I have terrible visuospatial skills. It's why I could never be a general surgeon or a gastroenterologist, or any field where you need to work a camera in more than two dimensions.
Believe it or not, good visuospatial skills are required for interventional pain medicine. I did a rotation in Pain Medicine as a resident where I spent a lot of time in the fluoroscopy suite doing injections. And I was terrible at it.
One day when I was working with an attending named Dr. Contrast, I spent practically the whole day in the OR and the whole time was extremely frustrated that I never knew which way to move the needle. We were using fluoroscopy to look at the course of the needle into the spine and based on what we saw, used tricks to redirect it. But I just. Didn't. Get it.
Finally, I 'fessed up to Dr. Contrast:
Me: "I don't get it."
Dr. Contrast: "Yeah, I can see that."
Me: "How do you decide what direction to move the needle in?"
Dr. Contrast, bless his heart, launched into a big explanation of how to move the needle, equipped with drawings. I understood about 50% of what he was saying. I was just having trouble visualizing it.
Me: "Man, I wish I had played more video games as a kid. I'm good at math, but my visuospatial skills suck."
Dr. Contrast: "I know. I thanked my parents for letting me play video games as a kid."
It's true: when I attempt to play 3D games, I'm so bad at them, it's actually hilarious to the people watching. When I held the camera during surgery, the surgeon kept telling me they were going vomit (but maybe they say that to all the med students). And my husband won't play 3D Wii games with me, because he says I'm giving him a headache.
So kids, that's what you need to tell your parents when they tell you to stop playing those video games. Don't they want you to be a doctor someday??
Friday, November 30, 2012
Thursday, November 29, 2012
What's my but for?
In my daughter's kindergarten class, they are learning to read and write new words. I caught a glimpse of one of her recent assignments from class:
(Answer: It's for pooping.)
(Answer: It's for pooping.)
Wednesday, November 28, 2012
The TOMM
I work closely with neuropsychologists, so one day, I asked one of them to go over some of the tests they do. I thought it might have been fun to actually get tested, although I'm too worried I'd do badly and they'd lose respect.
Anyway, one of the tests they do is called the TOMM: Test Of Memory Malingering. It's an "effort measure," which is basically a really easy test that even demented patients can do well on, so if the patient fails it, they're likely not making an effort to do well.
The neuropsychologist told me that she tries to cover up the name of the test, the TOMM, so the patient doesn't go home and Google it. I made a suggestion that she could tell them that the test is named after the guy who authored it, whose first name is Tom. But it turned it, the guy who authored it really is named Tom. And actually, it turned out the guy's last name is Tombaugh.
So in summary, the test is called the TOMM, developed by Tom N. Tombaugh.
Is it just me, or is that funny?
Anyway, one of the tests they do is called the TOMM: Test Of Memory Malingering. It's an "effort measure," which is basically a really easy test that even demented patients can do well on, so if the patient fails it, they're likely not making an effort to do well.
The neuropsychologist told me that she tries to cover up the name of the test, the TOMM, so the patient doesn't go home and Google it. I made a suggestion that she could tell them that the test is named after the guy who authored it, whose first name is Tom. But it turned it, the guy who authored it really is named Tom. And actually, it turned out the guy's last name is Tombaugh.
So in summary, the test is called the TOMM, developed by Tom N. Tombaugh.
Is it just me, or is that funny?
Tuesday, November 27, 2012
Too many jackets
Chief complaint: Neck pain
I walk into the room and see patient is wearing a heavy sweater, covered by a light jacket, covered by a second, heavier jacket. She's also wearing a silk scarf. Even though a gown has clearly been provided for her, it is lying unused on the examining table. For the record, it's really not that cold out.
I finish taking the history, then say to the patient: "I'm going to examine your neck. Can you please remove your jacket?"
Patient: [removes ONE jacket]
Me: "Can you please remove your other jacket."
Patient: [reluctantly removes second jacket] "Do you want me to take off my scarf too?"
Me: "Yes, that would be wonderful."
I walk into the room and see patient is wearing a heavy sweater, covered by a light jacket, covered by a second, heavier jacket. She's also wearing a silk scarf. Even though a gown has clearly been provided for her, it is lying unused on the examining table. For the record, it's really not that cold out.
I finish taking the history, then say to the patient: "I'm going to examine your neck. Can you please remove your jacket?"
Patient: [removes ONE jacket]
Me: "Can you please remove your other jacket."
Patient: [reluctantly removes second jacket] "Do you want me to take off my scarf too?"
Me: "Yes, that would be wonderful."
Monday, November 26, 2012
Healthy babies are worth the wait
When I was 36 weeks pregnant, I was just done. My feet hurt, I was waking up every hour to pee, and my back was killing me. I didn't want to be pregnant for a second longer.
During my OB appointment, I told my doctor how miserable I was feeling. "Next week I'll be full term," I pointed out. "Can you induce me then just so I can get this pregnancy over with?"
"Absolutely!" she said. "I'll put you down to be induced at 37 weeks, so you'll be full term."
She put me down on the calendar and I went in to be induced at the hospital at 37 weeks. My baby was a little on the small side, but she was fine.
Or........ none of that actually happened.
