Dog vs. Baby

This is a story that always irked me:

A friend of mine named Alice adopted a new dog. She named the dog Mason and was in the process of getting his paperwork filled out when she received an email from a good friend of hers who was pregnant that said the following:

Do you think you could change the name of your dog please?? Mason is on the short list of names we're considering for the baby!

I felt like Alice's response should have been, "Screw you." But instead she actually felt guilty about the fact that she didn't want to do this.

Now I'm not a dog person, but I think it's pretty obnoxious to tell a person that their dog is so unimportant that they need to change his name just to avoid picking a name they might use for their child.

Guide to choosing an 80s movie

HIPAA attack!

I feel like HIPAA alternates between going too far and being totally disregarded.

When I was a med student, they suddenly started to get incredibly strict about HIPAA, and I felt it was to the detriment of patient care. For example, you were suddenly no longer allowed to have any patient information on the computers (i.e. for a signout sheet), even if it was under your own login which nobody else had access to. We could use an ID number to identify the patient, but not their name.

We argued about this with the powers that be, saying, "Well, why is that any worse than just carrying around a piece of paper with the patient's name and medical information on it?"

Their reply? "You're not allowed to do that either."

So basically, they were saying that we were not allowed to carry or have on the computer any information linking the patient's name to their medical information. And I can see how that totally protects the patient from anyone learning any medical information about them. It also protects them from being treated properly.

For example, humans are prone to error, and I think it's a great way to make an error if you're not allowed to use the patient's name on any sign-out sheets. It seems almost impossible not to make a mistake in that situation.

In other HIPAA-protection efforts, I've seen hospitals that only referred to patients by their first names or by their room numbers. Again, this provides an increased probability of error. In the first case, because first names are generally more common than last names so it's easier to mix up two patients, and in the second case, because patients frequently change rooms.

On the other side of things, it's actually very easy to get medical information on a patient despite HIPAA. When I get a new patient, I'll frequently call their PCP or the hospitalist that saw them before me, and they're only too happy to tell me absolutely everything about the patient without my giving any proof of who I am. Of course, it makes my life easier that I don't have to sign some release before they're willing to talk to me, but it also always makes me a little uneasy.

And I don't know if this is a HIPAA violation, but one thing that really irritates me is that when I go to the doctor, and the nurse calls out my first and last name in the waiting room. That happens all the time.

Precarious

I was taking the stairs at the mall last weekend and I came across the following ladder:

Lawsuit waiting to happen?

Depression and Medical Training

When I was a resident, prior to contract renewal, I had to complete an online "education session" on depression.

They had a little scenario where a resident is presenting a patient and fumbles a little, resulting in getting completely reamed by the attending who says something like, "Hello? Anybody home?" Then resident bursts into tears, says, "I'm sorry, I can't do this anymore!" And dramatically runs off.

I'm not sure if that was supposed to be the "bad" scenario or simply the most realistic one.

In the second scenario, the attending is a little more understanding and talks to the resident privately after rounds about her recent decline in performance. The resident says that she's having some problems with her husband and the stress of work is too overwhelming. And she reveals that when her husband took her twins (!) out for ice cream the other night, she stayed behind and just cried. Then the attending asked her if she'd ever thought of hurting herself and she replied no, but that she sometimes thought she'd be better off dead.

What struck me about this exercise was how realistic the first scenario was compared with the second. If you, as a resident, fumble, most of the time the attending isn't going to sit you down and have a heart to heart. You're going to get reamed.

(I'm not sure why they were showing this to us anyway, considering we were residents. What were we supposed to do about this? Wish vehemently for Attending #2?)

The truth is, if you're at all inclined to get depressed, medical training is going to bring it out in you. Especially intern year. Interns have it really hard--you pretty much get dumped on by everyone and you're constantly exhausted. In retrospect, that was possibly the worst year of my life.

I personally know two interns who attempted suicide, one of whom succeeded. It's really horrible when someone you know does that, and it's hard not to get really angry at the culture that nurtures it. The culture of med school and residency is that when you start to struggle, things get infinitely worse. In the several programs that I attended, there were no resources readily available for trainees who were struggling.

I don't think the culture of medical training is going to change. It's not realistic to think the old school attendings are going to stop making interns cry. But I think having some mandatory (or at least very easily accessible) counseling might improve things. I don't think half-hearted group "wellness" meetings that get canceled half the time are really cutting it.

Regrades

I talked recently about the H/HP/P/LP/F system at my medical school. In our anatomy class, you needed 85 for honors and below 65 was failing.

