee to be here...."
"Sorry, but no."
So, as it turns out, that's exactly what happened this morning. Some poor girl who came all the way from Tennesse got kicked out of orientation. Imagine lining things at home to live for a month in a different city and then getting there and the job you thought you were there for is still open, but since your paperwork wasn't finished before 7 am on day 1 you lose that whole month. And even though the administrative people beg and plea for the boss to let you stay, the boss says, "No. Rules are rules." And then you're totally screwed, because it turns out that the big, burly guy is actually the residency director for that school and you've now made a situation where you'll never get in to that school because you couldn't get your paperwork together in time.
It's more of an emotional horribleness.
So imagine this. You are a new 4th year medical student and your first rotation is an ER elective. You absolutely fall in love with it and decide, "This is IT! This is what I'm doing." You talk to lots of people and find out it's a really good idea to get at least one away rotation if that's what you're going into. Great. So you get on the ball trying to find one. Turns out the only ER program in a city you want to go to has a couple openings. You try as hard as you can to get it set up and are even told when and where orientation is the first day. So you DRIVE from Tennessee across the country to get there in time to start on August 1st.
So you get to orientation just as its starting. Some big burly guy at the front is counting people and says, "There's one more person here than there should be." You say that it's probably you because you've been trying to get all the paperwork ironed out still.
"I'm sorry, but you have to leave. We don't have you on our roll and so you can't be here for orientation."
What do you say? Well, how about, "All my stuff is at student affairs. They're getting it together so I can be here."
"No. I'm sorry. We don't have your stuff yet from them and so we can't enroll you, so you can't be here."
"Can I pick my shifts and do all this after I get it worked out."
"No. You can't be here. We don't have you on our rolls so you can't be in orientation and if you miss orientation you can't rotate this month."
"But I drove from Tennessee to be here...."
"Sorry, but no."
So, as it turns out, that's exactly what happened this morning. Some poor girl who came all the way from Tennesse got kicked out of orientation. Imagine lining things at home to live for a month in a different city and then getting there and the job you thought you were there for is still open, but since your paperwork wasn't finished before 7 am on day 1 you lose that whole month. And even though the administrative people beg and plea for the boss to let you stay, the boss says, "No. Rules are rules." And then you're totally screwed, because it turns out that the big, burly guy is actually the residency director for that school and you've now made a situation where you'll never get in to that school because you couldn't get your paperwork together in time.
Tuesday, July 31, 2007
The Good, The Bad, and The Ugly
After a month long hiatus of updating this, I figured it was time seeing as I just completed my Anesthesia rotation and this blog is called "The Gas Mask".
The Good
So first the good. I really enjoyed a lot of things about this month. The schedule was pretty awesome. I mean, when an attending tells you, "You're a fourth year; you need to leave before noon," it's gotta be a good rotation. I also enjoyed getting to do lots of procedures everyday. Well most everyday. It's something I really like about medicine and it was nice to get to do it. I was proactive about it and even got to help do central lines and do my own spinals for c-sections. Part of me feels like it was kind of sneaky to stand back there while the first patient thought the resident was doing it, but who would say, "It's your first time? Go right ahead!" Needless to say my technical skills got a lot better this month. The residents were great, and one even let me start an IV on him when I blew one on the sleeping patient in front of the attending. Then he took a picture of it with his iPhone to show the attending that I actually could do it.
I also really liked the test at the end. Mostly because when I went to take it, the director told me I didn't have to. You gotta love having special exceptions made for you. Turns out it pays off to do a little hard work before hand.
The Bad
I learned that while most people graduate medical school and change their name to Dr. ____, people who go into anesthesia graduate medical school and change their name to "Anesthesia". Surgeons tend to be a little condescending to anesthesiologists. Maybe because anesthesiologists make just as much, but also get to see their families. And get to practice the ABC's. Airway Book Chair. Anyway, the biggest bad of it all is just not having control of your own time - you have to meet the surgeons' schedules.
One of my favorite residents from this month actually defected out of general surgery into anesthesia. He was always happy and never once complained, "It's four in the afternoon and I'm still here!" He was one of the most laid back, easy going residents and it was shocking to hear him talk about how he was as a surgeon.
