Tips for lecturing to med students and residents

In all seriousness though, I've been to more than my share of lectures for med students, residents, and beyond. I've heard some people who were clearly naturally good speakers but didn't know how to give a good lecture. Anyway, in my opinion, these are tips you can do to give a good powerpoint lecture:

1) Lots of pictures! Pictures to illustrate your points, not stupid clipart.

2) Limit the number of words on a slide. One thing that drives me nuts is a slide filled with so much text, you can't even begin to read it. What's the point?

3) Involve the audience if possible. A good speaker is engaging without having to even talk to the audience, but if you're like me and not the greatest speaker of all time, asking questions of the audience keeps them awake.

4) Involve the audience BUT don't pick on the audience. I still will never forgive this pathologist who called on me by name to answer a question during a grand rounds with like 200 people in the audience. Even in a small group, I think it's kind of mean.

5) Don't have text fly in from off the screen. Do people still do this? If so, stop it.

6) Don't go into too much detail about research studies. Especially YOUR research studies. Unless of course, it's a journal club.

7) Repeat key points. I've read that people can retain 3 points from any lecture, so figure out what those 3 points should be and make sure to hammer them home.

8) Don't go on too long. After a certain point, no matter how good your lecture is, everyone just wants to leave and won't hear a word you're saying.

Also, if you can possibly manage, do NOT show photos of your children and/or dog during the lecture. Seriously, I hate that. (I'm sorry, I didn't mean that. Your kids are adorable. I love that little hat your daughter is wearing.)

Blogging and privacy

As some of you know, I am a regular blogger for Mothers in Medicine. Recently, there have been some issues about the posting of patient information on this blog, and a new blogger expressed concern about how many details you need to change to really "de-identify" a story. Naturally, I have a few opinions about this.

When I was a resident, I remember there was some scandal because a patient had an arm amputation and apparently a staff member took a photo of his amputated arm "inappropriately." I'm not sure what this means. I assume the photo was not taken for medico-legal reasons or for academic research purposes, because it probably wouldn't be such a scandal. We hypothesized the photo ended up on something like Facebook or MySpace or something, and didn't just stay quietly on the staff member's iPhone. I don't really know any details.

I'd hope it's pretty obvious something like that is inappropriate. I read a story about some nursing student who got kicked out of school for posting a photograph of a placenta, although was later restored. And then there was the med student who took a photo with a cadaver and got in trouble for that one.

So I think it's safe to say that you should never post any patient-related photos taken at work. That's the obvious part.

But how about patient-related stories, if several of the details are changed and disguised? Technically, I guess it's okay, right? HIPAA isn't being violated. I can't say I never did it, because I have. It's hard not to. I mean, that's a huge part of our lives.

However, I do think there's a risk. I think even with several details changed, there might be a small chance of the patient will discover the blog and recognize themselves. This risk is probably extremely small if you don't post many details and blog anonymously, but it's possible. I'd like to think that on the rare occasion I post about a patient (although I try not to do this), I'm safe in doing so because I both change details, don't post more than a few sentences on anyone, and don't post about any patient I've seen in the last 3-4 years. But is it absolutely 100% safe? I guess not.

You have to weigh the risks and benefits. Is sharing this story with the public worth the chance of being discovered? Maybe. Maybe not.

(Also, I think the risk of having someone discover your true identity is higher than you think. After posting one or two details about yourself, such as what state you work in and what field you do, it's not that hard to use google. Mention one of your hobbies and a personal detail or two, and that's the end of it. It's kind of the equivalent of Superman putting on some glasses and then being "unrecognizable." And some people outright post under their real names, which amazes me.)

And then there's non-patient stories that could get you in trouble...

Several weeks ago, I made a post about a student at work who was annoying me. Although this was just a student (so no HIPAA violation) and I changed details of the story so I think the chances of the student discovering the post were basically nil, this experience made me realize that it is a risk to post anything about my current job. To me, it isn't worth that risk. So I will never again be posting any specific stories about my current job or people who work there.

