Tuesday, September 16, 2014

Dr. Orthochick: Off topic

So before you do an outpatient surgery, you have to make sure the H&P (history&physical) has been done within the past 30 days. If it hasn't, you have to write one out. It's this little form and you pretty much just have to write out a sentence for the 'history of present illness,' so it's not a big deal and it takes less than 5 minutes to write. It is far and away not my least favorite job. Although I feel dumb asking patients what happened because I feel like I should know a little bit more about them 5 minutes before I take them down to the OR to start cutting. My solution to this is, I kind of pretend I already know what's going on. So I always say, "I know this is a pain for you because I'm sure you've gone over this a million times already, but I just need to ask you one last time to tell me what happened." Most people laugh and tell me, in two sentences or less, when they fell and broke their distal radius.

Me: OK, so I know this is a pain for you because I'm sure you've gone over this a million times already and everyone's asked you, but--

Yesterday's patient: How many times do I need to tell you people? I'm gay!

It was really hard to segue from that into "so when did your trigger thumb start bothering you?"

Monday, September 15, 2014

Recruiting

I got an email just now with the subject "California Corrections." I got really scared. I thought maybe they caught up with me on that hit and run. (Just kidding, but I really did get a little scared.)

Anyway, this was the email:

I hope that you do not mind me emailing you this afternoon. I am quickly sending this email to you in case you are looking for a new opportunity or perhaps a higher paying job. The California Detentions Centers (CDC) have contact us to assist them in providing Family Practice coverage. The compensation is in the range of $130.00 an hour to $160.00 an hour. Credentialing and getting processed through the CDC system is a lengthy process. It can take about 3 to 4 months.


It's nice that although I told this recruiting agency to leave me alone, they are still sending me jobs nowhere near where I live, as well as in the wrong field. Good work, Staff Care. I also find it kind of funny that they're looking for family practice doctors for detention centers. I just picture a whole family in jail and being seen by the doctor.

Saturday, September 13, 2014

Weekly Whine: Insurance

Recently my husband and I bought life insurance. It was a huge saga, which I may post about in the future if I am motivated.

One thing that struck me about the whole process of applying for insurance is how it punishes both honesty and self-improvement.

For example, my husband has sleep apnea. Obviously, this is not something that would be picked up by a clinician during a routine exam like high blood pressure or high cholesterol. However, in order to improve his health, he opted to get diagnosed and treated. And he has faithfully used a CPAP machine every night for the last six years.

Unfortunately, a person who never bothered to get treated for severe sleep apnea and presumably has higher health risks would probably have a much lower insurance rate than my husband. Ditto for people who seek treatment for mental health issues like depression or anxiety, which probably wouldn't be caught during a routine exam.

I understand that insurance companies need to use some sort of model to assess risk. But I do feel like that model shouldn't punish people who try to help themselves.

Thursday, September 11, 2014

Suicide Med

If you read and enjoyed Suicide Med, please consider going to Amazon and leaving a review. I would really appreciate it!

Either way, if you read it, I would love to hear from you and get any sort of feedback, so send me an email.

Tuesday, September 9, 2014

Dr. Orthochick: TOXIC SHOCK SYNDROME

If your first thought upon reading the subject was "tampons," then congrats, you're normal. (If you don't know what that is, then that's normal too.) If your first thought was something other than tampons or nothing, then you're a freak of nature. (sorry. I hate to be mean, but really...what else is there besides "tampons"? Freak.)

We learned about it at some point second year of med school and they didn't teach us anything you can't find on the side of a tampon box. It's not particularly common, even among dedicated tampon wearers, but it does happen, in which case the treatment is removal of the tampon. Once you get that thing out, TSS usually clears up pretty quickly. Allegedly there are other ways of catching it, but as far as me and the rest of the world can tell, that's the only important way. Also, I remember Dr. McYummy telling me that I didn't need to know anything about it since I would never see anyone with it, now that the particular brand of tampon that was responsible for causing the outbreak was recalled.

Anyway, the other night when I was on call we got consulted in the ER for a 15 year old boy who had had metal pins stuck in his arm for a humerus fracture and was now presenting with an infection. The pin sites looked fine but the kid looked pretty sick. I asked the ER attending if we could consult pediatrics to admit the kid, he agreed, the kid got admitted that night. It wound up being the right decision because something happened that night and the kid crashed. Between when I saw him on Friday evening and 6AM Sunday, the kid wound up intubated, ventilated, sedated, and with a blood pressure so low they had to start him on multiple pressors.

He was diagnosed with toxic shock syndrome, source of infection unknown.

Dr. Sweaty: They now think he has toxic shock syndrome
Me: Has he been using tampons?
***
Me: They now think [your pediatric patient with the pins] has toxic shock syndrome
Dr. Orthoking Jr.: Where is he hiding a tampon? It comes from tampons, right? I think that's what we learned in med school.
Me: I think that's the only thing we learned about it in med school.
Dr. Orthoking Jr.: It's nice to know that med school hasn't changed.
***
Dr. Orthoking Jr.: That patient who we put the pins in now has toxic shock syndrome.
Scrub Nurse: Why is he using tampons?
***
Me: Hey mom, what's the first thing you think of when you hear "toxic shock syndrome"?
Mom: TAMPONS

We took out the pins, but they looked fine and they have yet to grow anything in the microbio lab. Anyway, I'm no doctor or anything, but I'm starting to wonder if it's not completely impossible that the kid actually does have a tampon inside himself. Assuming that Chuck Palahniuk short story did not lie to me, 15 year old boys like to do...uh...disgusting things to...uh...self stimulate. So I don't think it's completely inconceivable that he could have, well, I'm not going to spell it out here. But 15 year old boys are disgusting human beings and I don't think it's out of the realm of the possible that he does, in fact, have a tampon lodged inside him and it's causing all these problems.