What really happened? At 39 weeks, I felt like my baby was never coming out. I asked my OB if she'd consider inducing if I made it to 41 weeks so I wouldn't spend my entire maternity leave pregnant. She reluctantly said she'd consider it, but my cervix didn't look favorable so we'd talk about it then. (Fortunately, my water broke two days later.)
I'm honestly baffled by the March of Dimes campaign that says "healthy babies are worth the wait" that strives to eliminate non-medically indicated (elective) deliveries before 39 weeks. I just saw a commercial for it on TV where they were trying to convince pregnant women to wait till 40 weeks. Who are all these women who are being induced prior to 40 weeks??? I don't know one woman who was induced before 40 weeks. I had to BEG for an induction at 41 weeks!
I've asked a couple of OBs and they seem equally baffled by this campaign. Who is it aimed at anyway? It's not like you can just go the mall and get an induction. The OB has to be on board with it too, and from what I've seen, most OBs wouldn't want to induce too early for no medical reason and risk a complication.
Can someone please explain this to me?
During my OB appointment, I told my doctor how miserable I was feeling. "Next week I'll be full term," I pointed out. "Can you induce me then just so I can get this pregnancy over with?"
"Absolutely!" she said. "I'll put you down to be induced at 37 weeks, so you'll be full term."
She put me down on the calendar and I went in to be induced at the hospital at 37 weeks. My baby was a little on the small side, but she was fine.
Or........ none of that actually happened.
What really happened? At 39 weeks, I felt like my baby was never coming out. I asked my OB if she'd consider inducing if I made it to 41 weeks so I wouldn't spend my entire maternity leave pregnant. She reluctantly said she'd consider it, but my cervix didn't look favorable so we'd talk about it then. (Fortunately, my water broke two days later.)
I'm honestly baffled by the March of Dimes campaign that says "healthy babies are worth the wait" that strives to eliminate non-medically indicated (elective) deliveries before 39 weeks. I just saw a commercial for it on TV where they were trying to convince pregnant women to wait till 40 weeks. Who are all these women who are being induced prior to 40 weeks??? I don't know one woman who was induced before 40 weeks. I had to BEG for an induction at 41 weeks!
I've asked a couple of OBs and they seem equally baffled by this campaign. Who is it aimed at anyway? It's not like you can just go the mall and get an induction. The OB has to be on board with it too, and from what I've seen, most OBs wouldn't want to induce too early for no medical reason and risk a complication.
Can someone please explain this to me?
Sunday, November 25, 2012
FOO fighters
When I was an intern, one of our ICU attendings was very distrustful of the ortho service. He had two acronyms he liked to use: FOO and FOOBA.
FOO = Found On Ortho
FOOBA = Found On Ortho Barely Alive
(I don’t think he thought much better of PM&R though. He was also quoted as saying, “Being on the rehab service is kind of like a death sentence.”)
Still, FOO and FOOBA remain two of my favorite acronyms. What are yours?
FOO = Found On Ortho
FOOBA = Found On Ortho Barely Alive
(I don’t think he thought much better of PM&R though. He was also quoted as saying, “Being on the rehab service is kind of like a death sentence.”)
Still, FOO and FOOBA remain two of my favorite acronyms. What are yours?
Saturday, November 24, 2012
Weekly Whine: Don't be a doctor if....
I had another whine scheduled for today, but in light of that delightful Thanksgiving discussion, I decided to write something else that's been on my mind.
I made a post about covering holidays and stated the opinion that I thought parents of young children should have priority for holidays. It got one or two comments, as you can see. Truthfully, I'm not passionate either way. I don't usually care much about taking holidays off because my husband has a very flexible job, so I try my best to be flexible to help others who actually need it for whatever reason. However, I felt it would be more entertaining for you (and me) if I took a side and you got to argue with me (or yell at me, in some cases).
One thing I found particularly interesting is that in refuting my statements, multiple people commented, "If you aren't willing to work holidays, you shouldn't become a doctor."
In all honesty, that's an excellent point. What kind of idiot would become a doctor if they don't want to work on weekends/holidays/etc?
Here's the thing:
Many people *raises hand* are 22 years old and single when they start medical school, with zero obligations beyond getting yourself clothed and fed. And maybe you've even heard that medicine is a good career for a mother because it pays well and you can work part-time. As a little fresh-faced med student, it's difficult to even contemplate what it will be like in the future when (if!) you get married and have children. All you know is that you can manage it all now.
Then it's ten years later. Everyone expects you to put your job before your kids, even though you love your kids more than anything. And when you take maternity leave people give you dirty looks. When you return, they say in a snarky voice, "Did you have a nice vacation?" And you can't take any actual vacation for another year and have to make up missed calls, even though your baby is still waking up twice every night and you're so tired, you could just die. And when people visit your house, they make disparaging comments about how cluttered it is because you don't have time to clean. And people on a blog will write over a hundred comments, furious at your sense of entitlement for hoping to get Christmas off when your nanny is gone so that your baby won't have to be cared for by a stranger that day. And how dare you take a day off because your grandmother died, after you left early last week because your kid was vomiting? After all, having children was a choice you made, so don't expect anyone to help you. You are just another unreliable parent, using your kid as an excuse. For Christ's sake, why did you go into medicine if you can't handle the lifestyle?