If you got a 84 or a 64 average, you were allowed to ask for a regrade. The anatomy professor would go through your two midterms and the final exam in order to look for extra points to boost you to either a passing grade or an honors grade.

I always thought my anatomy professor said some really wise things, and this was what he said on the topic of regrades:

"I've found that students who got a 64 don't have a very good grasp of the material, so usually we aren't able to find enough places to give extra points on the exam to help them to pass. But students who got an 84 usually have an excellent grasp of the material and usually there are ample opportunities to give extra points on the exams."

Lucky me, I had an 82.

Weekly Whine: Kindle

This isn't going to be a whine about the Kindle per se. I like books in paper... I enjoy holding the book in my hand and having the flexibility to bring it with me in the bathtub without fear of major electronic damage, but I definitely see the benefit of the Kindle. It's lighter than even one hardcover book and I like the idea of being able to change the font however I want. Someday when my kids are older, I'll probably buy one.

But what annoys me is how much books cost on the Kindle. And this is after you've already shelled out a bunch of money for the Kindle itself.

You can't get Kindle books at the library, so the free option is out. You can't buy Kindle books used (I get Amazon used books for about $4 or less). So you basically have to pay the "new" price for Kindle books, even though there's zero production costs.

For example, take the new Sophie Kinsella book I've Got Your Number. It's in hardcover, so it costs about $15 new. Yet the Kindle version is $13. So even though there's zero production cost and Amazon made you pay for the Kindle, you only save $2. Kind of ridiculous.

Moreover, if I wanted to get Kinsella's older book, Confessions of a Shopaholic, published four years ago, the paperback is the exact same price as the Kindle version. WTF?

Kindle books need to get cheaper. Like, now. Until then, I'm officially boycotting Kindle books. Which is pretty easy, since I don't own a Kindle.

Grading system

The great thing in most med schools is that there aren't standard grades. Premeds are so obsessed with grades, so it's nice not have to worry about getting an A vs. a B. You'd think that it would make things less competitive, right?

Except where I went to med school, we had: Honors, High Pass, Pass, Low Pass, and Fail. And this grading system seems to be pretty common in med schools.

So... how exactly is this different from A, B, C, D, and F?

Fit me in!

When I was in residency, one of my awesome responsibilities in Pain Clinic was to return phone calls from patients. They all started kind of like this:

Patient: "I'm in pain. I need an appointment immediately and you need to fix me right now."

It was especially fun when the primary Pain attending went on vacation, as in this particular situation:

Patient: "I'm in pain. I need an appointment immediately and you need to fix me right now."

Me: "Dr. Medrol is out for the rest of the week."

Patient: "I'm in pain! I need an appointment immediately and you need to fix me RIGHT NOW!"

Me: "Um."

Patient: "I can come in tomorrow morning."

Me: "Let me consult with my... um, colleague, and I'll call you back."

Patient: "I can't even sleep."

Me: "OK, I understand. Let me call you back."

I hung up with that patient and spoke with an alternate attending, Dr. Lidocaine. He heard the whole story and kindly agreed to overbook the patient for 10:45 tomorrow morning.

Me: "OK, patient. We can give you an appointment for tomorrow morning at 10:45AM." [waits to be showered with thanks]

Patients: "That's too early!"

Me: "Fuck you."

I didn't really say that, but seriously? He asks for an appointment tomorrow morning and 10:45 is too early? What time did he think the morning clinic started? 5PM?

Fortunately, Dr. Lidocaine heard me starting to tell off that patient, and quickly ran over to me and whispered that he'd see the patient at 11:30AM, preventing me from launching into a speech to the patient about how we were going out of our way for him and he didn't even appreciate it, you bastard.

Should I go to med school?

This should probably be a weekly whine, but I've got WW's scheduled till like 2015, so I'm just making it a regular entry.

It really irritates me when someone presents their story to a large community and asks the question, "Should I go to med school?"

The reason it bugs me is because the answer is usually no. It's usually some crazy situation where the person should do ANYTHING BUT go to med school. But of course, the person posting doesn't want to hear anything besides a unanimous yes.

For example, in some med school community I was reading, someone posted (paraphrased, but not made up):

I'm a college sophomore and it's my dream to become a doctor. However, I've been recently diagnosed with lupus and I'm concerned about how this will affect my dream. Recently, I've been put on immunosuppressants, and I'm not allowed to go into a hospital. Also, due to my medical issues, I haven't been able to make it to many of my classes and I've been about an hour late every day.

