Oh my. "I already told you, I was stamping out disease in my outpatient clinic." Classic from ZDogg.
Wednesday, September 7, 2011
Thursday, September 1, 2011
Long time, no see
Here are a few of the tough questions I have faced in the last few days:
- What do you do when you walk in an exam room and a patient hands you a newly removed body part? And then another, from a different part of the body?
- What do you do when you run out of pretzels and you're running an hour late, and your coffee gave out several hours ago when you stopped drinking it because if you kept drinking it you'd never sleep and you hardly sleep as it is? And your next patient is on 24 medications?
- With what do you follow when you're trying to establish that mythical rapport with a new patient when you ask, "Where are you from?" and the patient answers, "Yes, yes, I work very hard."
- When a very large woman says to you during a discussion about her weight "I never eat candy" and you can see the Reese's Cup in her purse AND you're out of pretzels, what do you do?
Extra credit points:
Your answering service informs you that you need to call a radiologist for an abnormal result. The radiologist screams at you for about 3 hours (okay, it was two minutes) because, he says, your answering service hung up on him. You call your answering service to see what happened and they play the recording of the radiologist screaming at the patient and polite operator. His screed ends with "USELESS!" and he hangs up. Now, the service has his direct number and so do you. What do you do? Harass him, or let him enjoy the money he got for reading the CT while you spend the next hour negotiating with the patient to go to the hospital for the serious abnormality said radiologist told you about, all of which you do completely for free?
Spoiler alert: These questions ARE NOT on the Family Medicine board certification exams.
Wednesday, June 2, 2010
Ah, Residency
This took me back to late nights in the ER being amused and irritated by le crack addict. (Mostly irritated.) Funny and worth a watch.
Monday, May 31, 2010
What's your name?
A poignant post over on "A blog inspired by my mom's brain". The author, an old friend of my sister's, has been caring for her mother. Mom has Alzheimer's Disease. If you've cared for somebody with dementia, professionally or personally, it's easy to empathize. Under your nose, the essence of the person ebbs away. The decline is usually gentle. You don't realize that you're losing ground. Occasionally, though, are the jolts, the capricious little insults of nature. They're not on a scale of say, a volcano in Iceland, but on a personal level: ouch. Say, for example, your mother doesn't remember your name. Mom's Brain author grits her teeth and gracefully accepts this. She also explores her own feelings about her mom's new special friend. Not only is mom confused about her own daughter, but mom prefers another's company! Double ouch. Read her lovely post yourself:
What's your name?
In "small world" news, a nod to Mom's Brain's father. Long ago, for a career day in junior high, already a decade into exploring a medical career, "Dr. Brain" graciously let me tag along with him for an hour or two. He was an attending in the old school sense of the word. He had a starched white coat and worked at the huge academic medical center here in town. He radiated smart, calm, and expertise. I don't remember what he said, but I remember he was kind and treated me respectfully and not like the chunky, starry-eyed, clueless 14 year old I was. He seemed like he was eleven feet tall as he took me on a tour of the hospital, including a swing around the emergency room. We might have walked by the door of the OR area. I was on fire! Thirty years later I still remember quivering with excitement, suffused with the light pure emotional clarity you can only have when you are all hormones and feeling, and haven't been beaten down yet by organic chemistry, pharmacology, drug addicts in the ER, not to mention less gracious attendings who whomp your butt just because they can.
I work now about a block from said academic medical center, and often run over because they have the best hospital gift shop. Penny candy, neat gifts, cool cards, and yes, Graeters Ice Cream. There is also a cookie store, and the cafeteria still has the chili which sustained me through many painful 3d and 4th year rotations. They have caffeine-free Diet Coke and hard-boiled eggs.
I had to go there recently to pick up a DVD of MRI films for my dad. It was a typical maddening experience. I walked into the clinic building. It's a mess since it is being torn down to build another, more fantastic and no-doubt labyrinthine facility. I followed the signs for "radiology" and went down not one, but two dead ends. Now, how hard it it to put up good signage? How do people who didn't live in these buildings for medical school or residency find their way? I'll bet if I looked in corners and stairwells I'd find skeletons next to their O2 tanks who got lost trying to find radiology, ran out of oxygen, and gave up.