I consider myself very fortunate in that both my husband and I have a lot of flexibility in our jobs. But that's actually very rare in medicine. I don't think I appreciated when I was 22 years old how much of a challenge it is to work in medicine or to be a mother, both of which are obligations that expect you to give practically all of yourself. If someone had warned me, I probably wouldn't have listened. I would have figured they were trying to scare me or they were just weak.
When I was 22 years old, I truly thought I could do it all. It's only as I got older that I realized that not only couldn't I do it all, I didn't want to. But by that point, it's too late for most of us.
Premeds and med students: Be warned.
In any case, my follow-up question is: why can't medicine be a field that's more friendly to parents? Must it be the case that becoming a physician dooms you to spend 20 Thanksgivings in a row away from your family (as one commenter stated). And that we should be furious with people who don't want to do this? Maybe instead of being angry at a mom who just wants to spend a holiday with her baby (how dare she??), we should be working toward ways for doctors who want a normal lifestyle to have one. Perhaps hiring per diems to cover holidays or calls in exchange for a slight dip in salary? I don't know. But I believe there is a solution, and it isn't going to be achieved by calling parents selfish because they want to spend time with their kids.
Fifty years ago, they said to exhausted residents who were working three days in a row, "This is how it is. Deal with it." Now we realize how crazy that was, and we let residents work normal human hours. Will the medicine attending lifestyle similarly change in the future, and will we look back with disbelief on people who mocked physicians for daring to want to spend Christmas with their families?
I made a post about covering holidays and stated the opinion that I thought parents of young children should have priority for holidays. It got one or two comments, as you can see. Truthfully, I'm not passionate either way. I don't usually care much about taking holidays off because my husband has a very flexible job, so I try my best to be flexible to help others who actually need it for whatever reason. However, I felt it would be more entertaining for you (and me) if I took a side and you got to argue with me (or yell at me, in some cases).
One thing I found particularly interesting is that in refuting my statements, multiple people commented, "If you aren't willing to work holidays, you shouldn't become a doctor."
In all honesty, that's an excellent point. What kind of idiot would become a doctor if they don't want to work on weekends/holidays/etc?
Here's the thing:
Many people *raises hand* are 22 years old and single when they start medical school, with zero obligations beyond getting yourself clothed and fed. And maybe you've even heard that medicine is a good career for a mother because it pays well and you can work part-time. As a little fresh-faced med student, it's difficult to even contemplate what it will be like in the future when (if!) you get married and have children. All you know is that you can manage it all now.
Then it's ten years later. Everyone expects you to put your job before your kids, even though you love your kids more than anything. And when you take maternity leave people give you dirty looks. When you return, they say in a snarky voice, "Did you have a nice vacation?" And you can't take any actual vacation for another year and have to make up missed calls, even though your baby is still waking up twice every night and you're so tired, you could just die. And when people visit your house, they make disparaging comments about how cluttered it is because you don't have time to clean. And people on a blog will write over a hundred comments, furious at your sense of entitlement for hoping to get Christmas off when your nanny is gone so that your baby won't have to be cared for by a stranger that day. And how dare you take a day off because your grandmother died, after you left early last week because your kid was vomiting? After all, having children was a choice you made, so don't expect anyone to help you. You are just another unreliable parent, using your kid as an excuse. For Christ's sake, why did you go into medicine if you can't handle the lifestyle?
I consider myself very fortunate in that both my husband and I have a lot of flexibility in our jobs. But that's actually very rare in medicine. I don't think I appreciated when I was 22 years old how much of a challenge it is to work in medicine or to be a mother, both of which are obligations that expect you to give practically all of yourself. If someone had warned me, I probably wouldn't have listened. I would have figured they were trying to scare me or they were just weak.
When I was 22 years old, I truly thought I could do it all. It's only as I got older that I realized that not only couldn't I do it all, I didn't want to. But by that point, it's too late for most of us.
Premeds and med students: Be warned.
In any case, my follow-up question is: why can't medicine be a field that's more friendly to parents? Must it be the case that becoming a physician dooms you to spend 20 Thanksgivings in a row away from your family (as one commenter stated). And that we should be furious with people who don't want to do this? Maybe instead of being angry at a mom who just wants to spend a holiday with her baby (how dare she??), we should be working toward ways for doctors who want a normal lifestyle to have one. Perhaps hiring per diems to cover holidays or calls in exchange for a slight dip in salary? I don't know. But I believe there is a solution, and it isn't going to be achieved by calling parents selfish because they want to spend time with their kids.
Fifty years ago, they said to exhausted residents who were working three days in a row, "This is how it is. Deal with it." Now we realize how crazy that was, and we let residents work normal human hours. Will the medicine attending lifestyle similarly change in the future, and will we look back with disbelief on people who mocked physicians for daring to want to spend Christmas with their families?
Friday, November 23, 2012
Positive U/A
(And now for something a little less controversial. Unlike my last post, I expect significantly less than 100 comments.)