Is this a joke? Are you serious?? You want to become a doctor, but you can't even set foot in a hospital?? What am I supposed to say to that? Do I think it's a good idea to become a doctor if you can't do your classes and can't enter a hospital? Do I really have to dignify that with an answer?

Another example is that of the new mother of an infant, who wanted to go to medical school. The catch? She's divorced. She is already struggling to pay the bills. She has no nearby family to help with childcare. "Should I go to med school?"

No problem! The dog can babysit for free, right? Wait, they can't?? That's considered child neglect and you can go to jail? Well, damn. Then I don't know, maybe med school isn't such a great idea.

Of course, in both these cases, when it was even suggested that med school might not be the best choice, both of these individuals were enraged.

Here's a controversial opinion: med school ain't for everyone. If you have a serious medical condition, maybe it's not such a great idea. Especially if that medical condition precludes you from entering a hospital. If you have a small child and no means to get childcare, maybe it's not such a great idea.

Can you go to med school if you have lupus or are a single mom with no family support or financial resources? Yes, of course! But just know, it's going to be really, really hard. And you should probably look into other possible career options first, and be really sure that's what you want before you invest a lot of time and money. And if you don't want to hear that, then why the hell are you asking in the first place?

Outgoing

One thing I've realized lately is that as a doctor, it helps immensely to be outgoing. It also helps in life, but especially in medicine.

I don't think I'm naturally outgoing. I'm not introverted either, but maybe something in-between. Like if there was a 10 point scale where 1 would be a computer programmer who works at home and has Asperger's, and 10 would be, like, Jim Carrey, I'd be a 5. Or maybe, at best, a 6.

If you work in an office, there's usually a constant set of coworkers and staff that you can get to know over time. But in most fields of medicine, you're constantly meeting new people, both patients and staff. If you're not good at it, people won't like you as much.

For that reason, even though I'm a 5, I really try to make an effort. But it's hard.

When I was a fourth year med student on an away rotation at an outpatient clinic, I started one week before another student named John. Within a day or two, John knew the names of all the staff at the front desk and was friendly with them. I'd been there over a week, and I barely knew who they were.

It's entirely possible the staff thought I was too big a snob to get to know them. But that wasn't the case. My natural instinct is that I feel too shy to just go up and start introducing myself to all the staff. But I still think it ended up reflecting badly on me.

The same is true when meeting new patients. If you're nervous about meeting new people, patients may also see you as cold and unlikable. I recall doctors I've seen as a patient that I didn't like, and many of them were probably somewhat introverted.

I guess my point is that if you're an introvert, you should probably either avoid medicine, or choose a field that doesn't involve much patient care.

Scrubs

Pretty much the only medical show I've ever watched on TV is Scrubs. Is that still on TV? I think Grey's Anatomy is too serious and sad, and Dr. House annoys me.

One reason I like Scrubs is that I find it realistic. On the couple of episodes I've watched of House, it always strikes me as incredibly contrived and unrealistic. (And why does House got to always be so sarcastic all the time?) Maybe the cases are interesting, but nobody actually practices medicine like that.

Scrubs may not be totally realistic, but the vibe seems real to me. When J.D. was doing some long shift at the hospital, I was like, "Yeah, it's just like that!"

That said, there's a lot of stuff that isn't much like being a real resident/doctor:

1. Why are Dr. Cox and Dr. Kelso the only attendings that J.D. works with for the whole three years he's in residency? I am lucky (or unlucky) if I work with just one attending for a whole month, much less all of residency.

2. When J.D. is an intern, there are mysteriously NO senior residents around. J.D. reports only and directly to Dr. Cox. No wonder Cox thinks he's so annoying. Then when he graduates to being a resident, there are mysteriously NO interns around.

3. There's some episode where J.D. is an attending and he's paged at home by an intern. He comes all the way to work and is extremely irritated to discover that the intern paged him about something really stupid. Um, instead of coming all the way into work, why didn't he just answer the page??

4. In the episode where Elliot is showing off her endocrine knowledge, she "cheats" by keeping pages of an endocrinology textbook hidden all around the hospital and whenever she's asked a question, she runs over and checks the textbook pages for the answer. But how could she guarantee she'd be near the pages she needed? Unless that hospital is the size of my living room, I don't see how a person could possibly pull that off.