The other bad is mouth noises. I'm not a fan of them and there is an awful lot of suctioning that goes on in anesthesia. At least it's suctioning there and not somewhere else.
The Ugly
Guys who wear those decorative surgical caps. With Hawaiin print. Or worse yet, A&M. Girls like to look pretty, and that's fine if they buy decorative head wear. But no self respecting man should don one of those. Ever. Ever ever.
Tuesday, June 19, 2007
Whiff Test
So today was my last glorious day of OB/Gyn, and more importantly, of my 3rd year. And I had an extra special way of rounding out my 3rd year experience. Today I got the opportunity of going to the county jail OB clinic to treat all the incarcerated women. They should really change the name of the clinic though. I suggest they rename it, BV clinic, because everyone who came in (with one exception) had really florid BV.
So, for all my non-medical fans, BV stands for bacterial vaginosis. It is essentially an infection caused by overgrowth of certain types of normal vaginal flora, much like a yeast infection except with bacteria and not yeast. What is extra special about BV is that the discharge has these cells in it (see picture) called "Clue Cells". I have yet to figure out why they call them clue cells. Mostly because the first clue you get that someone has BV is not the clue cell, but by the very distinct odor that wafts your way as you get up close and personal with an infected person's nether region. Who needs yet another clue as to what's going on? There's actually a test called the "whiff test" where one adds potassium hydroxide to the already foul smelling substance to see if you can make your sample smell even worse than it already does. While clue cells are rather inappropriately named, the whiff test (much like dumping syndrome) is quite an accurate description of the test.
BV is also associated with a discharge. Usually its white and somewhat thick. Sometimes its a little different. My favorite was asking the patients about it. "It's like boogers coming out my hoochie," was my personal favorite description. At least it painted a vivid image.
Wednesday, June 13, 2007
End Of Slavery
You might have noticed a little clock counting down almost a year's worth of time there to the right. Actually it's really more like about 10 and a half months. It's the countdown to the end of slavery.
You may be thinking, "But slavery was abolished by Abraham Lincoln in the early 1860's". Wrong. Today in medical education medical students everywhere pay for the priveledge and honor to be able to take 30 hour shifts of doing work for people who are being paid to be there. Medical students everywhere are dumped on by residents, interns, nurses, LVNs, janitors, transport, and even volunteers. All for the low, low price of $10,000 / year. That's not a salary, that's "tuition". Multiply that by 220 students in a class and 4 classes in the school and that's like 10 million dollars of "tuition" that we pay.
And we still have to pay for parking, books, syllabuses, meals, etc, etc.
So keep an eye on that clock, because when it reaches zero, I no longer will be paying to work for the school.
On a side note, commencement was officially announced for exactly one month following the end of that countdown, on Saturday May 31st at 10 am.
You may be thinking, "But slavery was abolished by Abraham Lincoln in the early 1860's". Wrong. Today in medical education medical students everywhere pay for the priveledge and honor to be able to take 30 hour shifts of doing work for people who are being paid to be there. Medical students everywhere are dumped on by residents, interns, nurses, LVNs, janitors, transport, and even volunteers. All for the low, low price of $10,000 / year. That's not a salary, that's "tuition". Multiply that by 220 students in a class and 4 classes in the school and that's like 10 million dollars of "tuition" that we pay.
And we still have to pay for parking, books, syllabuses, meals, etc, etc.
So keep an eye on that clock, because when it reaches zero, I no longer will be paying to work for the school.
On a side note, commencement was officially announced for exactly one month following the end of that countdown, on Saturday May 31st at 10 am.
Thursday, June 7, 2007
Strange Day
Today was perhaps one of the strangest day I've ever had on this rotation. It all started nice and early at 5 AM. I got to the hospital and rounded until 6 without ever seeing a resident. "That's weird," I thought.
At 630 at board checkout finally the residents showed up, a whole new set just because it was Thursday. Apparently the regularly scheduled residents all have clinic on Thursday and so the clinic residents come and take their place. We ran around the whole day with crosscover residents and a cross cover attending, on what was actually a pretty slow day, but somehow managed to not actually round on the patients at all. But back to my morning...