A page I got at 1AM:
Nurse: "I'm calling to let you know that the urinalysis on Mrs. Burns is positive. There are a lot of white blood cells."
Granted, I'd never been paged before urgently with the results of a urinalysis, but the patient had a mild fever earlier so it didn't seem unreasonable.
Me: "Oh..." [groggily trying to decide what med to start her on or to wait till morning] "Is the patient on any antibiotics right now?"
Nurse: "No."
Me: "Any allergies?"
Nurse: "No. There's also trace leukocyte esterase in the urine."
Me: [finally waking up] "Trace? Wait, can you read me the full results of the urinalysis?"
Nurse: "Protein negative, ketones negative, trace leukocyte esterase, nitrite negative, 0-3 red blood cells, and 3-5 white blood cells...."
Me: "Three to five white blood cells???"
I made her repeat that number twice to make sure I heard right. I can't believe I got woken up in the middle of the night about three white blood cells in a patient's urine. That was like the least remarkable urinalysis ever.
A page I got at 1AM:
Nurse: "I'm calling to let you know that the urinalysis on Mrs. Burns is positive. There are a lot of white blood cells."
Granted, I'd never been paged before urgently with the results of a urinalysis, but the patient had a mild fever earlier so it didn't seem unreasonable.
Me: "Oh..." [groggily trying to decide what med to start her on or to wait till morning] "Is the patient on any antibiotics right now?"
Nurse: "No."
Me: "Any allergies?"
Nurse: "No. There's also trace leukocyte esterase in the urine."
Me: [finally waking up] "Trace? Wait, can you read me the full results of the urinalysis?"
Nurse: "Protein negative, ketones negative, trace leukocyte esterase, nitrite negative, 0-3 red blood cells, and 3-5 white blood cells...."
Me: "Three to five white blood cells???"
I made her repeat that number twice to make sure I heard right. I can't believe I got woken up in the middle of the night about three white blood cells in a patient's urine. That was like the least remarkable urinalysis ever.
Thursday, November 22, 2012
Humanitarian
Happy Thanksgiving everyone!
I figured there aren't going to be many people online today, what with all the turkey making. So I decided to take a break from my usual stories and post something that I found... interesting. I figure I won't get bombed with comments since it's a holiday and all.
I made a post on Mothers in Medicine yesterday about whether people with small kids should get preference for having specific holidays off in jobs that require people to work holidays. My argument was yes, mostly because you can just as easily see family or friends on Jan 25 as you can on Dec 25, but there's less flexibility when it comes to schools or daycares being closed and people with kids having to scramble for reliable childcare.
Just to be clear, I absolutely wasn't trying to say that a parent should get every holiday off and a non-parent should work every holiday or anything close to that... but if everyone gets, say, three holidays off and the parent says they really need Christmas off due to not being able to find anyone to help watch their child, that should receive preference. I'd feel the same way if someone was caring for an elderly or disabled relative. As a society, I think we should try to provide flexibility for these people who need it, or else risk driving them out of the workforce entirely.
However, putting all that aside for a minute... one person argued that while you could see family and friends on any day, if you want to go to the Christmas church services, that can only be done ON CHRISTMAS. And that is just as legitimate an excuse as having nobody to watch your kid that day.
This argument struck me more than anything. I respect people who value religion and find comfort in their faith. But at the same time, don't most churches teach you to be a humanitarian? Maybe I'm wrong, I don't know. But would you really feel worse about yourself if you had to miss church than if you, say, forced a single mom to have to scramble for childcare for her small children because you were in church? Is a good Christian someone who goes to church on Christmas or helps a parent be with their small children during Christmas?
I feel like an attitude like this is all about following some kind of mantra and not about caring for your fellow human beings. It's like politicians who restrict abortions and at the same time, cut off funding to poor, single mothers. I think you should practice what you preach.
I figured there aren't going to be many people online today, what with all the turkey making. So I decided to take a break from my usual stories and post something that I found... interesting. I figure I won't get bombed with comments since it's a holiday and all.
I made a post on Mothers in Medicine yesterday about whether people with small kids should get preference for having specific holidays off in jobs that require people to work holidays. My argument was yes, mostly because you can just as easily see family or friends on Jan 25 as you can on Dec 25, but there's less flexibility when it comes to schools or daycares being closed and people with kids having to scramble for reliable childcare.
Just to be clear, I absolutely wasn't trying to say that a parent should get every holiday off and a non-parent should work every holiday or anything close to that... but if everyone gets, say, three holidays off and the parent says they really need Christmas off due to not being able to find anyone to help watch their child, that should receive preference. I'd feel the same way if someone was caring for an elderly or disabled relative. As a society, I think we should try to provide flexibility for these people who need it, or else risk driving them out of the workforce entirely.
However, putting all that aside for a minute... one person argued that while you could see family and friends on any day, if you want to go to the Christmas church services, that can only be done ON CHRISTMAS. And that is just as legitimate an excuse as having nobody to watch your kid that day.
This argument struck me more than anything. I respect people who value religion and find comfort in their faith. But at the same time, don't most churches teach you to be a humanitarian? Maybe I'm wrong, I don't know. But would you really feel worse about yourself if you had to miss church than if you, say, forced a single mom to have to scramble for childcare for her small children because you were in church? Is a good Christian someone who goes to church on Christmas or helps a parent be with their small children during Christmas?