My weekly whine this week was supposed to be a story about a junior resident I worked with during residency who annoyed me A LOT. I basically wrote a manifesto about his unbelievable behavior that I thought was pretty entertaining. But I thought about it and I realized that the field I'm in is pretty small, and there was a small but reasonable chance that he might read it and recognize himself. And although I hated working with him, I didn't hate HIM. So I nixed the entry. Of course, there are plenty of residents or med students that I've written negative things about on here who I would LOVE to see the entry about them. I'm tempted to do some forwarding.

When I write an entry, I try to imagine what would happen if everyone I know read the entry. If there would be any consequence to this beyond a little embarrassment, I don't post the entry. (Well, usually.) I don't believe any blog is entirely anonymous and I think it isn't worth the risk. I think all bloggers are taking a bit of a risk, but obviously we get something out of it too. Blogging is fun! And it's way less risky than skydiving.

Fun with hospital operators

Weekly Whine: Book Club

Next week, I'm going to a meeting of a fledgling book club. It's right in my building, so it combines my two great loves: reading and being lazy.

My husband asked me what you do at a book club. Damned if I know. Presumably you discuss books, right? I told him that, and he commented that it kind of sounded like school. True. But I liked school. Well, not med school. But other kinds of school.

At the first meeting, we're going to be deciding on what book to discuss at our second meeting. I asked what book we were going to be reading and the leader of the group said she was thinking about a book called Little Bee by Chris Cleave.

Little Bee. That sounded interesting! Sounded like it might be funny, possibly about bees, maybe bees doing something funny.

I looked it up on Amazon and started reading the description: "Little Bee braids the fates of a 16-year-old Nigerian orphan (who calls herself Little Bee) and a well-off British couple..."

And that's all I got through before I zoned out.

Maybe this Little Bee book is great. Maybe I'll love it. I'm sure I'm unfairly judging it. After all, it's on the NYT Bestseller List, so presumably there are a lot of people at least purchasing it. But what I really want to do is read a book that I'll lose myself in. That I'll be turning the pages in desperation to get to the end. I'm too old to be reading fiction I don't really enjoy And I just don't see myself really enjoying Little Bee.

(My suggestion for the book club was Water For Elephants, which didn't sound that much more appealing to me, but I've heard good things about it and it got more stars on Amazon.)

I guess my whine is this: why does book club reading have to be so damn pretentious? Why does it always have to involve some Nigerian orphan? Right now I'm reading Watermelon by Marian Keyes, about a woman whose husband dumps her a day after she gives birth... I don't see that being on any book club lists, but it's sure fun to read. The best I can come up with is that maybe there isn't enough to discuss about Watermelon. Maybe a book has to be really deep in order to spend a whole hour talking about it while drinking wine and eating cheese.

But I'm trying to keep an open mind. After all, some of my favorite books of all time were ones assigned to me by teachers in order to enrich my little mind (A Tree Grows in Brooklyn, Jane Eyre). But a few of them I really hated and thought were pointless (Frankenstein, Zen and the Art of Motorcycle Maintenance). And some made no impression on me whatsoever (????). Maybe I'll end up loving Little Bee.

Probably not though.

The 10 Types of Physican Bloggers

I've been reading a lot of blogs over the years, and I've noticed that physician bloggers tend to fall into roughly 10 different categories:



And yes, I realize they don't speak their blog entries.

Tales from Intern Year: Night Pages from Nurses, Part 2

This is a follow-up from my cartoon about Types of Night Pages from Nurses....

No offense to any nurses or future nurses because many are truly fantastic (I love all the nurses I work with now), but I've had some pages from nurses that made me almost pop an aneurysm in my brain. Seriously, you'd think when you give a verbal order, they wouldn't have to page you again later to clarify the order, cuz if there were a mistake, they should have caught it while I was saying it, right? Anyway, during one of my overnight calls as an intern, I wrote down a few choice pages:


8PM: "Doctor, Mr. L's blood pressure is now 86/55."
"Okay, what's his pulse?"
"Oh. Hold on..."
(five minutes later)
"His pulse is 100."
"And what's his O2 sat?"
"Oh. Uh, hold on again...."
(five minutes later)
"Sorry, I can't find his vitals."

10PM: "Doctor, you wrote for Mr. J to be NPO until the morning, but can you write for a diet for the morning?"
"OK, let's give him a diabetic diet in the morning."

