Saturday, March 28, 2015

Weekly Whine: Psychiatrists

I'm writing this from the perspective of somebody who has a close family member who is a psychiatrist, and is great at his job. However, I have to say, pretty much every psychiatrist that I have worked with has been terrible at psychotherapy.

I am not ashamed to admit that I have seen therapists intermittently in the past. I believe the talk therapy can be really helpful during stressful periods, or when making important life decisions. My understanding is that therapists can be either psychiatrists, psychologists, or social workers.

The worst therapist I have ever seen by far was a psychiatrist. This woman had the worst interpersonal skills I have ever experienced, and had no business being a therapist, in my opinion. Maybe she was good at medication management, I don't know. But every time I spoke with her, I felt awkward and uncomfortable.

Since then, I've talked with some patients who saw psychiatrists for talk therapy, and they all had similar experiences. Sometimes they just went for a medication adjustment, and they were frustrated that they felt the psychiatrist didn't understand them.

It makes me think that psychiatrists don't get enough training in how to do psychotherapy, and most of their training is just focused on medications. Which means that they're about as qualified to give talk therapy as I am.

Thursday, March 26, 2015

Rejection Letter

Despite being so completely awesome, I did get my fair share of rejection letters when I was applying to medical school. However, there were a few times when the tables were turned, and I had to tell a medical school that wanted me that I wasn't interested in them. I crafted the following letter to send them:

Dear Medical School:

With sincere regret, I am writing to share what I believe will be disappointing news. I have considered with care your school for admission. Unfortunately, because of the rigorous competitiveness of the medical schools that have accepted me this year, I am unable to attend your school.

I very much appreciate the time and effort you have spent crafting and compiling your brochure and application materials, and the interest you have shown in me. The fact that I am only one person dictates that I must limit my enrollment to a frustratingly small proportion of those seeking my enrollment. I can assure you that your school was considered with thoroughness and care despite this disappointing outcome. I commend you for your patience during this interview season, and I am aware that my words may do little to assuage your disappointment.

In closing, I wish to express my regret that all medical schools can't be allowed to fulfill their aspiration of educating me at their fine institutions. Because of your excellent medical facilities, it is my hope that you will find the students you seek for your class of 20xx and beyond, be it as a medical school, or else maybe as a dental school or clown college or something.

Yours sincerely,

Feel free to use it if you need to.

Tuesday, March 24, 2015

Dr. Orthochick: Ice

Nurse: Your patient in room 222 has a temperature of 43.5 Celsius and the computer notification went off that I need to tell you about that.

Me: Yeah, I'm sure it did because the computer is trying to tell us that there's no way that's possible.

Nurse: Well, he just got done with surgery and we took his temperature and that's what it was.

Me: Yeah...but that's over 110 degrees Fahrenheit.

Nurse: Oh. Maybe we should retake it.

Me: Yeah, let's start with that.

Lo and behold, it was a normal 98.6.

To quote "Player Piano":
He who lives by technology, dies by technology. Sic sempre tyrannis.

Monday, March 23, 2015

Where are my patients?

When patients are acutely ill, finding them is usually not so hard. Usually they're in bed. But at the point that I get consulted, patients are usually a little bit more mobile, which means sometimes I have to search for them. These are some of the places that my patient usually are when I try to see them to do my consult:

Saturday, March 21, 2015

Weekly Whine: Donations

Sometimes I will see some article online about some poor family whose home burned down on their child's birthday and that on that same day, their other child was diagnosed with cancer, or something horrible like that, and donations from strangers poured in and now they have half a million dollars to buy another home. And I feel guilty that I never give money to these unfortunate strangers because their stories are so compelling.

But when it really comes down to it, I think these donations are a little ridiculous. For every sob story on the Internet that gets way too much money, there are probably thousands of other families in a similar position who aren't as attractive, don't have as compelling a story, or just aren't as Internet savvy or lucky enough for their story to have gone viral. And those families get nothing.

It's sort of like the lottery, in a way. One family gets rewarded with more than they actually need, while everyone else gets nothing.

I think it's great that there are people out there kind enough to donate their money to help others. We make donations every year, but I let my husband handle it because I think he is smarter about choosing charities that are worthy (I know he gives a lot to Doctors without Borders). I just think it makes more sense to donate to a large charity that will help a large number of people, instead of just rewarding one lucky family.

What charities do you think are worthwhile to donate to?

Thursday, March 19, 2015

psychogenic polydipsia

Recently, I overheard a nephrologist, a resident, and a med student discussing a psych/med patient with hyponatremia from psychogenic polydipsia. The nephrologist was arguing that a patient couldn't maintain that significant degree of hyponatremia just from drinking lots of water.

Nephrologist: "Hey, we have a third year med student... we can experiment on her."

Med student: "Huh?"