I feel like an attitude like this is all about following some kind of mantra and not about caring for your fellow human beings. It's like politicians who restrict abortions and at the same time, cut off funding to poor, single mothers. I think you should practice what you preach.
Wednesday, November 21, 2012
Doctors are human too
Through interactions with my husband, I've gradually come to the realization that many civilians (i.e. non-physicians) don't appreciate that doctors are, in fact, human.
For example, a while ago, we were at our pediatrician, and he had told us he'd get us some information sheet before we left. After a significant amount of time, nobody had returned with the sheet for us. I said, "He probably forgot."
Husband: "No. I'm sure it will be here soon."
Me: "I'm sure he forgot."
Husband: "He didn't forget."
I finally went to check. Guess what? He forgot.
Totally understandable. He's human and humans forget to give out information sheets when they're seeing five patients at once. That's why I was so quick to think he probably forgot.
On another occasion, my husband had some lab test done, and got a call from his doctor in the late afternoon same day about an out of range result, and she asked him to repeat it. He repeated the lab the next day, and then was super upset that she didn't call him again about the result being either normal or abnormal (despite the fact that it would available online the next day).
Husband: "How come she didn't call? That's pretty obnoxious."
Me: "Why would she call you same day about either a normal or unsurprising lab result that you're not going to do anything about right away anyway?"
Husband: "Well, she called yesterday."
Me: "That's because she wanted you to repeat it. And she might have had a break in her schedule."
Husband: "I think she should have called."
Me: "Maybe she's in clinic the whole afternoon with patients. Maybe she doesn't have time to be calling every patient back about non-urgent lab results."
Husband: "Okay, okay..."
I think that as doctors, we have a much better understanding of what's humanly possible for a physician. Non-physicians don't quite seem to understand that.
For example, a while ago, we were at our pediatrician, and he had told us he'd get us some information sheet before we left. After a significant amount of time, nobody had returned with the sheet for us. I said, "He probably forgot."
Husband: "No. I'm sure it will be here soon."
Me: "I'm sure he forgot."
Husband: "He didn't forget."
I finally went to check. Guess what? He forgot.
Totally understandable. He's human and humans forget to give out information sheets when they're seeing five patients at once. That's why I was so quick to think he probably forgot.
On another occasion, my husband had some lab test done, and got a call from his doctor in the late afternoon same day about an out of range result, and she asked him to repeat it. He repeated the lab the next day, and then was super upset that she didn't call him again about the result being either normal or abnormal (despite the fact that it would available online the next day).
Husband: "How come she didn't call? That's pretty obnoxious."
Me: "Why would she call you same day about either a normal or unsurprising lab result that you're not going to do anything about right away anyway?"
Husband: "Well, she called yesterday."
Me: "That's because she wanted you to repeat it. And she might have had a break in her schedule."
Husband: "I think she should have called."
Me: "Maybe she's in clinic the whole afternoon with patients. Maybe she doesn't have time to be calling every patient back about non-urgent lab results."
Husband: "Okay, okay..."
I think that as doctors, we have a much better understanding of what's humanly possible for a physician. Non-physicians don't quite seem to understand that.
Tuesday, November 20, 2012
Things you learn about in med school (that probably aren't as funny as they sound)
*Urachal fistula: Connecting fistula between bladder and belly button
Cremaster reflex: Elicited by lightly stroking the inner part of the thigh, resulting in elevation of the scrotum and testis on the side stroked.
Maple syrup urine disease: An autosomal recessive metabolic disorder that gets its name from the distinctive sweet odor of affected infants' urine.
Monday, November 19, 2012
How to be competitive
Ever since I made my post about why I didn't do dermatology, I've gotten responses reprimanding me for implying that dermatologists are all terrible people.
They're not. Back in the old days, it was much easier to match in derm. And I'm sure the people who trained back then are nice people. Just the new ones are terrible.
(I'm joking.)
(Or am I?)
One of the responses got me thinking about my own classmates who matched in derm. There weren't many of them, and yes, they were very very competitive. They were the ones who fought to have every exam postponed, who showed horrible behavior during clerkships that made everyone hate them. Future dermatologists: if you want people to stop saying you're terrible, stop doing things to make us hate you! (But you can't, because then you won't match in derm...)
Then I got to thinking about the people in my class who were junior AOA.
For those of you not in the field, AOA is the medical honor society. In most schools, a few people get elected early to AOA due to just being totally awesome. And these people are called "junior AOA."
In my class, there were five. Four of them were incredibly competitive, very cutthroat students. They actually had a fair amount of charisma as well, which meant that they weren't quite as hated as maybe they could have been. But believe me, if you were on a rotation with any of these students, you got to dislike them. Or possibly even refer to them as "the devil incarnate."
Those four matched in ortho, plastics, derm, and rad onc. Coincidentally, none of them had their interest sparked by peds or family medicine.
The fifth junior AOA member, the only female, was a little different. She was a little quieter and more studious. I never heard any horrible stories about her behavior on clerkships. And then when match came along, she failed to match in the surgical subspecialty of her choice and had to settle for general surgery.