10:15PM: "Doctor, did you want to write for a diet for Mr. J?"
"YES, I wanted to give him a diabetic diet starting the morning. I JUST talked to the charge nurse about this."

4AM: "Is this Dr. K?"
"No, I'm covering for her. What's the problem?"
"Doctor, Mr. Q had a surgery today, but Dr. K never wrote a set of new orders for after the surgery. You need to write a completely new set of orders for him."
"Well, she's out of the hospital now and I don't know the patient. Can you wait a few more hours till she comes in?"
"No. Mr. Q has been sitting here without orders for nine hours and he needs orders NOW."
"So he's been back from the surgery since 7PM yesterday and you waited until 4AM to call? Why didn't you call during the daytime hours if it was so urgent?"

5AM: "Doctor, you wrote for Mrs. N that she has no allergies, but she says she's allergic to Vicodin."
"Okay."

5:20AM: "Doctor, I called you just before about Mrs. N being allergic to Vicodin, but she's actually allergic to Lithium, not Vicodin."
"Okay."
(As if they were about to administer a dose of Lithium to her imminently and only waking me up at 5 in the morning to tell me she was allergic would be able to stop this from happening. FYI, I didn't write to give her lithium OR vicodin.)


After the nonstop pages finally stopped, I managed to fall sleep. Except I fell asleep on top of my phone, which contains the alarm that wakes me up. So I ended up waking up half an hour later than I intended. I woke up to a page from a nurse, who was trying to get in touch with my co-intern. I still had my co-intern's pager from last night, even though she was in the hospital. (I have no idea why she didn't try to get it back from me. It's not like I was difficult to reach with TWO pagers. I'm guessing she didn't want it back.)

I did the quickest rounds in history. I checked labs super-fast, got all the vitals, then I basically just peeked my head into each patient's room to make sure they weren't dead. Somehow I finished with one minute to spare. I used that minute to pee for the first time that entire morning. What a luxury.

Weekly Whine: Pick up the phone!

The above cartoon demonstrates why I never answer the phone on the ward. I figure it's not my job and I shouldn't be answering if I don't know what to do with the calls. I never even answered the phone at the nursing station if I was pretty sure it was for me, because what if it wasn't? This philosophy has served me well for many years.

However, lately I've been feeling pressured to answer the phone. It seems like on the ward where I work, the rule that only designated people may answer the phone does not seem to hold. In fact, I've been embarrassed a few times when I've been sitting near the ringing phone at the nursing station and some other random person (a therapist, PA, etc) rushed to answer it.

That said, the person who did answer the phone usually ended up on some wild goose chase, which I really, really don't have time for. I recently overheard a PA mumbling to herself, "Why do I answer the phone? Why??"

Also, I haven't actually seen another doctor answer the phone.

I don't know what to do. Do I waste my time answering the phone and end up wasting chunks of time fielding calls, when my job is to see and treat patients? Or do I risk looking like a primadonna who will sit by a ringing phone and let someone else answer it?

My arm hurts: the saga continues

I posted earlier in the week about how my doctor's office does these remarkably painful blood draws. I had one of them on Monday, with a tech who'd apparently been there for 20 years, and was in so much pain, I couldn't sleep that night. Finally, now that it's Saturday, it feels better.

But while I was in the shower this morning, I noticed an interesting bruise on my arm where they did the blood draw:



I've certainly had bruises from blood draws before, but this one baffled me. Why is there one central bruise then another one so high up? Does this offer any clues to what went wrong?

Types of night pages from nurses

What is Match Day?

Actually, Match Day is the day when all the fourth year medical students find out where they'll be spending the next 3-5 years of their life. In February, you enter your residency choices in numerical order into a computer. The programs likewise enter their top choices for residents into a computer (a different computer... not one giant computer). And some program somehow magically matches med students to residencies.

One day this program will likely become self-aware and launch an attack on the US. Or develop compassion. I'm not sure which. In the meantime, this is how the matching process works.

In my med school, we all found out where we matched at once. We had a little ceremony where the dean gave a speech while we all jumped up and down waiting to see where we matched. When the speech ended, we all gathered around tables corresponding to the letter of our last name. They handed us an envelope and inside that envelope was a one-inch wide strip of paper that determined the next 3 to infinite years of our lives.