5. J.D. is somehow able to spend hours and hours on end with each patient.

6. For some reason, there's only ONE lawyer for the entire hospital and he sucks.

7. There's an episode where Dr. Kelso gets angry at Elliot for leaving the hospital for another job after they trained her. OMG. And she eventually realized he was right because the hospital had given her SO much in terms of training. For one thing, who the hell stays at the hospital where they did residency forever and ever? People move on. For another thing, I don't think most doctors feel they owe a huge debt of gratitude to the hospital that paid them slave wages to work 80 hours a week.

8. Nobody sings in real hospitals. Or at least, rarely.

9. J.D. and Elliot are clearly internal medicine residents (which deals with adults only), except every once in a while, they have a pediatric patient for no particular reason (except that it fits in with the plot). And why are they expected to be able to intubate people?

10. The assigning of patients is nowhere near as exciting as they make it seem on that show. I remember some episode where they're having some epic race to get a patient. IRL, whoever is up next for a patient gets the next patient admitted. There is no racing of the residents.

I'm sure I could think of more, but that's what pops into my head.

Weekly Whine: Chick lit

I took a long hiatus from reading while I was in medical training, and when I returned, I discovered chick lit. I devoured books by Sophie Kinsella, Emily Giffin, and Jane Green, to name a few. I found a top 100 list of chick lit novels and eventually discovered something important:

Most chick lit sucks.

As I made my way down the top 100 list, I realized how many of these books are complete and utter crap. They were so cliched and uncreative. And the protagonists are often vapid and unlikeable.

This entry was inspired by reading a book by a chick lit novelist named Laura Zigman. Her first novel was called Animal Husbandry. It's about this woman who gets dumped by her boyfriend in a really cliched way, and the woman develops this really innovative theory about men that nobody has ever heard before. Get ready for it....

Men prefer having sex with a new woman to having sex with a woman they've already had sex with.

You're blown away, right? I mean, nobody's ever thought of that before. Moreover, the character doesn't change or grow. She just continues to be bitter until you're like, "Get the hell over it."

I was given a copy of her other book, Dating Big Bird, so I decided to give it another chance. I hated it slightly less, but the writing still irritated me and none of the characters were likeable. It was so pseudo-deep. Take the following exchange between the protagonist and her boyfriend:

"I could help you," I said.

He shook his head.

"I could," I said. "I could bring you back."

He shook his head again. "People don't come back from where I've been."

Puh-lease!

This is why I love Sophie Kinsella. She's genuinely funny, she doesn't take herself too seriously, her storylines are bizarre but at least they're not cliched, and she makes you really adore the male love interest. That's how every chick lit writer should write.

But clearly everyone doesn't agree with me, or else those terrible Laura Zigman books wouldn't get such great reviews.

Boxed

As you may or may not know, I sometimes dabble in writing sometimes (less so recently). This is a (very) short story I wrote a while ago that my husband found amusing. I think it was some kind of writing exercise where I had to follow some restriction, but I can't remember what.

So what do you think? Am I the next Hemingway?


BOXED

I grew up in a box. The box was red on the inside. I couldn’t see the outside. The box was poked with holes. The holes allowed me to breathe. The largest hole was about two millimeters. I could not see through it.

I was fed only at night. Food was slipped into the box. It was usually pasta. Once a week, I got chicken. Three times a week, I got broccoli. This was how I learned colors. Broccoli was green. Chicken was brown. The pasta sauce was red. The box was red.

The box was not soundproof. But sounds were muffled. I heard talking sometimes. I could never make out the words. It didn’t matter though. I couldn’t understand any languages.

I was naked inside the box. Sometimes the box got cold. I hugged myself to stay warm.

I don’t know what’s behind the box. Someone put me in the box. Someone decided to raise me in it. I don’t know why. I wondered about it often. Why raise a child in a box? And why was that child me?

On my seventeenth birthday, I escaped. Getting out of the box was easy. Getting out of the house was hard. I killed a man smoking a pipe. I killed two women. I killed a guard. I killed three vicious dogs. I don’t know the breed of dog.

I found a job outside the box. Ironically, I worked in a box factory. The pay was good. I never learned to speak.

I eventually married. I married a woman with red hair. We had five children. We raised the smallest in a box.

WNL

In residency, we got a patient who had an aneurysm burst with several interventions. When she came in, speech therapy evaluated her and said that her "cognitive-linguistic skills are normal." Now I may not have the same level of expertise and sophisticated testing as a speech therapist, but I am pretty sure that adults with normal cognition don't sign their names like this:

(Not her actual signature, but my reproduction of it.)

They also don't try to grab your notes from you as you're talking to them. Or think you disappeared when you stand on their left side. Or put their feet up on the neuropsychologist's desk as they're being tested.