Five students. All very smart. All very good at studying and getting high grades. Four matched in highly competitive specialties, one didn't. Apparently, being smart and studious isn't enough. Being a huge competitive jerk is requisite to getting what you want.
They're not. Back in the old days, it was much easier to match in derm. And I'm sure the people who trained back then are nice people. Just the new ones are terrible.
(I'm joking.)
(Or am I?)
One of the responses got me thinking about my own classmates who matched in derm. There weren't many of them, and yes, they were very very competitive. They were the ones who fought to have every exam postponed, who showed horrible behavior during clerkships that made everyone hate them. Future dermatologists: if you want people to stop saying you're terrible, stop doing things to make us hate you! (But you can't, because then you won't match in derm...)
Then I got to thinking about the people in my class who were junior AOA.
For those of you not in the field, AOA is the medical honor society. In most schools, a few people get elected early to AOA due to just being totally awesome. And these people are called "junior AOA."
In my class, there were five. Four of them were incredibly competitive, very cutthroat students. They actually had a fair amount of charisma as well, which meant that they weren't quite as hated as maybe they could have been. But believe me, if you were on a rotation with any of these students, you got to dislike them. Or possibly even refer to them as "the devil incarnate."
Those four matched in ortho, plastics, derm, and rad onc. Coincidentally, none of them had their interest sparked by peds or family medicine.
The fifth junior AOA member, the only female, was a little different. She was a little quieter and more studious. I never heard any horrible stories about her behavior on clerkships. And then when match came along, she failed to match in the surgical subspecialty of her choice and had to settle for general surgery.
Five students. All very smart. All very good at studying and getting high grades. Four matched in highly competitive specialties, one didn't. Apparently, being smart and studious isn't enough. Being a huge competitive jerk is requisite to getting what you want.
Sunday, November 18, 2012
Sliding pain scale
Back pain clinic can get very repetitive, so you kind of appreciate it when a patient does something that's unique.
For example, there are many patients who have been having back pain that started before I was born. This guy I saw last week? He had back pain since before my parents were born.
And then I asked him for his pain score (on a scale of 1 to 10). Sometimes patients will say something like 3-4 out of 10, which is kind of annoying because I want to just write down one number. But this guy was, again, totally unique.
Me: "What is your pain level on a scale of one to ten?"
Patient: "Oh, it's two-three-four." [Pause] "Five, six."
Um, did he think I just asked him to count to six?
For example, there are many patients who have been having back pain that started before I was born. This guy I saw last week? He had back pain since before my parents were born.
And then I asked him for his pain score (on a scale of 1 to 10). Sometimes patients will say something like 3-4 out of 10, which is kind of annoying because I want to just write down one number. But this guy was, again, totally unique.
Me: "What is your pain level on a scale of one to ten?"
Patient: "Oh, it's two-three-four." [Pause] "Five, six."
Um, did he think I just asked him to count to six?
Saturday, November 17, 2012
Weekly Whine: Hyphenated Names
I think that parents who given their children a hyphenated last name are doing them a great injustice.
First, it's hard to put a hyphenated last name on forms. And what do you do as a kid? You spend half your time filling out forms. Even these days, when you may not be dealing with scantrons, it's still got to be a pain in the ass.
Second, think about what happens when you give your last name for an appointment or whatever. Nobody ever knows how to spell it, so you have to spell it out. Then you have to tell them there's a hyphen. Then you have to spell the second name. Think about doing that your whole life.
And if you do this to a boy, what happens when they get married? Does the wife drop her own name and taken on both her husband's parents' names? I wouldn't be thrilled about doing that. And what if she wants to hyphenate? Will she now have three names? And what if her name is hyphenated? Will her new hyphenated name now have four parts?? And what about the children? Will they each have four hyphenated names???
I think it's selfish to hyphenate. To me, it means that neither parent was willing to compromise their precious last name in order not to saddle their child with that burden. Especially when the two names sound awful together. Like I knew this guy whose last name was O'Malley-Goldstein. Seriously??
Options that I think are okay:
--Making one parent's last name the child's middle name
--Alternating which child gets which parent's last name
--Creating some new last name that's one word but somehow a fusion of both names
--Anything that doesn't involve a freaking hyphen!
And don't get me started on hyphenated first names, Mark-Paul Gosselaar.
First, it's hard to put a hyphenated last name on forms. And what do you do as a kid? You spend half your time filling out forms. Even these days, when you may not be dealing with scantrons, it's still got to be a pain in the ass.
Second, think about what happens when you give your last name for an appointment or whatever. Nobody ever knows how to spell it, so you have to spell it out. Then you have to tell them there's a hyphen. Then you have to spell the second name. Think about doing that your whole life.
And if you do this to a boy, what happens when they get married? Does the wife drop her own name and taken on both her husband's parents' names? I wouldn't be thrilled about doing that. And what if she wants to hyphenate? Will she now have three names? And what if her name is hyphenated? Will her new hyphenated name now have four parts?? And what about the children? Will they each have four hyphenated names???