What's crappy about match is that it's basically a one-year contract. So if you put down Bumfuck University as your #20 match choice, thinking you'll never get it in a million years, but somehow you end up with it, you're screwed. That's why everyone says, "Don't rank a program that you don't want to go to." But we never learn, do we?

The Monday before match day is Black Monday (or maybe I just made that up). It's the day you find out IF you matched. If you didn't match, you have to Scramble. Although that sounds fun, I've heard it actually isn't. It involves furiously faxing your resume to gabillions of unmatched programs in the hopes that one of them will take you. Sometimes you can end up getting a better spot by doing this. Like in Happy Gilmore, when the grandmother loses her house and it goes up for auction and they think they can now buy the house back for cheaper. Although that didn't work, did it? That evil Shooter McGavin got the house.

This is what I wrote on my own match day:

This was a really intense day, second only to my wedding. There were moments when I thought I might faint, especially when they couldn't locate the envelope that had my match information.

I matched for primary care at ________, which was my first choice. I was so happy about it at the time and I still am. I don't think I realized quite how much I wanted to get into primary care. So now I'll have an easier life than if I were categorical IM. I really think it's the best match I could have made, so I'm happy with it. I almost started crying when I first found out and I started crying a little bit the first time I typed this, but I think now I'm ok.

It's ironic that I was talking about a program that I quickly came to hate with every fiber of my being. I mean, I was actually crying with happiness that I matched there. How naive I was.

My arm hurts!

I got my blood drawn yesterday and my left arm still hurts for some reason.

Despite no major illnesses, I've had my blood drawn a lot in my life. Like, hundreds of times. OK, maybe not hundreds, but a good amount. (I've also been fingerprinted more than a dozen times, despite not having ever committed a major crime.) It's like any time I go to the doctor, they find some reason to take some blood. I'm only in my early thirties and I've had my cholesterol checked four times! My HDL is 80 -- my greatest achievement in life.

I used to be a little squeamish about blood draws. In college, I valiantly donated blood, but then I made the mistake of looking at the blood after it was out of me. I told the guy drawing the blood that I was a little queasy and the bastard stuck smelling salts under my nose. Have you ever smelled smelling salts? It kind of feels like being punched in the nose. I didn't like it.

Anyway, I'm all deconditioned now from being a doctor, so I don't really mind having my blood drawn. It hurts for a minute, then for a bit after, then the tape hurts coming off, then that's it. I've given birth, I can deal with pain. No big deal.

Except last year I got a new doctor, and of course, during my first visit, they wanted to draw blood. And it hurt a good amount while they were doing it, which was okay. But then it hurt the next day and the day after that, and a week later, my biceps was still sore. Finally, it faded.

I figured it was some kind of fluke. I had my blood drawn since then at another place and it was fine. Except I went back to that doctor's office today, again consented to have my blood drawn, and while the needle didn't hurt going in, afterwards I had a lot of pain in my biceps and forearm. I was hoping to sleep it off, but my biceps still hurts a day later! I fully expect it to be sore for the next week again.

I don't get it. It didn't even hurt that much when they were drawing the blood. There's not really any bruising. How do they so consistently make my arm this sore? Is there some kind of special needle they're using to cause extra pain? Seriously, what's up with that?

AOA vs. residency match

Recently, I made a post about male/female hotness vs. residency match. I expected a bunch of people to get offended by this, but strangely enough, only like one person said, "Hey, I'm hot and this is offensive!"

Anyway, someone wondered what the correlation might be for AOA (honor) students. So I decided to take a look at this as well for my class:

Junior AOA males (4): Plastic surgery, Radiology, Ortho, Derm

Junior AOA females (1): Gen surgery (but wanted plastics)

AOA females (6): Gen Surgery, Psychiatry, OB/GYN x 2, Anesthesia, Pediatrics

AOA males (8): Anesthesia, Ortho, Derm, IM x 2, Urology, Pediatrics, Otolaryngology

So we can draw the following conclusions:

1) Males are more likely to be AOA

2) AOA males tend to match in more competitive fields than AOA females

3) Medical training is obviously totally sexist.

