Monday, June 11, 2018

Sorry

I feel massive, crushing guilt about not posting here more frequently.  Well, not really.  But I do feel a little bad about it. 

The problem is, the less you post, the less you post.  No, that's not a typo.  Basically, if you're only posting every couple of weeks, you start to feel like every post you make has to be incredibly profound.  It's not enough to make a post about a Cheeto you found that looks like a guy masturbating.  And since my life is not that profound, I don't know what to post.

Also, I'd post more if the blogger app didn't suck so bad.  Just sayin'.

The big drama in my life these days is I bought a new car.  It's a Subaru Forester--my first SUV.  I'm horrified I did this... the best thing about my kids getting older was I didn't need to have a bigger car, but somehow this car happened. I love/hate it.  I love the way it drives and the visibility is great.  I hate everything else about it. 

The thing I hate most this week is I realized I had the option of getting a trunk that opens automatically, but because the salesman didn't tell me this was an option (because he probably wanted to unload a car nobody wanted), I didn't get it.  So now I have a trunk that's impossible to close for short little me.  I called the car dealership and cursed them out, but it's not like it's some big revelation that car salesmen are skeezy. 

Question of the day: if I live in a place where snow comes out of the sky on a regular basis during the winter months, do I need special tires?

Monday, May 21, 2018

chitchat

I don't want to overgeneralize, but when it comes to patients, all old women love me.

Partially because I really try to relate to them.  I ask them about their kids and their grandkids.  Again, I don't want to overgeneralize, but all old women love to talk about their grandkids.  Although I do pretty well with the ones who don't have grandkids too.  Like, we talk about bridge.  I think deep down, I'm actually a 70-year-old woman.

The only problem is that once I get them talking, it's hard to stop.  I find it very easy to do a directed history on a chatty patient, but I feel bad interrupting someone in the middle of a story about their grandchild.  But if I let them, each of these patients would go on for hours and I'd get home sometime after midnight.

Any advice on how to cut these conversations short after a respectable amount of time?

Thursday, May 10, 2018

Vitamin D

Vitamin D seems to be the new big thing.  I've had multiple friends tell me they were feeling tired, then they were diagnosed with Vitamin D deficiency and started feeling better after taking supplements.  We check Vit D levels all the time on patients.  I myself have been a believer in the Vit D hype, and even take supplements myself.

But now this review has come out, stating that "Routine vitamin D supplementation does not prolong life, decrease the incidence of cancer or cardiovascular disease, or decrease fracture rates... Randomized controlled trials of vitamin D supplementation in the treatment of depression, fatigue, osteoarthritis, and chronic pain show no benefit, even in persons with low levels at baseline."

Interesting.  I have to admit, it gives me pause.  Is all the Vit D hype over nothing?  Is this like when I used to take zinc when I thought I was getting sick?

Monday, April 30, 2018

Supposably

Maybe it's just my imagination, but lately, I feel like I've been noticing a lot of people saying "supposably."  And I'm talking about college-educated people who should supposably know better.

Supposably--not a word.

And neither is "irregardless."

But I'd probably sound like a jerk if I said that.

Monday, April 23, 2018

Being responsible

It feels like the people I know who don't work in medicine don't seem to understand the responsibilities people in medicine have toward their jobs.

I was ill with a fever a few weeks ago, and I was having a bit of post-viral malaise (still am).  I wasn't feeling fabulous, but I wasn't actively sick or anything.  Just dragging a bit since the fever, although improving.  I was supposed to work at the hospital over the weekend, and multiple people told me I should blow it off.  Adults.  Who have had or currently hold jobs.

One person further suggested I should take several months off.

It's exhausting to explain this to people.  Including my husband.  Do people in other fields really don't get that you can't just take off work without warning just because you're a little tired?

Monday, April 16, 2018

Our neighbors

I don’t know what to do about my neighbors.