I think it's selfish to hyphenate. To me, it means that neither parent was willing to compromise their precious last name in order not to saddle their child with that burden. Especially when the two names sound awful together. Like I knew this guy whose last name was O'Malley-Goldstein. Seriously??
Options that I think are okay:
--Making one parent's last name the child's middle name
--Alternating which child gets which parent's last name
--Creating some new last name that's one word but somehow a fusion of both names
--Anything that doesn't involve a freaking hyphen!
And don't get me started on hyphenated first names, Mark-Paul Gosselaar.
Friday, November 16, 2012
Pleasant
Attending: "Are you ready to present your patient?"
Resident: "Oh sure. This was a.... very pleasant 46 year old man--"
Me: "Very pleasant. Wow."
This particular resident always gave a little commentary on how pleasant the patient was as part of his presentation. Admittedly, I usually made a remark to that effect, muttering under my breath about how the patient was either a nightmare who drove me nuts or a generally nice person. But I never made it part of my presentation.
In my dictations, I used to put in little judgments about the patients' personality in my physical. "The patient was a [pleasant/anxious/rancid], well developed, well nourished man in no apparent distress." These days I just say everyone was pleasant. Unless they were really an asshole.
Resident: "Oh sure. This was a.... very pleasant 46 year old man--"
Me: "Very pleasant. Wow."
This particular resident always gave a little commentary on how pleasant the patient was as part of his presentation. Admittedly, I usually made a remark to that effect, muttering under my breath about how the patient was either a nightmare who drove me nuts or a generally nice person. But I never made it part of my presentation.
In my dictations, I used to put in little judgments about the patients' personality in my physical. "The patient was a [pleasant/anxious/rancid], well developed, well nourished man in no apparent distress." These days I just say everyone was pleasant. Unless they were really an asshole.
Thursday, November 15, 2012
All accounted for
Usually in residency I was fairly busy, but there were also times when my schedule was pretty light.
For example, there was one afternoon when I was covering EMGs and consults, but there was only one EMG scheduled and only two consults.
After I saw and staffed the two consults, I got an email from my EMG attending, saying, "What were you doing all afternoon? We have to document your time."
What?
Apparently, all our time had to be "accounted for". We can be doing admissions, consults, clinic, or even "directed reading", but we can't be, like, out skateboarding in the parking lot, I guess.
The email kind of irritated me because much of the time, the days were long, and if I were to somehow luck out and not have anything scheduled for the afternoon, why couldn't I go skateboarding in the parking lot? Or better yet, spend a little quality time with my daughter. No, that's crazy talk.
For example, there was one afternoon when I was covering EMGs and consults, but there was only one EMG scheduled and only two consults.
After I saw and staffed the two consults, I got an email from my EMG attending, saying, "What were you doing all afternoon? We have to document your time."
What?
Apparently, all our time had to be "accounted for". We can be doing admissions, consults, clinic, or even "directed reading", but we can't be, like, out skateboarding in the parking lot, I guess.
The email kind of irritated me because much of the time, the days were long, and if I were to somehow luck out and not have anything scheduled for the afternoon, why couldn't I go skateboarding in the parking lot? Or better yet, spend a little quality time with my daughter. No, that's crazy talk.
Wednesday, November 14, 2012
Ticketed
One day during residency, on my way to the VA for lecture, I saw one of my co-residents standing outside his car, flanked by two very serious-looking police officers. This particular resident was always a little on the sketchy side, so I was pretty much dying of curiosity. Maybe the cops caught on to his, like, drug trafficking side business or something.
But it was nothing so exciting. Apparently, he got pulled over for speeding in the VA parking lot. Got a $200 ticket.
Someone later told me that they did this constantly on the VA hospital campus. Lots of doctors received tickets for going FIVE miles over the speed limit (which was like 10 MPH). I'd imagine patients get pulled over a lot too. Considering how behind we always get in clinics and how long patients have to wait, is it really a good idea to start pulling over doctors just as they're getting to work and making them wait 20 minutes for you to write out a ticket? Or patients who are already probably running late to their appointments?
Me: "I can't believe they pulled you over when you were wearing your white coat!"
Resident: "Yeah, they don't care."
Me: "You should have told them you were, like, on your way to deliver a baby."
Resident: "At the VA???"
Me: "Oh. Maybe not."
But it was nothing so exciting. Apparently, he got pulled over for speeding in the VA parking lot. Got a $200 ticket.
Someone later told me that they did this constantly on the VA hospital campus. Lots of doctors received tickets for going FIVE miles over the speed limit (which was like 10 MPH). I'd imagine patients get pulled over a lot too. Considering how behind we always get in clinics and how long patients have to wait, is it really a good idea to start pulling over doctors just as they're getting to work and making them wait 20 minutes for you to write out a ticket? Or patients who are already probably running late to their appointments?
Me: "I can't believe they pulled you over when you were wearing your white coat!"
Resident: "Yeah, they don't care."
Me: "You should have told them you were, like, on your way to deliver a baby."
Resident: "At the VA???"
Me: "Oh. Maybe not."
Tuesday, November 13, 2012
Confessions of a Curly Girl
I am a curly girl.