I followed sign #3 and found myself on the third floor. Trifocals on full power, I find myself in front of the urology clinic. I stand, confused and irritated. I'm looking for radiology. Surely such a popular destination should not be so difficult to find. Blood pressure rising, I spy a tiny little note about two feet above the giant "Urology Clinic" sign which says, "Radiology, 3d desk." At the third desk I say, "I need to pick up a disk...." The employee at the desk holds up her hand to stop me. "Go to the hall. Turn left. Turn left again. Find the hallway marked 'G' then turn right. Keep walking until you find a hall marked 'PACS'. Turn right. Look for the small door." She turns away from me. Really? Is this a Grimm's Fairy Tale? Should I leave a trail of crumbs? As I turn left, left, right, left, and right I can smell the gray institutional green beans for sale today in the cafeteria. I walk by other lost souls who've parked on chairs randomly set up in dark, windowless hallways, trapped in a modern-day Dickens novel.
Finally, I get the disk and make my way back through the more familiar back hallways cursing under my breath. Why is everything so difficult here? Why is everything so unpleasant? Storming through the new cardiac hospital, or "Heart Hyatt" I bump into an old patient whose husband is getting a stress test. I stop and chat. An old medical student walks by me, now a resident. We chat. Next I see an old patient who works in housekeeping, then a medical student, now a patient. We talk about where she'll be for residency. I stop by the cookie shop and by the time I leave, I'm back in the grip of everything I love. I love medicine, even at a hospital full of stinky green beans. I love patients. I love working in my hometown, where I am continually reminded of career days in the hospital when I was 13, of jobs I have had, patients I've known, and late nights watching residents struggle with sick patients. Amusing attendings, maddening assignments, endless bowls of $1 chili and all the saltines I could carry. I'm a junkie for it, even awash in fury over the journey of of a thousand miles to pick up a disk.
At this hospital, it all started with Dr. Brain.
What's your name?
In "small world" news, a nod to Mom's Brain's father. Long ago, for a career day in junior high, already a decade into exploring a medical career, "Dr. Brain" graciously let me tag along with him for an hour or two. He was an attending in the old school sense of the word. He had a starched white coat and worked at the huge academic medical center here in town. He radiated smart, calm, and expertise. I don't remember what he said, but I remember he was kind and treated me respectfully and not like the chunky, starry-eyed, clueless 14 year old I was. He seemed like he was eleven feet tall as he took me on a tour of the hospital, including a swing around the emergency room. We might have walked by the door of the OR area. I was on fire! Thirty years later I still remember quivering with excitement, suffused with the light pure emotional clarity you can only have when you are all hormones and feeling, and haven't been beaten down yet by organic chemistry, pharmacology, drug addicts in the ER, not to mention less gracious attendings who whomp your butt just because they can.
I work now about a block from said academic medical center, and often run over because they have the best hospital gift shop. Penny candy, neat gifts, cool cards, and yes, Graeters Ice Cream. There is also a cookie store, and the cafeteria still has the chili which sustained me through many painful 3d and 4th year rotations. They have caffeine-free Diet Coke and hard-boiled eggs.
I had to go there recently to pick up a DVD of MRI films for my dad. It was a typical maddening experience. I walked into the clinic building. It's a mess since it is being torn down to build another, more fantastic and no-doubt labyrinthine facility. I followed the signs for "radiology" and went down not one, but two dead ends. Now, how hard it it to put up good signage? How do people who didn't live in these buildings for medical school or residency find their way? I'll bet if I looked in corners and stairwells I'd find skeletons next to their O2 tanks who got lost trying to find radiology, ran out of oxygen, and gave up.
I followed sign #3 and found myself on the third floor. Trifocals on full power, I find myself in front of the urology clinic. I stand, confused and irritated. I'm looking for radiology. Surely such a popular destination should not be so difficult to find. Blood pressure rising, I spy a tiny little note about two feet above the giant "Urology Clinic" sign which says, "Radiology, 3d desk." At the third desk I say, "I need to pick up a disk...." The employee at the desk holds up her hand to stop me. "Go to the hall. Turn left. Turn left again. Find the hallway marked 'G' then turn right. Keep walking until you find a hall marked 'PACS'. Turn right. Look for the small door." She turns away from me. Really? Is this a Grimm's Fairy Tale? Should I leave a trail of crumbs? As I turn left, left, right, left, and right I can smell the gray institutional green beans for sale today in the cafeteria. I walk by other lost souls who've parked on chairs randomly set up in dark, windowless hallways, trapped in a modern-day Dickens novel.