I really think someone should give the kid a good rectal exam, but I'm not sure how to suggest it. And i'm not exactly about to sneak into his room and do it myself. Also, I didn't really want to dwell on what the kid did or didn't have lodged in his anus. (hey, there's a reason I'm in ortho and part of it involves staying the hell away from that thing) And it's possible that the kid has some foreign body that's not disgusting that's causing this problem, but we already removed the pins. What else is there?

I guess I'll never find out.

Monday, September 8, 2014

Lesson in Honesty

A few days ago, I was at Kmart and I was taught a valuable lesson about honesty.

My daughter found a really cool pair of sunglasses in a three dollar bin. She loved them so much, she wore them all around the store. We bought about $50 worth of stuff, and when we were paying for it, she was still wearing them, so we accidentally forgot to pay for them.

When we got to the car, I noticed she was wearing the sunglasses and I asked if we had paid for them. She said that we hadn't. Obviously, at that point, we had gotten away with it, but I wanted to teach my daughter that it's not okay to steal, even accidentally. I wanted to teach her to be honest. So we went back to the store to pay for the sunglasses.

The lines were long, but we got back in line, so we could pay for the sunglasses. Unfortunately, it turned out the sunglasses didn't have a tag on them. The cashier asked for a price check, and let somebody else go in front of us while we were waiting, because obviously getting a price check is such a long ordeal that we couldn't possibly allow the line not to move. She was right. The person didn't know what the price was and we had to locate another pair of sunglasses in the bin, but those weren't labeled either.

We had to call another person to find out what to do about the situation. This person suggested getting another pair of sunglasses from another place, and then marking those down to three dollars. At this point, we had been dealing with this for at least 10 minutes.

We followed the cashier and she got us another pair of sunglasses and then we had to get in the customer service line, because obviously the cashier couldn't do it herself. That line was very long too. I said to the cashier that I would just hand her three dollars and then asked if we could leave. She said it didn't work like that.

After several minutes of waiting in line, I started to get pretty pissed off because it didn't look like the line was moving at all. I asked to speak to the manager. The manager came over and I told them all we had been through in attempting to pay for the sunglasses, and they said since they were only three dollars and we just spent $50 at their store, I thought he should let us just have them and let us leave.

He said he couldn't do that and then I started fighting with him. I said that this was ridiculous, that it was their fault that they didn't label the item had such terrible customer service that they had no way of dealing with us without it taking practically 30 minutes of my time. I was SO ANGRY. Finally, he agreed to give me the sunglasses for 50% off. I said fine and that I was never going to shop there again.

Maybe it's impossible to get an item for free just because the store sucks, but considering it was only three dollars, I don't think it was worth anyone's time. For me it was just about principle at that point. What sucks the most is that my daughter was so miserable through the whole process and I was just trying to teach her to be honest. I don't think that lesson succeeded.

Saturday, September 6, 2014

Weekly Whine: Health insurance is expensive yo

Recently, I had a really bad sore throat. Instead of abusing one of my colleagues, I decided to take a trip to urgent care to rule out strep.

Obviously, I have health insurance. However:

It cost $20 co-pay for the visit.

It cost $30 for the Z pack they prescribed.

It cost $30 for the throat culture.

So with my health insurance, it was $80 to treat my sore throat, which turned out to just be viral after all. Good thing I make a doctor salary.

Thursday, September 4, 2014

Stick Figure Death

Circa 1998, there was a little fad on the internet called STICK FIGURE DEATH THEATERS....

The basic idea is that you animate little scenarios of stickmen dying in creative ways. Always one to get sucked into internet fads (in college), I immediately downloaded some animation software and made my own stick death site.

I made about a dozen or so animations. I showed them to everyone. I was very ghetto and low tech about my animations, but I got a lot of hits initially because I came into the game early. I was on the top 20 site for a while and I was an early member of the stick death ring. The animations on other sites quickly became pretty elaborate and my site got pushed out of the mainstream, but I will always carry a piece of that site with me (on my harddrive).

Here's a sample:



For the next month I'm going to keep posting these intermittently. Because it's my damn blog and I want to.

Wednesday, September 3, 2014

Three common myths about brain injury

As somebody who frequently sees patient who have real head injuries, it bugs me how many misconceptions are inflicted upon the public. So I want to share with you three common myths about brain injury that I frequently see in movies and TV shows.

Three common myths about brain injury

1) A second head bonk is not curative

You know what I'm talking about. Somebody gets hit in the head, gets amnesia, and this lasts until something hits them in the head again. And presto, they're cured! Recently I saw this depicted on The Muppets Take Manhattan, which my kids were watching. (Muppets frenzy and all.)

Actually, there is a phenomenon called Second Impact Syndrome, involving getting hit in the head again shortly after a first impact. Unfortunately, this second head bunk does not cure you but rather kills you.

2) You don't wake up from a coma one day and are just totally fine

The length of time you are in a coma is extremely predictive of outcome. If it lasts longer than three months, even if you "wake up", you will almost certainly have severe cognitive deficits. At that point, it is essentially impossible to wake up and be completely normal.

And you definitely won't have a psychic powers. I'm looking at you, Dead Zone.

3) You can't really function in normal society with severe short-term memory loss from a head injury

It wouldn't be possible to have a head injury with severe memory loss, but still be able to drive a car, have normal conversations, normal relationships, or solve mysteries about who killed your wife. You might not even be able to figure out how to bathe or dress yourself.

But you probably could go on 50 first dates with Adam Sandler, because I'm pretty sure that having impaired cognition would be a plus in that situation.