Also, I found it interesting that I wrote down some guesses for AOA at the end of third year and only 4 out of 15 guesses were correct. I'm not sure what that means.

Anyway, good look on the match!

Weekly Whine: Can't Remember Shit

Why does being a doctor require you to remember so much shit?

First, there's med school. You think that you just need your memory to hold out through anatomy and all those damn nerves and arteries and muscles. Except that's just the beginning.

As a med student in my clinical years, I was usually not responsible for more than a couple of inpatients at a time. It was actually sort of a struggle to remember things about these patients. And not just medical stuff. Sometimes I'd even forget their gender, which was a huge hazard when you're on peds, the patient is six months old, and you keep having to use gender-neutral statements when talking to the parents because you let this important piece of information slip your mind.

During residency, you take responsibility for more and more patients. The max was 12 inpatients at a time during my internship, and 17 during my residency. If on a given night of call, I admitted three or four chest pain patients, I was almost guaranteed to get them mixed up. Okay, I'll be honest: I'd get them mixed up if there were only two. That's why I used notes and checkboxes meticulously.

Now, post-residency, I follow anywhere from 20-30 patients at a time.

That's a lot of shit to remember.

It's hard. It's not like my memory has miraculously improved in the last ten years to the point where I can keep track of all the details of 30 people. And it's not realistic to carry around summaries of each patient's information like I did in residency. And you're not supposed to because it's dorky... you're just supposed to remember it.

I manage. Somehow. Actually, sometimes I surprise myself by somehow keeping track of random details of 30 different patients at once. But it really sucks when people working on the ward seemed surprised that I can't remember every fact about every patient. One thing that drives me crazy is that nurses refer to patients by their room numbers when asking questions... then when I ask the name of the patient, sometimes they don't know! I can't remember the room numbers of every patient too. I can't.

I don't know what I could do to improve my recall of all this information. More sleep might help, I guess.

I'll tell you this: I'm no longer impressed by teachers in high school who managed to remember all their students' names.

Memory Aids

Photographic evidence

Just in case you had any doubt that this cartoon demonstrated anything short of the truth, I present a photo I discovered that was taken on the evening of a call during intern year:

Night shift

Believe it or not, I'm not a big fan of night shifts.

Rereading my entry from last night, I got to thinking about night shifts and how you feel during each successive day:

Day 1: Usually not fun but at least you have the energy of being fresh.

Day 2: The worst day of night shift. You're still recovering from the night before, and your sleep schedule is still not adjusted. Usually whichever of your muscles and joints have a tendency to hurt will start hurting a LOT during this shift.

Day 3: The least painful, in my opinion. You've sort of gotten in the groove of sleeping days and working nights.

Day 4+: Constant exhaustion from keeping up a schedule that's so wrong.

Of course, I've never done more than two weeks in a row of a night shift. Maybe it eventually gets better. I read about some study where a person adjusted to glasses that flipped the world upside down, so if you can adjust to that, I guess you can adjust to anything.

Tales from Intern Year: 22 Short Films about the ER

2000: I arrive at the hospital, bright eyed and bushy tailed.

2005: I realize I forgot my stethescope at home. Fuck!

2012: I arrive at the hospital again, somewhat less bright eyed but equally bushy tailed.

2020: I pick up my first patient, a woman going through alcohol withdrawal.
Woman: "I'm going to have a seizure."
Me: (checks her pulse, which is 65) "No, you're not."
Woman: "I really am."
Me: "I don't think so."
Woman: "I definitely am."
Me: "OK fine, here's 1mg of ativan."
Woman: [falls asleep]

2200: I see a guy who cut his leg open with a bandsaw. After cleaning it off, the wound is judged to be "too deep" for me to be allowed to suture it by myself. Lame. At least I got to cause him lots of pain by injecting inside the wound with lidocaine.

2230: I'm discussing my shifts with the PA on duty. When I tell him that I have to do five 11-hour overnight shifts in a row, he says, "Wow, that really sucks!"
And I think to myself, "Hey, yeah... that DOES really suck."
I spend the next half hour wallowing in self-pity.