Top 10 Favorite Childhood Books

My favorite books as a child/adolescent:

1. The Chocolate War

This book is about chocolate and is about a war, but unfortunately not in the way you'd think. Still, it's really good.

2. The Twits

Man, this sick, twisted, racist guy was an amazing writer (and sure plays a mean pinball). Really, all his books were awesome, but I especially liked the idea of storing little morsels of food in your beard for later. (Note to self...)

3. Just as long as we're together

Me: "Judy Blume, I'm writing a novel and I can't figure out how to end it..."

Judy Blume: "Have the narrator get her period."

Me: "But Judy Blume, it's a mystery novel..."

Judy Blume: "It doesn't matter."

Me: "But the narrator is a 45 year old man!"

Judy Blume: "Look, which one of us is an award-winning author??"

OK, a lot of Judy Blume books ended with the narrator getting her period. But that's what's interesting to a 9 year old girl. And this particular book had all the essential Judy Blume elements of losing your best friend, liking a boy, and getting your period. This book was my life. I loved Judy Blume. I even loved the book Superfudge, where nobody got their period. I even loved that book about the boy who gets erections and has wet dreams, although I had no idea that Tony wasn't just wetting his bed until like... last year. (I'm a little slow.)

4. Encyclopedia Brown

Until I actually started reading these books, I could never understand why my friends liked reading the encyclopedia so much. I guess this isn't one book, but a series, but since they were all pretty much the same, I am just naming the series. I was always amazed that every criminal made one mistake that gave away the crime to someone just hearing about it. Like what if Bugs Meany hadn't written September 31 on that check? Then what, Encyclopedia? Huh??

5. Sideways Stories from Wayside School

So the school was supposed to be one story with 30 classrooms, but instead it's 30 stories with one classroom in each story. And the rest writes itself.

6. The Phantom Tollbooth

OMG, it's a Witch!!! No, it's a Which. See, because "witch" and "which" sound the same. See what they did there? Pretty clever, huh? Never has learning been so much fun.

7. The Third Eye

Really, I could have picked any Lois Duncan book cuz they were all Teh Awesome. I might have picked I Know What You Did Last Summer, but Jennifer Love Hewitt just ruined it with her big boobs and skinny little body and the singing... ugh. (I don't know if she sang in the movie, but she sang in general, so ugh.)

8. The Chosen

This book taught me what it's like to be an orthodox Jew growing up in Brooklyn. Yeah, Brooklyn! No sleep till Brooklyn!

9. The Indian in the Cupboard

This book taught me what it's like to be an Indian growing up in a cupboard.
You know, I used to think it was cool that they put a toy in a drawer and it came to life... now I just think it's really, really, really frightening.

10. To Kill a Mockingbird

Ah, who can forget little Scout and her adventures with old Boo Radley? And I think we all learned a valuable lesson about racism. Boo Radley.

11. A Tree Grows in Brooklyn

I avoided reading this book for a long time because I'm not really into plants, so I figured I wouldn't like the book much. But believe it or not, this book isn't actually about a tree. It's about a girl. Although it IS about Brooklyn. (Apparently, I like books about Brooklyn.)

12. The Lion, The Witch, and the Wardrobe

This is the one "fantasy" book I really liked as a kid. I can't for the life of me remember anything about it except for this chicken dish that was magic (?).

13. Number the Stars

A really sad, touching story written at the time of the Holocaust about a young girl who goes up against the Nazis. And then she faces her worst fears and battles a room full of snakes. Oh wait, that was Indiana Jones. Still, this was a good book too.

14. Where the Red Fern Grows

This book wasn't just a typical story about a boy and his dog. It was a story about a boy and his TWO dogs. 'Nuff said.

15. Jelly Belly

Kid gets sent to fat camp. Even though I wasn't in danger of such a thing, I think there's a little piece of all of us that's afraid of getting sent to fat camp.

16. Summer Camp Creeps

Kids go to camp, hilarity ensues. I'm embarrassed to pick a book free of deeper meaning, but I just loved this book when I was a kid.

17. Little Women

"How little were these women? Like, scary little?" See, I understand why Rachel would like The Shining, but why would Joey like Little Women? It's such a girly book! And furthermore, the "all work and no play" thing is only in the movie version of The Shining and not in the book at all. Friends, you need to work on your fact checking.

Somehow this top 10 list ended up with 17 books on it. Oh well.

What's a sontimeter?

