Sunday, June 5, 2011

Most Anal Attending Ever

As a resident, I had one attending who I liked a lot in general, but she was definitely the most anal attending I'd ever had. Here are a few examples to demonstrate her anality:

1) I typed the H&P on a new patient I saw and she went through it line by line, pointing out all the mistakes I made. What were these horrible mistakes that took us like an hour to fix?

--In a few places, I accidentally put two line breaks instead of one

--A list I made got slightly misformatted by Word's autoformatting, meaning some list items had two spaces between the number and the text, and some had one space

--Certain words were bolded incorrectly

2) Apparently, the way our hole puncher was set up, the holes are about 3-4 milimeters off from where the pre-punched holes are on our progress notes. So when you put a paper in the chart that came from the printer or something, the pages are misaligned about 3-4 milimeters higher than rest of the pages in the chart. The attending paged the charge nurse overhead and pointed this out as "a big problem" that needed to be fixed right away.

3) She was constantly correcting the times written on my notes. The exact time. Like the time on my note would say "9:00" and she would cross it out and change it to "9:10".

4) Once she called me over because she didn't like the way I had written an order. this was the order:

Metoprolol 25mg PO BID
Ditropan 5mg PO BID

How is your anal insight? What do you think she thought I should have written differently?


  1. Let me guess, you needed a space between the number and milligrams?

  2. This comment has been removed by the author.

  3. Space between number and mg, 12-hourly rather than BD (or specific times), oxybutynin instead of Ditropan, or specific dose forms, e.g.

    Metoprolol 25 mg tablets 1 PO BID?

  4. You used the trade name for oxybutynin and the generic name for metoprolol?

  5. Should have capitalized the Ditropan but not the metoprolol? Tabbed the dose, route and frequency so they lined up?

  6. Nobody got it yet...
    If it helps, the order was handwritten, not typed.

  7. Drug name should be written all in capital letters in a drug chart?

    BD instead of BID?

  8. po should not be capitalized because it comes from the latin per how you don't capitalize e.g. ?

  9. Ditropan should have been listed first to be in alphabetical order and because its a smaller dose than the Metoprolol?

  10. As a retail Pharmacist I would say:

    Metoprolol (is it the tartate or succinate?)25 mg tablet: 1 tab PO BID

    Ditropan 5 mg (is it the IM or ER?)tablet: 1 tab PO BID

    I have seen both the IM and ER of these meds dosed in various ways so I never ever assume unless the patient has a previous history of a medication with the same doctor

    also I think BID is not on the offical whatever "DO NOT USE" abbreviations. I got dinged on that a ton during rotations.

  11. Specify tartrate vs. succinate? I also cannot imagine she would have allowed use of brand names based on her general fastidiousness.

    @Pharmacist JCAHO still allows BID, TID, & QID but not QD and QoD.

    Please tell me this was an IM attending and not a physiatrist! At first I worried I would relate to your "most anal attending ever" as I am detail oriented. Then I got to the part about the line breaks and breathed a sigh of relief.

    The worst part (in addition to wasting untold amounts of energy noticing every single thing outside of perfection) is that she thought it was ok to bring these things to your attention as corrections. Do you think she might have had OCD?

  12. Nobody got it yet.

    PGYx: This was a physiatrist. And she was well aware of her OCD. When she was paging the nurse to complain about the sheets not being aligned properly, she actually laughed and said to me, "I'm pretty anal, huh?" She was nice, but I don't think she could help herself.

  13. Metoprolol 25 mg PO BID
    Ditropan 5 mg PO BID

    Maybe you needed to align it in columns? Did she want everything in caps for clarity?

  14. Wordpress won't accept the alignment, but the drug names, alignment, and instructions should each be in a separate column?

  15. Metoprolol 25mg PO twice a day? q12h?
    Oxybutinin 5mg PO twice a day? q12h?

    Did she want specific times in the day?
    Did she want stop dates?

  16. I'm not even in medicine but I'll take a stab at it...she wanted P.O. and B.I.D.?

  17. Let's see how anal, was it Metoprolol tartrate or Metoprolol succinate?

  18. Nobody's got it yet!
    It's something very simple (but stupid).

  19. metoprolol in lowercase since it's a generic?

  20. I bet she wanted it numbered:
    1) Metoprolol 25mg PO BID
    2) Ditropan 5mg PO BID

    Sounds like she is enslaved by her OCD... UGH.

  21. Well, obviously you forgot your punctuation. Those abbreviations need periods!

  22. When I was getting my paralegal certification, I had one profession who went totally batshit because I once forgot to put two spaces between a period and the start of a new sentence.

    You would've thought that I had beaten a puppy to death right in front of her...

  23. Actually the time is very important medicolegally. When the lawyers get ahold of charts they map out events according to time.

  24. I hope you are sufficiently chastened by the 13 other things you got wrong as identified by commenters to this thread. Just be lucky you only have one anal attending and not 25!

  25. If she is anything like the administrators at my hospital, maybe she wanted you to not use abbreviations at all? As in:

    Metoprolol 25mg by mouth 2 times a day
    Ditropan 5mg by mouth 2 times a day