Then I went upstairs to see a baby born earlier. They told me I needed to see it for my education. So I get up there and the nurse says, "Oh, you want to see his malformations. Look here." And she takes off the diaper. I've seen ambigious genitalia before, but this was not ambiguous..definitely a boy. After trying to figure out what his problem was called, I found one single case report at pub med here. If the link is too medical mumbo jumbo for you, what it says is that this particular problem is where the scrotum is actually ABOVE the shaft. I didn't know what to think, and then the nurse says to look at his bottom. At which point I noticed his anus was way too high. It was posterior, just not low enough. The attending said he would never sit down to poo. Poor kid.
And then I met the mail-order bride. She was pregnant and not really having a problem but her husband was a complete nervous wreck. With way too much coffee. He kept checking the empty mug he brought in with himself in case magical coffee appeared in it again. And he never let her answer for herself. And asked a million and one irrelevant questions. "Why are you asking about that? Is something wrong? Is it bad that she is hurting like that? What should I do? Should she be taking her medicine more often? Is the baby a boy or girl? Is the cord wrapped around the neck? Is the baby too low? Where's her uterus?" 1) I can only answer 1 question at a time 2) I don't know the sex of a baby by asking about contraction pain 3) I don't have xray vision 4) I really wanted to find this guy some xanax just to shut him up so we could talk to his wife who actually knew what symptoms she was having.
At least it was interesting today.
At 630 at board checkout finally the residents showed up, a whole new set just because it was Thursday. Apparently the regularly scheduled residents all have clinic on Thursday and so the clinic residents come and take their place. We ran around the whole day with crosscover residents and a cross cover attending, on what was actually a pretty slow day, but somehow managed to not actually round on the patients at all. But back to my morning...
Then I went upstairs to see a baby born earlier. They told me I needed to see it for my education. So I get up there and the nurse says, "Oh, you want to see his malformations. Look here." And she takes off the diaper. I've seen ambigious genitalia before, but this was not ambiguous..definitely a boy. After trying to figure out what his problem was called, I found one single case report at pub med here. If the link is too medical mumbo jumbo for you, what it says is that this particular problem is where the scrotum is actually ABOVE the shaft. I didn't know what to think, and then the nurse says to look at his bottom. At which point I noticed his anus was way too high. It was posterior, just not low enough. The attending said he would never sit down to poo. Poor kid.
And then I met the mail-order bride. She was pregnant and not really having a problem but her husband was a complete nervous wreck. With way too much coffee. He kept checking the empty mug he brought in with himself in case magical coffee appeared in it again. And he never let her answer for herself. And asked a million and one irrelevant questions. "Why are you asking about that? Is something wrong? Is it bad that she is hurting like that? What should I do? Should she be taking her medicine more often? Is the baby a boy or girl? Is the cord wrapped around the neck? Is the baby too low? Where's her uterus?" 1) I can only answer 1 question at a time 2) I don't know the sex of a baby by asking about contraction pain 3) I don't have xray vision 4) I really wanted to find this guy some xanax just to shut him up so we could talk to his wife who actually knew what symptoms she was having.
At least it was interesting today.
Friday, June 1, 2007
SP Heaven
Today I had my end-of-third-year clinical skills test, aka the CCCE, or as I like to call it the CCCCCCCCCCCCE. I don't know what any of the C's actually stand for. It's just it's name. Because doctor's like abbreviations. Especially OB/Gyn's.
It was an standardized patient's dream. 11 of us showed up at 0730, which was sleeping in for me this month, and went and talked to 11 different "patients". Some of them had just histories to take, and some of them had physical exams on top. And the pedi patient wasn't even there, just their parent. It was a long grueling day of taking histories and doing physicals on people who were just pretending to be sick. My favorite was the patient who was supposed to be homeless and somehow the testing center had let a fly into that exam room. I guess they were just going for realism.