During my first year of medical student, we had this radiologist who lectured to us once a week. He kept talking about things being "2 sontimeters" long or whatever, and I had no idea what he was talking about. By the time I realized a sontimeter was the same as a centimeter, the semester was over.

On an informal survey of physicians, when asked how to pronounce the word "centimeter":

I still don't get it. Why do some doctors insist on pronouncing it "sontimeter"?

Note: Thanks to Dr. Grumpy for inspiration on the cartoon

Negotiation

I am not good at getting stuff for free.

My uncle, who is a lawyer, is very good at getting stuff for free. Too good. If he's at a restaurant and someone looks at him wrong, he gets the meal for free. On one occasion, I was having dinner with him at an expensive restaurant, and he got them to not charge him for an expensive dish he had finished because he didn't like it. At hotels, he almost always manages to get one night for free.

I dated a guy a long while ago who was a law student and told me that he was always writing to companies, complaining about whatever, and then they'd give him free stuff.

This must be a lawyer thing because I am absolutely terrible at it. I don't know what their secret is.

For example, my husband recently bought me Cake of the Month club. Our first order arrived great, but the second sat around too long in a warehouse or something, because all the dry ice had long melted and the cake (which was a cheesecake) arrived spoiled.

I called to complain, obviously. But they couldn't send a new cake because they all came in a single shipment, and now they were gone. They offered to send me something else from a non-perishable "month club" but I was annoyed that I didn't get the thing I wanted, and they weren't offering me something extra to compensate.

I asked to talk to the manager and we literally talked for like twenty minutes and she absolutely refused to give me even any token offer to make me feel better and, like, use their company again. Isn't it cheaper for them to offer me something free rather than lose my business forever? I'm fairly sure these month clubs are a big rip-off.

Meanwhile, I'm 100% sure that my uncle would have gotten like ten free cakes.

Tales from Residency: Doctor's appointment

On an inpatient rotation during residency, I had a doctor's appointment at 2PM, which I told the attending about well in advance. She scheduled a family meeting at 1:30, which was fine, but I told her I couldn't make it.

Attending: "Well, you could be there for the beginning."

Me: "You want me to be there for the first ten minutes?"

Attending: "Fifteen minutes. It should take you only fifteen minutes to get to the doctor."

Me: "No, it takes me twenty minutes."

Attending: "It should only take fifteen minutes."

Me: "It takes me twenty."

Attending: "Well, you should come to the beginning of the meeting. For your own sake, to learn how to deal with a difficult patient."

Me: "I could come. But it will probably start late. It probably won't even start till 1:45."

Attending: "Why do you say that?"

Me: "Because every meeting here starts late."

Attending: "No. What meeting started late?"

Me: "Well, the radiology conference this morning started ten minutes late."

Attending: "No, it didn't." And how does she know this? "Because I was 15 minutes late to the meeting and they were already on the second patient, so it must have started on time."

Nice. I was actually THERE when the meeting started late, but she was insisting it started on time based on how far along it was when she arrived late. (She was, in fact, ALWAYS at least 10-15 mins late. I was forced to run a few meetings on patients I barely knew because she was late.)

Then she started telling me how the clock in the room is fast so maybe that's why I think the meetings are starting late, even though I have a watch.

Long story short, I didn't end up going to the family meeting. When I got back from my appointment, the attending was just getting out of the family meeting, which apparently didn't start until 2PM (half an hour late).

I didn't even say "I told you so".

Weekly Whine: How are you?

It bothers me immensely that when you see someone in the hallway, in addition to just saying hi, you feel compelled to say, "How are you?"

This happens to me all the time. I'll exchanged hi's with someone, and then they'll say, "How are you?" And I'll say "fine" or "good." And a lot of the time, I'm not fine or good, but what else am I supposed to say? They've already practically walked past me.

And then of course, I'll have to say back, "And how are you?" And then they answer "fine" or "good" except I'm not even sure because we already passed each other five minutes ago.

Why do we say that? We don't actually care how the other person is feeling. If we did, we'd stop walking.

The other day, I did the whole exchange with someone in the hall, and they responded to me, "Uh, not that great." And I was like, shit. I have to be at a meeting in about thirty seconds and I don't have time to delve into this further, although I wish I could. But if I don't care about the answer, then why ask?

I propose that we stop the automatic asking "how are you" unless you actually care and want to hear how the other person is.

Dictation

One of my co-residents named Lucy had the funniest way of dictating. It totally cracked me up. She dictated the way you present a patient to an attending.