2300: Suicide attempt. 16 year old bipolar girl swallowed 50 Tylenol... not to kill herself, mind you, but just to "get sick or go into a coma". I spent a while talking to her. That poor girl was a mess.
Attending: "Is there a diagnosis code for bad fashion sense?"

2345: Most uninteresting patient ever. Guy who can't pee has foley catheter placed. Tries to take shower and foley falls out. Patient comes to ED. I write order that says: "Put in foley catheter." Learning value: 0.

0030: Baby with fever. There is nothing I hate more or suck at worse than looking in little screaming baby ears.

0130: Guy from prison with vomitting and diarrhea after eating some burritos. Apparently there were two other prisoners in the back of the ED who ate the same burritos. It's a prison diarrhea outbreak.
Prisoner: "Can I have some orange juice?"
Me: "You want orange juice? But I thought you're nauseated and you can't stop vomiting?"
Prisoner: "Yeah, but isn't orange juice, like, medicinal?"

0200:I discover that the box of free candy I've been taking candy from the last few days actually has a sign that says "$1 each".

0300: Woman who just had abdominal surgery presents to ER with abdominal pain. She didn't take any of the painkillers that they gave her after the surgery. Maybe I was misinformed, but I heard having your belly cut open kind of hurts. (I'm being a little overly sarcastic, but I later found out that the symptoms the woman had were exactly what the surgeon told her to expect.)

0330: Woohoo for testicular pain, especially when associated with lots of psych comorbities and no health insurance.

0400: Girl who accidentally poisoned herself when she locked herself in the windowless bathroom and tried to clean with a new mold remover product. What did she think was killing the mold? Sugar water? (OK, I've done it too.)

0430: I take a half hour break, where I hide in the family conference room, drink a glass of water, and eat three marshmallow cookies. I feel guilty for it.

0500: Woman with severe migraine who looks like she's in a hell of a lot less pain than I'm in right now.

0530: At this point, I realize that although I feel really dizzy and tired, if I pass out and fall to the floor, they'll have to scan my head and I'll never get out of this fucking emergency room.

0535: Another screaming baby with fever.

0600: 16 day old baby boy who has little boobies.
Me: "I wouldn't worry about it. It's very common for newborn babies to get a little bit of breast enlargement due to the mother's hormones during pregnancy."
Father: "Are you a pediatrician?"
Me: "Uh... no..."
Father: "Well, we want to get a real professional opinion."
[I bring in attending.]
Attending: "I wouldn't worry about it. It's very common for newborn babies to get a little bit of breast enlargement due to the mother's hormones during pregnancy."
Father: "Oh, thank you, Doctor."

0630: Hypertensive guy who woke up with arm numb, now resolved. Differential: transient ischemic attack vs. arm fell asleep.

0700: "Well, the sun is up. I guess you can go home."

More transcription errors

Recently, our hospital has started using automated transcriptions.... and the errors have been getting weird. The transcript from a recent dictation I did: "Patient was started on coumadin with the Lovenox Bridge."

As in...

Lovenox Bridge is falling down
Falling down...
Falling down...

Weekly Whine: Recruiters

For those of you who are still early in your training, I will give you this warning: Do not encourage the physician recruiters. If you sign yourself up for one physician recruiting site, it's sort of like signing up for one porn site (I assume, *cough cough*). Sign up for one site and you will immediately find yourself immediately innundated with emails, except they'll send you jobs instead of porn. Presumably.

You can't stop it. Telling them that you already have a permanent position doesn't even remotely work. You can never escape!

It might not have been so bad when I was still job hunting if they sent any even remotely viable jobs in my direction. Even though I told them that I don't do fluoroscopic pain injections, I get tons of ads for jobs that call for interventional training and a fellowship in Pain Management. I tell them that I want to restrict myself to the midwest and the next day they call with a great opportunity in Maine. And one site has chosen to only send me primary care jobs (I am not an internist).

In nearly three years of dealing with physician recruiters, they have not presented me with even one job opportunity I might have considered.

Oh, and they call. During the day, when I'm with patients. And I see the number and feel obligated to take it because it's a number I don't recognize and WHAT IF THERE'S BEEN A HORRIBLE ACCIDENT??? Then I hear them say, "Is this Dr. Fizzy?" And I know. It's them.