I live in an apartment building, so I’ve never actually met them. I’m not even sure if it’s my upstairs neighbors or my side neighbors. But lately, they’ve been bothering me a little.

The guy who lives there shouts curses a lot. That part doesn’t bother me. Usually I notice it because I’ll be getting dressed in the bathroom and I’ll hear him screaming curses.  It’s a little unsettling, but also somewhat amusing.

However, on two occasions, his shouting woke me up. Last night, it woke me up at 1:30 in the morning. On another occasion, I think he might have been having a fight with his wife at six in the morning. I heard him screaming, “What the fuck do you want from me???” over and over at what sounded like the top of his lungs, and then a woman giving a muffled response.

I’m not sure what to do about this.  It’s not in a place where the kids can really hear it, so I’m not bothered if he yells curses during the day, but I’d rather not be woken up by shouting. But I’m not even sure where the guy lives, and he seems like a possibly unstable person I don’t want to antagonize. We’re only going to be living here for a few more months. What do you think I should do?

Sigh.  Just when the baby moved out...

Monday, April 2, 2018

Customer service

I feel like as a doctor, part of my job is customer service.  Because when I see inpatients, a lot of the time when I ask at the end of seeing them if there's anything else I can do for them, they have a complaint about their call button taking too long to be answered, the food being bad, their roommate being too loud, etc.

I try to handle the complaints best I can.  I never ignore them.  I say something like, "I'm so sorry that happened.  Let me see what I can do to fix it."  Then I tell them my plan, which involves anything from talking to the nursing supervisor about nursing issues or to the unit coordinator to get them a room change.  I can't personally fix the problem, but at least I try to show I'm taking it seriously and addressing it.

It's made me a lot less tolerant of bad customer service.

Recently, I got an email at 6PM from our leasing office, saying that tomorrow (a holiday when kids were off from school), they were doing repairs and our water would be shut off intermittently "after 8AM."  I was horrified.  We didn't even have a day's notice of this!  I was going to be home with the kids all day and how can you do anything at home when you don't know if you're going to have water to clean it up?

I called the office, and the woman I spoke to was almost rude.  She assured me they were in no way obligated to inform us in advance of such a thing.  When I asked for a better estimate of when the repairs were being done, she huffed, "I gave you an estimate already!  It's going to be after 8AM."  I was like, "But that's the WHOLE DAY."

Finally, after talking for several minutes, I pleaded with her to at least talk to the repairmen in the morning to see about getting a better estimate on the time, and she very grudgingly agreed.

How hard would it have been to apologize to me for this unexpected inconvenience?  How hard would it have been to offer to check with the repairmen instead of forcing me to beg her to do it?

I think Customer Service 101 is not acting like the complaint is the fault of the customer.

Wednesday, March 14, 2018

Do you smoke?

Me: "Do you smoke cigarettes?"

Patient: "No."

Me: "Did you ever smoke in the past?"

Patient: "Yeah, I quit a week ago when I was admitted to the hospital.  Before that, I smoked a pack a day."

I don't get that.  If a doctor asks you if you're a smoker and you only quit a few days ago, you are still a smoker.  Why do people do that?

Friday, March 2, 2018

Women in medicine

Yesterday, a female resident went in to see a patient.  A bit later, she returned with her male attending.

Patient (to the attending): "You're so lucky you get to bring your wife to work with you!"

Attending: [horrified] "She's not my wife!"

Patient: [winks] "Even better..."


Monday, February 19, 2018

Survey on your experience...

I recently bought some expensive tickets for a show through a ticketmaster-type website.  After the purchase, it said my e-tickets would be delivered to me in twenty minutes.

Three hours later, I still hadn't gotten the e-tickets.  So I sent an email to customer service.

The next morning, I still hadn't gotten tickets or a response, so I called customer service.  The rep I spoke to basically acted like I was being impatient.  She was like, "Well, you bought your tickets at 7PM on a Friday night... what did you expect?"

