Tuesday, June 30, 2015

Dr. Orthochick: Misspeak

I was giving a presentation today and I accidentally said "patient was born full term via spontaneous vaginal deformity." (instead of delivery)

If nothing else, it killed some time while everyone tried to collect themselves. I think I got a bigger laugh than my co-resident did that time he wrote "interanal condyle" instead of "internal condyle" in his slide. Or that time another resident presented an article that not only contained the phrase "depth of penetration," but also discussed factors that influence the depth of penetration, such as reaming harder, faster, deeper thrusts...

Monday, June 29, 2015

Won't we all...

Conversation with patient being fitted for an artificial leg:

Me: "how are you doing?"

Patient: "I'll be feeling a lot better once I get my prostitute."

Saturday, June 27, 2015

Weekly Whine: Happy Birthday, buy a car

I'm finding it more and more irritating to get birthday messages from my dentist, eye doctor, car mechanic, etc.

It's not that I don't appreciate that they have an automatic system that's considerate enough to remember my birthday. But it just makes me feel kind of like a loser when I get more birthday wishes from people who want to sell me stuff than I do from people who actually are my friends.

Thursday, June 25, 2015

Comorbid

Me: "do you have any medical problems?"

Patient: "no."

Me: "do you have diabetes?"

Patient: "yes, but it's controlled."

Me: "with diet?"

Patient: "no, with two medications."

Me: "And do you have high blood pressure?"

Patient: "yes, but it's controlled."

Gah!

Tuesday, June 23, 2015

Dr. Orthochick: High school sports clinic

As luck would have it, since I'm this month's sports chick, I got roped into helping with high school student sports physicals on Saturday. Technically I didn't have to, but the way it was worded meant I sort of had to if I wanted to pass this rotation. Also, Dr. Douche kept on talking about how this would not only benefit my education now, it would also benefit me in the future so I could have a job doing sports physicals. I guess he doesn't think I'm going to be a very good surgeon if my best option is to do sports physicals for the rest of my life.

Back in the olden days, when I was doing high school sports, you brought the form to your pediatrician, he signed it, and you were good to do sports for the year. That does not fly anymore. Now you need a comprehensive examination by a medical doctor, a musculoskeletal specialist, and a cardiologist before you get cleared to play sports. And if anyone in your family has heart disease, you need a transthoracic echocardiogram for clearance. So our Ortho group organizes it so that you can get all of this done on one day for free, which is a pretty sweet service because otherwise it would take a lot of time and money. (and my parents were into us doing sports, but if mom had to drag us to a cardiologist every year, I think she would have told us to get fat and make daisy chains in the backyard for exercise)

Physical-a-palooza started at 8AM, I got there around 8:30 because I had to change a wound vac before leaving the hospital and it took a little while, and there was a line of high school students and parents that curled around and outside the parking lot.

I started out in the musculoskeletal section, which consisted of doing a scoliosis check, anterior drawer tests of the knees, moving the hips, and checking neck and shoulder range of motion. On anyone who had a specific complaint I did a focused physical, but for the most part that was alls I did. I did it at least 25 times before I got switched to the medical stuff because they had enough musculoskeletal specialists but you need to be a doctor to do medical exams. (MSK can be done by a physical therapist or PA) I guess "ortho resident" falls under the realm of "doctor," but I feel like if we're going to all the trouble of cardiac screenings, we might want to have someone who uses a stethoscope on a regular basis do these medical exams. Not that it's hard and G-d knows I did a trillion heart-lung-abdomen exams in medical school, but by this point I don't remember which murmurs radiate to the carotids and which ones increase with valsalva etc etc etc. Good thing no one had a murmur. I did at least 50 medical exams, except I made it very clear that I was only going to do medical exams on girls. For boys you have to do a hernia check and yes, I do know how to do that, but I don't want to be in a room with a teenage boy who's naked from the waist down without a chaperon. I feel like that's putting me in a potentially litigious situation and whereas I'd like to think no one would accuse me of anything, honestly, I don't want to put myself in that position. Plus I feel like most teenage boys would probably prefer a male doctor doing that. So I did the girl stuff which involved asking a lot of questions about menses (r/o Female Athlete Triad) but didn't require anyone to disrobe.

Dr. Douche must have been bored because he kept on wandering over to my examining room to talk. He asked me repeatedly if i was learning about the importance of the physical exam and OK, it is important, but checking neck range of motion on 25 asymptomatic high school students is not going to convince me of that. Also, I'm not sure what he thinks I do all day if asking about menses is going to prepare me for the future.

So yeah, not sure I really got out of that what i was supposed to get out of that but I guess it's good to know that if this surgery thing doesn't work out in the future then yes, I feel very comfortable doing high school student sports physicals and I can make my living doing that.