Nephrologist: "So she would have to drink about a liter and a half of water every single hour, right? Actually, she's small, so maybe only a liter. She'd have to drink a liter an hour every hour, 24/7."

Med student: "I think I'd get tired..."

Nephrologist: "What do you think? Could she keep it up?"

Resident: "I don't know. Is she a psych patient?"

Nephrologist: "Well, she seems like a pretty nice girl. Also I don't think they let psych patients into medical school. So is it possible?"

Resident: "I think it's possible."

Nephrologist: "She'd have to keep drinking while she was peeing."

Resident: "You mean you don't do that?"

Nephrologist: "Yes, but I thought I was the exception."

Tuesday, March 17, 2015

Dr. Orthochick: ROM

Physical therapist: I'm a little confused about the activity restrictions for [your patient who just had a hip revision.] Can you please clarify?
Me: Yeah. Dr. J wanted her on anterior and posterior hip precautions. And no hip abduction.
PT: active motion? Because with those precautions she can't internally rotate, she can't externally rotate, she can't flex, she can't extend, she can't abduct, and she can't adduct.
Me: Yeah, and she needs to wear a knee immobilizer brace at all times as well.

Sometimes the cure is worse than the disease.

Monday, March 16, 2015

The LP

When I was a medical student on my neurology rotation, I was sent down to radiology because the radiology attending who was doing an LP didn't want to take more than 6 cc out of the patient's spine, because he was worried the patient would get a headache. So in order to absolve himself of responsibility, he said that if neuro wanted more than 6 cc, we physically had to go down and take out the rest of the fluid ourselves. Specifically, I had to go down there and hold a test tube to catch the fluid (over 6 cc) dripping out of the patient's spine.

As soon as I got down there, the rad attending was acting like an asshole. After much ado and my having to page my attending, he agreed to let us take out 25 cc total, as long as I was the one taking it out.

So the radiology resident got the tube in his spine and got out the first 6 cc. He hands me the test tube and the attending said to me, "OK, we're all leaving now."

I looked at him with sheer panic and I was like, "Wait!" I didn't know what could possibly go wrong with the patient during this procedure, but considering I knew very little, and the attending felt it was dangerous enough that he didn't want to be there, I didn't want to be alone.

The resident was sympathetic and asked the attending if he could stay with me. But the attending was insistent that nobody be in the room with me. I said, "What if something goes wrong? How do I get it out?" The answer to that question was that they would be a few doors down and the patient's son could go get them. Finally, the resident told me quietly that he'd come back before I was done and remove the tube from the spine.

It baffles me that an attending could act that way. I was shocked and I felt awful for the patient who had to hear this exchange.

Saturday, March 14, 2015

Weekly Whine: Build a Bear

If you've never heard of the store build a bear, it's sort of the bear equivalent of an American girl doll store. I try to avoid them when possible, but last weekend, we were passing the store with my mother, and somehow we ended up inside. (I blame grandma.)

The premise is sort of cool. They have all these unstuffed bears that are only slightly creepy, and your kid gets to pick out one. You do a little ritual which involves naming the bear and picking out a heart to place inside it, then you press the pedal and the bear fills with stuffing. The bears aren't cheap, but not ridiculous. Least expensive one was $12, which is not entirely out of control for a pretty large teddy bear.

It's the rest of the store that's out of control.

For starters, my daughter wanted her bear to have a headband, which was not unreasonable. Just a headband cost four dollars. Four dollars for a headband for a toy bear. I could buy 10 headbands for my daughter to wear herself for less than that.

Then of course, you have to buy your bear some clothing, because in this state, there are nudity laws against build a Bears. The cheapest outfit for a bear is $12. My daughter picked out an Elsa dress for her bear, which was $20. I kid you not. That bear is better dressed than me right now.

The accessories progress in ridiculousness from there. You can buy your bear shoes for another $10, a hat for another five dollars, and there was even bear underwear. There even appeared to be some mildly sexy bear lingerie.

For $20, you could get your bear a motorcycle, and for $10, he could wear a leather jacket to look cool on his motorcycle. And if something went wrong when he was driving the motorcycle, you could get him a wheelchair for $25.

If I ever find myself buying my child a wheelchair for her bear, you'll know that I have done something seriously wrong as a parent.

Thursday, March 12, 2015

Work it out

When I was in medical school, I ran into a friend of mine in the bookstore one day. He told me he was about to start his OB/GYN rotation another month and he wanted my advice on something. I had already taken the rotation so I assumed he was going to ask me some sort of academic question.

Instead, he said, "do you think I should start working out?"

"What?" I said.

"Well," he said. "All the residents on OB/GYN or women, right? So maybe they'd appreciate it if I started working out and were in shape."

I didn't know what to say. "Um, you can start working out for yourself…"