Anyway, I have a special place in my heart for standardized patients. They have a job that honestly you couldn't pay me enough to do. Especially brave are the patients who taught us the urology (DRE and male genital exam) and the breast/pelvic SP. Can you imagine having your prostate checked and then having to turn your head and cough 10 times in a row for people who have no real experience doing said exam? How about having your well-woman done 6 times in a day by people who are highly likely to do it wrong? Somebody should call Mike Rowe.
It was an standardized patient's dream. 11 of us showed up at 0730, which was sleeping in for me this month, and went and talked to 11 different "patients". Some of them had just histories to take, and some of them had physical exams on top. And the pedi patient wasn't even there, just their parent. It was a long grueling day of taking histories and doing physicals on people who were just pretending to be sick. My favorite was the patient who was supposed to be homeless and somehow the testing center had let a fly into that exam room. I guess they were just going for realism.
Anyway, I have a special place in my heart for standardized patients. They have a job that honestly you couldn't pay me enough to do. Especially brave are the patients who taught us the urology (DRE and male genital exam) and the breast/pelvic SP. Can you imagine having your prostate checked and then having to turn your head and cough 10 times in a row for people who have no real experience doing said exam? How about having your well-woman done 6 times in a day by people who are highly likely to do it wrong? Somebody should call Mike Rowe.
Friday, May 25, 2007
Omega Beta Gamma
I was warned that when I started my OB/Gyn rotation that the residents were all gossipy and back biters. I heard that it was essentially like living through 6 weeks of some perverted sorority; the Omega Beta Gamma sorority, if you will.
I honestly can't say that's been my experience so far. I've worked with several residents, and while I have noticed that they are far more focused on their education than mine, I can't say it's been what I was expecting.
One resident, who is pregnant with twins, I have come to notice treats all encounters with medical students the same. She makes a few basic assumptions. 1) Each medical student encounter is the first time she has worked with that medical student. Today, after working with her sporadically over the past 2 weeks, she introduced herself to me and asked how long I'd been on the rotation. 2) All medical students are on their first rotation. Despite realizing that I had been to the OR with her before, I again got a lecture about how blue things are sterile and you sew in to out and then out to in. She also took my job everytime the chief resident asked me to do anything during the operation. I'm not helpless and can suture. The ones I did looked better than hers in the end anyway, despite her having to double check every aspect of how I had tied the knot. 3) Medical students do not understand medical theory. I may not know everything, especially about the eccentricites of gynecology, but I'm not stupid. If anything, my knowledge base is something that carries me through the other aspects of medical school.
The big down side is how little time we spend on each team. In order to get us out to clinic (which in my opinion is of little educational value) they pared down our time on gynecology and obstetrics to two weeks each. Now that I have the hang of the gynecology service and just what I need to do to stand out (in a good way of course), I am being shuffled off to the obstetrics team on Monday. Hopefully that one requires a little less scut, but I'm not keeping my hopes up too high.
I honestly can't say that's been my experience so far. I've worked with several residents, and while I have noticed that they are far more focused on their education than mine, I can't say it's been what I was expecting.
One resident, who is pregnant with twins, I have come to notice treats all encounters with medical students the same. She makes a few basic assumptions. 1) Each medical student encounter is the first time she has worked with that medical student. Today, after working with her sporadically over the past 2 weeks, she introduced herself to me and asked how long I'd been on the rotation. 2) All medical students are on their first rotation. Despite realizing that I had been to the OR with her before, I again got a lecture about how blue things are sterile and you sew in to out and then out to in. She also took my job everytime the chief resident asked me to do anything during the operation. I'm not helpless and can suture. The ones I did looked better than hers in the end anyway, despite her having to double check every aspect of how I had tied the knot. 3) Medical students do not understand medical theory. I may not know everything, especially about the eccentricites of gynecology, but I'm not stupid. If anything, my knowledge base is something that carries me through the other aspects of medical school.
The big down side is how little time we spend on each team. In order to get us out to clinic (which in my opinion is of little educational value) they pared down our time on gynecology and obstetrics to two weeks each. Now that I have the hang of the gynecology service and just what I need to do to stand out (in a good way of course), I am being shuffled off to the obstetrics team on Monday. Hopefully that one requires a little less scut, but I'm not keeping my hopes up too high.
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