"I expected the tickets in twenty minutes if that's what your site said would happen."

"Yes, but it was after business hours."

"Right, but the email didn't say I would get them the next business day.  It said I'd get them in twenty minutes so it's obviously automated."

"Yes, but nobody is working on a Friday night."

"Your site says the tickets are supposed to arrive in twenty minutes. If that's not going to be the case, the site shouldn't say that."

We went back and forth like that a bit, and she was basically blaming me for being impatient.  But the show was in a few days and it was clear something had gone wrong.  Finally, she basically put in an email to.... someone. 

"And when should I expect a reply?" I asked. "Like, at what point do I need to call again?"

"I don't know," she said, sounding very exasperated.  "Look, you'll get your tickets before the show!"

I finally gave up on her.  A few hours later, I got an email from customer service, saying my ticket purchase somehow hadn't been uploaded to the system, and they fixed it, and my tickets arrived five minutes later.

In any case, after my call with that woman, I got an email asking to rate my interaction with her.  I essentially never fill these things out, but i was so steamed, I did fill it out, and mentioned how unhelpful she had been and that she blamed me for being impatient when there was actually a glitch in the system.

It just got me thinking about surveys in general.  Sadly, I'm the sort of person who only fills them out when I have only an especially great or awful experience.  That's the inherent flaw in things like Press-Ganey.  Unless everyone is required to fill them out, how can you really get an accurate assessment of care?

Monday, February 5, 2018

Weirdest winter ever

Usually by this point in the season, I've been sick at least four or five times.  Having a cold is sort of my thing.  And this winter has been really bad for everyone around me getting sick.

Yet weirdly, I haven't had one cold all season.  I have had some sinus issues, but no actual colds.

It's honestly almost a little frightening. This hasn't happened since I've had kids. I'm wondering if my body is revving up for some monsto-virus that will result in my death.

Or have I now just acquired every upper respiratory virus circulating in a 30-mile radius and have become immune?

The only other thing I can think of is that I started taking multivitamins this summer.  Could that be why I'm not getting sick??


Thursday, January 25, 2018

An education on late term abortions

I was recently talking to a friend of mine named Joe who works in health care and is an intelligent, well-educated person.  The subject of abortion came up and Joe told me he was pro-choice, but...

Joe: "I just don't think women should be allowed to have abortions at 37 or 38 weeks pregnant.  That's just wrong."

I think I gasped audibly and said, "Oh no!"  I didn't understand how a smart guy in healthcare could believe women were having abortions two weeks before delivery.  Or putting it another way, that there are doctors out there who are effectively willing to murder full term fetuses.

Donald Trump said it during a debate though.  And while people did point out that this ridiculous, I always felt like a big enough deal wasn't made out of this.  Our presidential candidate believed women are allowed to have abortions at full term.  How can we brush that off?

I calmly tried to explain to Joe why this logic made no sense, and he quickly said, "I don't want to talk about it anymore."  And.... that was the end of the discussion.

Now I am someone who sympathizes with people who are genuinely pro-life.  I have female friends who believe life starts at conception, and can talk intelligently on the subject. I am willing to listen to anyone who does not just want to ban abortion as a way to punish women for having sex. But the issue of late term abortion is one that I think is confusing to a lot of people, and I genuinely believe that very few of the politicians, especially the ones trying to ban abortion after 20 weeks, really understand anything about it.

This is an incredible article by an OB/GYN about late term abortions.  Here are the highlights:

1) Late term abortions make up about 1% of all abortions, so banning them does not really reduce abortion rates much.

2) 80% of late term abortions are for serious birth defects, many of which are incompatible with life.  Should politicians really get to decide if women have to spend four months with a baby with no brain in her uterus?  Why is that even a political issue???

3) Most of the remaining 20% are for serious maternal health reasons.

4) After 24 weeks, abortion is NEVER performed.  Delivery is always attempted.