The way most residents dictate: "Mr.Smith-was-a-fifty-year-old-man-with-a-history-of-hypertension-and-osteoarthritis-who-presented-with-three-days-of-increasing-urinary-urgency-and-frequency-with-fever-to-101."

The way Lucy dictated: "Mr. Smith was a fifty year old man, who had a history of hypertension and osteoarthrits. So he came in with three days of increasing urinary urgency and frequency? Oh, and he had a fever of 101 degrees."

It was even funnier when she got to the plan, because her voice became more and more questioning. I almost expected her to ask the dictaphone if the plan sounded okay.

I teased her after, about how she was presenting her patient to the dictaphone, and asked if the dictaphone agreed with her assessment and plan.

Translator phones

When I was in internship and did outpatient clinic, we had a LOT of patients who didn't speak English. I do speak passable Spanish, but I couldn't even fake any other languages. So we'd use the Translator Phone.

Basically, you call a number, tell them the language you wanted, and they'd find a translator for you. You'd put the translator on speaker phone and make a valiant attempt to get a history.

Obviously, the translator phone was not great. It's hard enough to get a history through a translator, but to try to do it on speaker phone was pretty painful. But we had yet another problem, which was that it often took a long time to get a translator on the line. When we had a full roster of patients to see, this was not ideal.

I remember I was with a patient, waiting for an interpreter to come on the phone. After god knows how long, we finally got the interpreter. In my excitement, I stood up, knocked the phone, and hung up the line. I almost cried, but instead I think I laughed. I was so tired, I definitely had to do one or the other.

Eventually, we had a meeting where the residents complained about the translator phones and how long it took to get an interpreter. One of the administrators finally said she'd speak with them and make sure we always got a phone interpreter within five minutes. "Does that sound okay?" she asked.

We all mumbled that yes, it was okay. But then one intern in the back spoke up: "No, it's not okay! Five minutes is a long time! Why don't we just sit here in silence now for five minutes and see how that goes??"

He had a valid point. Five minutes of staring at the patient in uncomfortable silence is a long time.

The next year, I rotated at that hospital as a resident and the phones were better. I usually didn't have to wait very long for an interpreter anymore.

Gems from Psychiatry Consult

Of the following things on a 20 year old patient's problem list, what do you think is the highest priority:

1) the patient suffered a vertebral fracture at C5

2) the patient is unable to move either of his arms or legs

3) the patient is intubated

4) the patient has oxygen sats going down into the 80s

5) the patient is incontinent of bowel and bladder

6) the patient MAY have ADHD

If you ask me, I think the ADHD is top priority, for sure.

And that was one of the bullshit consults I got while doing psychiatry consults as an intern.

I had a long discussion with my attending about ADHD (formerly, ADD). He thinks that it's highly overdiagnosed, which I would agree with. One thing I've been noticing recently is that a lot of adults I know are getting diagnosed with it. My attending feels that anyone who's made it through a quality college couldn't possibly have ADHD. I'm sure a lot of people would vehemently disagree with this.

Personally, I've noticed my attention span is not what it used to be. It's become very hard for me to pay attention to a lecture from beginning to end. But in my case, it's more likely due to fatigue.

Name That Tune

One thing I’m really good at is naming that tune.

For example, when I was in college, a friend of mine told me there was a song in his head and he didn’t know what it was. I told him to sing it for me and he refused, for some reason. But later in the evening, I caught him humming, “Check it out now…” And I said, "The Funk Soul Brother..." And he stared at me, and I said, "Rockafeller Skank. Fatboy Slim." And he was SO HAPPY.

Another time, I was in a restaurant with a large group of friends, and there was a song playing on the radio. Two frowning waiters came over to our table and said, “Hey, do any of you have any idea what this song is?”

A bunch of my friends started hypothesizing (incorrectly) what song it was, and I spoke up very loudly: “It’s All For You by Sister Hazel. I’m 100% sure!”

One of the waiters looked at me and said, “YES! That’s it! You’re getting a free dessert.”

And I got a free dessert.

This ability somehow served me well in medical school too. I was in a surgery once with an OB/GYN, and he kept humming, “Just listen to the rhythm of the heart…” Finally, he looked up at me, and said, “Do you know what song that is?”

“It’s I Believe in a Thing Called Love by The Darkness,” I said.

And he had a scrub nurse write it down for him. I was the hero of the OR!

On a neurology rotation, I was working with an attending who kept randomly singing, “Pardon me while I burst into flames...”

I smiled at him because I thought his singing was amusing. He asked me, “Do you know that song?”

“Yes,” I said.