Monday, June 22, 2015

Last chance to contribute!

A long time ago, I posted about putting together an anthology of humorous medical stories, and donating the proceeds to Red Cross. Well, as I mentioned in a prior post, I have collected enough stories to start putting together the anthology:



It is nowhere near complete, but I have enough stories that I can definitely make the book. However, the more the better, so...

If you would like to contribute a humorous medical story to this anthology, send it along to me at fizzziatrist@gmail.com. This is a great opportunity to have your work published in a book, and also to make a contribution to what I consider a really worthy charity! This is the last time I'm going to solicit stories.

Specs: It must be at least a little bit humorous and also at least 1000 words. Other than that, go crazy. Deadline: July 31!

Saturday, June 20, 2015

Weekly Whine: Birthday rules

A few simple rules for people who get invited to a child's birthday party, especially if it is at a paid location rather than at somebody's house:

1) RSVP prior to the RSVP date. Not the day after the date, not the day before the party. Just let the parents know if you're coming or not with enough time to plan!

2) If your child is invited to the party and you want to bring your other children along, ask if it's okay. Don't just assume you can bring your other three kids and nobody will care. Many locations have an upper limit on the number of children that can come to a party.

3) If you RSVP that you are going to the party, go. If you RSVP that you're not going (or not at all), don't go.

4) Don't say something like "we might be able to stop by." Are you aware that these places charge $20 per kid sometimes and need to know in advance?

5) Just bring one present. Who started this precedent of every family bringing like three presents? My kid has enough toys already.

6) Do not leave your kid at the party unless you are explicitly told it is okay. If your kid is under five years old, it is probably not okay. The last thing I need to deal with when running a party is your kid sobbing because he can't find you.

I hope kids appreciate how stressful these parties are for the parents…

Thursday, June 18, 2015

Was I wrong?

One day when I was in the middle of a vacation, it was the last day at work for a friend of mine and they were having a special potluck breakfast for her at the nurse's station. So I decided to come by for an hour in the morning with cinnamon buns and my toddler to bid my friend goodbye.

I was glad I came to see her, and also my daughter had a great time, plus I got to show her off. But when I was there about half an hour, a nurse came up to me holding some pills and said, "Can I ask you a question?"

I said, "No, I'm on vacation. I'm not really here."

The nurse said, "It's just a quick question about a patient."

Then about three other people said, "No! She's not here! She's on vacation!"

The nurse gave me an exasperated look and said, "You're really not even going to answer a question?"

Then someone told her to go page the attending on the floor.

I mean, was I wrong? I was sitting there with my two year old child, chatting with friends, on my freaking vacation. Why should I have to answer non-urgent medical questions about patients I hadn't even seen in several days? But she seemed so irritated I wouldn't do it. It made me wonder if I should have just been nice and helped her.

(For the record, two of the people chatting with me were practitioners AND were working, and somehow she only asked me.)

Tuesday, June 16, 2015

Dr. Orthochick: Whoops!

I scrubbed in for bilateral knee multiligamentous reconstructions with Dr. New the other day. I figured he would appreciate having a more senior resident help him since his options were me or an intern and I'm better at holding the arthroscopy camera, I like to think.

In the first 5 minutes of the surgery, one of us broke both the patient's tibias and one of us broke sterility.

Alls I can say is, glad those two weren't reversed. Because whereas it was an accident, it would have been less of an accident had I been the one who broke the tibias.

I scrubbed in again. We then spent the next two hours putting plates on the proximal tibias.

Circulating nurse: Should I call the family [in the waiting room] and tell them what you're doing?
Dr. New: No...I don't think they'd understand.
Me: I bet they'd get it if we said "hey, sorry, we broke both your daughter's legs and now we need to fix them."
Dr. New: You should let me be the one to talk to the family when we're done.

So yeah. It added about 2 hours to the surgery, but I was so busy being relieved that I hadn't done it that I didn't really mind too much.

Monday, June 15, 2015

Squeaky Wheel

Recently I was wondering if more difficult patients get better care.

We recently had a difficult patient. Every day, a doctor would have to spend over an hour talking to the patient about her many concerns. There were meetings about how everything needed to be carefully documented for this patient so that she would not throw a fit. Considering how much time we spent on this patient, it seems like she was getting better care than any other patient.

But is that really true?

I'd like to think that every patient we treat receives good care. Just because that care was being meticulously documented to avoid a lawsuit doesn't mean that the care was better. Just because the doctor spent time arguing and discussing the same issues with the patient over and over doesn't mean the care was better.

But I did notice that nurses and staff would avoid going into the patient's room if remotely possible, unless they absolutely had to. Nobody wanted to see that patient because they didn't want to get yelled at.

What do you think? Does the squeaky wheel gets the most grease or the least?