Essentially, these politicians want to keep women with the most heartbreaking situations (tragic birth defects, life-threatening conditions) from getting medical treatment.  I can't figure out any way to justify it other than ignorance about late-term abortions.

Tuesday, January 23, 2018

Watch phone

You guys always give great advice when I ask for it, so I’ve got an important question:

My 11-year-old has already destroyed one laptop by dropping it on the floor.  I want her to have a phone but she’s assured me she’ll probably lose or break any phone I get her.  So I’ve been considering getting her one of those watch phones for kids that has a GPS, can call a few select numbers, and text a little.  They seem to run $30-70 on Amazon.

Does anyone have any experience with these phones? Recommendations? Advice? If it makes a difference, we have AT&T.

Tuesday, January 16, 2018

Physician suicide

I was talking to a medical student recently who said he didn't want to do a residency in NYC because "everyone there kills themselves."  I think that's a little dramatic, although I do recall several years ago there was a rash of suicides in residents.

I just read an excellent article on physician suicide.  What's sad is that if a physician really was feeling suicidal, I guarantee there's no way they could seek counseling quickly that wouldn't jeopardize their career and confidentiality--the only effective way would be to threaten suicide, which would take them to the ER and give them a record of suicidal behavior.... a fate many proud physicians would consider worse than death.

I'm going to take a step further and say mental health treatment in this country is really bad.  This is not a jab at mental health professionals, who are probably fine individually.... just saying there aren't enough of them. The system is bad. If someone is feeling depressed or suicidal, they can call their local behavioral health center and maybe get an appointment in a month or two.  Hopefully they're alive by then.

I had a few really down periods during my medical training, so I can speak to all this from experience.  There were no mental health services available.  At one point, when I was having a really hard time, I called some student health hotline, and the person told me that this wasn't the purpose of the line. I asked where I could go, and they said such a service didn't exist at the school. They talked to me a little, but it was clear that they were just doing it to be a good human being, and not because it was their job or something they were trained in. 

So.... I guess the takeaway is don't get depressed because if you do, you're shit out of luck.

Monday, January 8, 2018

Guest post: Weight loss surgery

Tuesday I sat through another hard sell for weight loss surgery. I'm so done.

I'm weary of doctors who won't hear my "no" and plow ahead extolling the virtues of procedures I have already investigated and decided are not for me. I would be at high risk of suicide if I allowed myself to be bullied into this. (That is not true for most people but would be for me.)

Today I felt calm enough to respond via email. To be sure, I responded plenty in the moment but everything I said was ignored or argued with and the doctor just kept going. My husband was present and he was shocked--as a fat man himself his doctors bring things up and then drop it if he says no. I talked with him about how hard it is to turn around and look for another doctor because I don't even know how THAT doctor will handle the sensitive issue of weight. If there's one thing I'd wish of doctors is that they come to appreciate how we've already survived a lifetime's worth of assaults on our self esteem based on our weight. Unless they've been there I don't know how easy that is to understand--but I wish they'd try.

I sent the following to Doctor M:

Subject heading was "Boundaries."

I understand that all doctors will discuss weight with their fat patients. I expect that it will be brought up. What I did not expect was the hard sell on weight loss surgery after I repeatedly indicated that I was not remotely interested in it and had firmly decided it was not for me for many reasons. You continued for something like 20 minutes AFTER I indicated that. But what is dangerous to my well being and survival was that you did so after learning I had spent months being verbally abused and was dealing with the resulting depression. Fortunately I've had years of therapy and could deal with the hurt, shock and distress I felt after having my boundaries violated.

It also concerns me that you'd dismiss the value of walking simply in relation to weight loss.

WEIGHT LOSS IS NOT A GOAL OF MINE. A Health at Every Size strategy of movement and eating healthy food IS. Obesity research has demonstrated that 95% of us regain. This is a feature not a bug.

Can you respect boundaries?