“Who sings it?”

“Incubus.”

“No, it can’t be. Incubus is too loud.”

“I’m 100% sure.”

We finally had to go back to his office to settle this argument, and he loaded up something called Launch Music. He played the video for the Incubus song Drive and then finally agreed with me that it was the same group. I had never seen the video for Drive before and it was basically the band singing topless. “I guess they don't believe in shirts,” the attending said.

We ended up spending the next half hour watching videos and the attending lent me an acoustic Sublime CD.

Tales from Med School: Liver

This is possible the dumbest statement ever uttered by a medical student ever:

During second year, we were having a small group session on the liver. At the end of the session, one of my classmates raised her hand:

Her: "Isn't it true that liver transplants aren't that hard to get because people have two livers?"

Attending: [stares at her] ".... Do you mean.... kidneys?"

Her: "Oh. Haha... yeah."

I don't think anyone in that room will ever forget that one.

America's Top Physicians

I'm very, very proud to announce that I have been named one of America's Top Physicians. Per a letter I received, the prestigious Consumer's Research Counsel of America has privately collected data to determine who the best physicians in the country are.

Now I'm not clear on how their algorithm works exactly. Something about pulling names out of a hat while wearing a blindfold... it's all very technical. In any case, it's definitely not a scam. Definitely not.

And oh yes, because I've been named a top physician, I can purchase an item to display this great, great honor I've received. For example, for only $229, I can purchase "a distinguished foil stamped proclamation certificate proclaiming your achievement and containing your personal information":

But for only $50 more, I can get a Lexington cup:

"Hand cut and polished crystal sets atop a solid block of Black Crystal and a laser engraved plate with your personal information."

Truly, I couldn't buy a greater honor.

Cross cover issues

Cross cover is always a sticky situation. You're dealing with patients you don't know and sometimes have to make important decisions about them. I feel like if it's at all possible to defer those decisions to the regular team, that's what should happen. I feel like the only things that should be changed during cross cover are potentially life threatening medications.

Other people feel differently. Here's a snippet from a cross cover I did a while back:

Nurse: "Doctor, Mrs. Chang is getting qAC fingersticks but her daughter doesn't want her to have them. I think she's only getting them because she wasn't eating before but now she is."

Me: "Is she diabetic?"

Nurse: "No."

Me: [checks sign-out sheet from primary team to make sure pt isn't diabetic] "And she's tolerating her diet?"

Nurse: "Yes."

Me: "OK, you can D/C the fingersticks."

Nurse: "Also, Mrs. Chang is written for morphine PRN, but her daughter doesn't want her to have it."

Me: "Uh ok.... well, it's PRN, so what's the problem?"

Nurse: "Can I D/C the morphine?"

Me: "But it's PRN. She doesn't have to take it."

Nurse: "Then I'll D/C it."

Me: [getting paged again] "Fine, whatever."

The next morning, the resident on Mrs. Chang's primary team comes up to me: "Why did you D/C Mrs. Chang's fingersticks? She's diabetic!"

And then he got mad at me for having D/C'd the PRN morphine.

(Here's a tip: If a patient is diabetic and you want them to stay on qAC fingersticks, maybe write that they're diabetic on the signout sheet.)

Tales from Residency: What did I tell you?

There was one attending I had who would sometimes come up to me all pissed off that I hadn't done something she told me to do.

For example, in rounds one morning, she asked me if I got in touch with patient Mr. Smith's therapists about some issue.

I was like, "What?"

She insisted that she had told me to do this the day before, but I highly doubted that. First, anything I was told to do, I immediately wrote on my to-do list, which I always consulted before leaving for the day.

Second, if she had asked me to do that, I would have immediately asked the follow-up question, "Who are his therapists?" (The assigning of therapists had no sort of logic I could determine.)

I think maybe she was thinking about telling me to do that. Or maybe she told me and I didn't hear her. But it seemed to happen all the time when I was rotating with this attending, but never happened with any other attending.

Weekly Whine: Brave

Usually I like the Pixar movies, so I found myself especially disappointed by Brave. FYI, this post contains spoilers.

Guessing game

(The third panel is pretty hard)

Pain relief

Patient: "My foot really hurts."

Me: "Oh..."

Patient: "Can I have some Vicodin?"

Me: "I have to talk to my attending."

Patient: "Also, do you have medical marijuana?"

Me: "No, we don't."

Patient: "And what's that other thing for pain...?"

Me: "??"

Patient: "Heroin."

Me: "!!!"

Patient: "I'm joking."