It's too late for me, I suppose. But for those of you who have not had the recruiters descend on you, I have some important words of wisdom: Do not give them your real email address! Create an email address just for job hunting so you can abandon it when you've found a job. And don't bother to sign up for any recruiting sites. They'll find you anyway during your last year of residency (god knows how), but signing up for a site is like putting a drop of blood into a pool of sharks with laser beams attached to their frickin heads.

What I learned my first year of residency

Tales From Intern Year: PT

At most hospitals, I think it's standard to write a physical therapy (PT) referral before a patient is discharged, just to make sure that when they try to leave their hospital room, they don't fall on their face and break their hip. The challenge is to remember to do this in advance so you don't end up either calling PT and begging them to see your patient ASAP or, worse, having to keep the patient an extra day.

During my intern year ICU rotation, I forgot to write for PT on a patient when I transferred him off the unit. This was a transfer I had to do when I was paged out of morning report and told that I had five minutes to get all his paperwork done because they had an unstable patient they had to get into the unit.... and four minutes into it, my senior resident Annie came by and said, "We're rounding NOW. Let's go!" So I forgot something. Big shock.

Unfortunately, Annie was not willing to let me forget that I had screwed up.

1)
Annie: "Did you write for PT?"
Me: "Oh shit! I forgot! I'll go write for it now."
Annie: "Every time you transfer a patient to the floor, you have to write for PT."
Me: "I know. I just forgot because I was in a hurry. I'll write the order now."

2)
Annie: "Did you put in the order for PT?"
Me: "Yeah, I did it just now."
Annie: "You have to write for PT when you transfer a patient."
Me: "I know. I just totally spaced that one time. I'm sorry. It won't happen again."

3)
Annie: "I don't think your patient can go home today because he hasn't had PT yet."
Me: "I'm really sorry about that."
Annie: "In the future, you need to write for PT on every patient."
Me: "Yes. I know."

I sort of felt like I was in that scene in Office Space, where the guy keeps getting told about that coversheet memo for his TPS report by all his different bosses.

Of course, maybe I would have remembered to write the order if I wasn't running around like an idiot trying to get everything done. Annie and I followed the same exact patients, yet I did all the work, wrote all the notes, and wrote all the orders. I know that stuff was my job, but she could have offered to do a couple of things just so I wouldn't have been in such a crunch. I don't even know what the hell she always did while I was running around all day. She was probably looking up labs or going to a spa or something.

The Clerkship Lottery

During second year of med school, most schools have a lottery to decide on what the third year rotations will be.

Prior to our 3rd year clerkship lottery, we voted on special considerations for the clerkship lottery. Basically, students emailed in their special needs, such as people who had kids requested to have all their rotations at the university hospital rather than satellite hospitals over an hour away. Other people had requests to take an elective month at a certain time due to getting married, their wife's due date, a parent with recently diagnosed cancer having surgery, etc. Most requests were pretty reasonable, I thought.

Out of our class of 100+ students, 12 anonymously asked for special considerations. Out of the 12, 10 passed through our class vote.

Anyway, the day after we found out which requests passed, one woman in our class sent out the following email:

This is ridiculous! Many of those reasons were absolutely silly. What was the percent of votes needed to pass this anyway? I can't believe the votes passed with those stupid reasons these students gave.

Because for one thing, if your parents are ill, get a visiting nurse, since there is nothing you can do while you are studying anyway. Secondly, all these people that want to take care of their family or assist with their wife's pregnancy or take care of the children or see your children and all that... well, we all have loved ones we would like to see as often as possible, but because we chose such a demanding profession, we simply don't necessarily have that luxury. We just make it work without having to subject our colleagues to it. If it matters so much, have your family member move to where you are or you can commute or hire a baby sitter that can pick your children up from school.

I easily could have said something equally lame, but I sacrificed and let people with more important reasons have their say. But all these crazy reasons, I tell you, is unfair to the class as a whole and it is especially unfair to people that had good reasons but took the initiative to find solutions to their issues.

We all just kind of thought she was a crazy bitch. What do you think?