Finally, I get the disk and make my way back through the more familiar back hallways cursing under my breath. Why is everything so difficult here? Why is everything so unpleasant? Storming through the new cardiac hospital, or "Heart Hyatt" I bump into an old patient whose husband is getting a stress test. I stop and chat. An old medical student walks by me, now a resident. We chat. Next I see an old patient who works in housekeeping, then a medical student, now a patient. We talk about where she'll be for residency. I stop by the cookie shop and by the time I leave, I'm back in the grip of everything I love. I love medicine, even at a hospital full of stinky green beans. I love patients. I love working in my hometown, where I am continually reminded of career days in the hospital when I was 13, of jobs I have had, patients I've known, and late nights watching residents struggle with sick patients. Amusing attendings, maddening assignments, endless bowls of $1 chili and all the saltines I could carry. I'm a junkie for it, even awash in fury over the journey of of a thousand miles to pick up a disk.
At this hospital, it all started with Dr. Brain.
Tuesday, May 11, 2010
The Vanishing Oath Part II
Here's another little clip. This physician is working at BLOCKBUSTER for health insurance. Oy.
The Vanishing Oath
If you're a complete medical internet dork like me, you've no doubt heard about The Vanishing Oath, a documentary put together over two years by an ER physician. I just ordered it. I just ordered it after I just watched this short clip
The path to patient care is lined with numerous obstacles
And then I just cried. Sure, our narrator is talking about the ER, but it's the same everywhere. Electronic charts, hospital administrators, forms, insurance companies, prior authorizations, Purell, CLIA-waived nonsense, 90-day prescriptions.....
How does this affect you? Every single doctor in these United States, unless they are cash-only (maybe), had to deal with about three of these before he or she walked into the room to see you, your child, your grandma, your sister, your husband. How distracted do you want your doctor to be? Medicine isn't easy. You're not easy. You want your doctor's full attention, or do you want 20%? The other 30% is going to the chart, 20% to racing mentally through the 50 things you have to do for other patients, 10% to the patient who just left whose electronic chart you didn't have a chance to finish because the computer crashed in the middle of your note, and 20% to just how pissed off you are....
New England Journal had an absorbing piece that resonated with moi about what keeps primary care docs to busy. It's free to read. Just skim it:
What's Keeping Us So Busy: A Snapshot from One Practice
You think your one or two little prescription refills handled over the phone add up to not much, and you're correct. Multiply that by 20 prescription refills, 10 consult letters to review, 5 xray reports, 3 pathology reports, 5 out of 20 appointments that ran over because the patient issues were so complicated, and it ain't nothing. It's the death of primary care.
The path to patient care is lined with numerous obstacles
And then I just cried. Sure, our narrator is talking about the ER, but it's the same everywhere. Electronic charts, hospital administrators, forms, insurance companies, prior authorizations, Purell, CLIA-waived nonsense, 90-day prescriptions.....
How does this affect you? Every single doctor in these United States, unless they are cash-only (maybe), had to deal with about three of these before he or she walked into the room to see you, your child, your grandma, your sister, your husband. How distracted do you want your doctor to be? Medicine isn't easy. You're not easy. You want your doctor's full attention, or do you want 20%? The other 30% is going to the chart, 20% to racing mentally through the 50 things you have to do for other patients, 10% to the patient who just left whose electronic chart you didn't have a chance to finish because the computer crashed in the middle of your note, and 20% to just how pissed off you are....
New England Journal had an absorbing piece that resonated with moi about what keeps primary care docs to busy. It's free to read. Just skim it:
What's Keeping Us So Busy: A Snapshot from One Practice
You think your one or two little prescription refills handled over the phone add up to not much, and you're correct. Multiply that by 20 prescription refills, 10 consult letters to review, 5 xray reports, 3 pathology reports, 5 out of 20 appointments that ran over because the patient issues were so complicated, and it ain't nothing. It's the death of primary care.
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