Having curly hair is probably the most distinctive thing about me. Like, if someone were to describe me from afar, that’s probably the first thing they’d say, “That doctor with the curly hair.” (Or they might say “the skinny doctor” but I know that would offend some of you.)
I always hated having curly hair. When I was a little girl, I had blond curls, and I wished I had straight brown hair like my best friend. My mother says I used to stand in front of the mirror, staring at my tight ringlets, saying, “I think it’s getting straighter.” It wasn’t.
Actually, things were fine when I had that great baby-fine hair. But as soon as I got to pre-adolescence and my hair took on a normal texture, it became uncontrollable. Sort of like this:
And the really rough part is that I inherited the curls from my father, who just cut his hair short and had no idea how to control them. And if you’re an eight year old girl with wild, curly hair, all any adult wants to do is brush it out. But that just makes the situation worse. Like this:
Rule #1 of curly hair:
Do not brush it.
By the time I was ten, I gave up on my hair. I was sick of the tangles, getting teased, and generally just being embarrassed by my curls. So I started just wearing my hair in a braid.
Every time I went to get my hair cut, I’d ask the salon if they had any tips for curly hair. They’d always sell me some expensive product that didn’t work. It’s like nobody actually has any idea how to deal with curly hair. I mean, there are only two kinds of hair: curly or straight, so it seems like if your job is hair, you ought to know this. That’s like, being a general practitioner and not knowing how to treat, like, women.
When I got to high school, I was still wearing my hair up all the time. Except I looked really young already so wearing my hair in braids wasn’t doing me any favors. Finally, when I was 15, I hacked it all off, short enough that I couldn’t physically pull it back anymore.
This started an era of trying a wide range of products to control my hair. I usually used gel, but that was no good—I needed too much of it and it made my hair crunchy. That was my biggest problem, that my hair was so thick, any product often wasn’t enough. A pea sized amount? No way. And putting a bunch of sticky gel in my hair meant that I couldn’t follow Rule #2 of curly hair:
You can’t wash your hair every day.
By the end of college, I had sort of figured things out. I still hated my hair, but oddly enough, I used to get constant compliments about it. At least a few times a week, some complete stranger would tell me they liked my hair. That wasn’t what I wanted though—I just wanted to get control over my hair so that I could blend in.
I found a book called Curly Girl: The Handbook which was technically an advice book but just as much a support book. The women pictured in the book look really great, but then again, they’re models and actresses who have probably had their hair professionally done. It teaches you to identify your curl type and teaches you never, ever to shampoo your hair. Instead, you’re supposed to use something called “no-poo”. You can’t make this stuff up.
Ultimately, as a mother of two kids, I don’t have time to spend hours making my hair look awesome. I have a very short, layered cut, and I’m mostly focused on not letting my hair get too wild. I just use Frizz-Ease mousse, adjust a few curls manually, and I’m usually good to go. Or good enough. Like this:
(Actually, I don't think I've ever had a hair day quite that good.)
I don't usually get compliments anymore, but that's fine. Better than fine.
There are times when I’ve been tempted to try straightening it, just to see what would happen. But I can’t do it to my kids. My children love my curly hair in ways that I never could. My older daughter is constantly talking about “mama’s curly hair.” And every night before bed, she has to touch it. Literally. She runs out of her bedroom, comes to me and strokes my hair for a minute, then runs back to bed.
So I guess I’m stuck as a curly girl.
Having curly hair is probably the most distinctive thing about me. Like, if someone were to describe me from afar, that’s probably the first thing they’d say, “That doctor with the curly hair.” (Or they might say “the skinny doctor” but I know that would offend some of you.)
I always hated having curly hair. When I was a little girl, I had blond curls, and I wished I had straight brown hair like my best friend. My mother says I used to stand in front of the mirror, staring at my tight ringlets, saying, “I think it’s getting straighter.” It wasn’t.
Actually, things were fine when I had that great baby-fine hair. But as soon as I got to pre-adolescence and my hair took on a normal texture, it became uncontrollable. Sort of like this:
And the really rough part is that I inherited the curls from my father, who just cut his hair short and had no idea how to control them. And if you’re an eight year old girl with wild, curly hair, all any adult wants to do is brush it out. But that just makes the situation worse. Like this:
Rule #1 of curly hair:
Do not brush it.
By the time I was ten, I gave up on my hair. I was sick of the tangles, getting teased, and generally just being embarrassed by my curls. So I started just wearing my hair in a braid.
Every time I went to get my hair cut, I’d ask the salon if they had any tips for curly hair. They’d always sell me some expensive product that didn’t work. It’s like nobody actually has any idea how to deal with curly hair. I mean, there are only two kinds of hair: curly or straight, so it seems like if your job is hair, you ought to know this. That’s like, being a general practitioner and not knowing how to treat, like, women.
When I got to high school, I was still wearing my hair up all the time. Except I looked really young already so wearing my hair in braids wasn’t doing me any favors. Finally, when I was 15, I hacked it all off, short enough that I couldn’t physically pull it back anymore.
This started an era of trying a wide range of products to control my hair. I usually used gel, but that was no good—I needed too much of it and it made my hair crunchy. That was my biggest problem, that my hair was so thick, any product often wasn’t enough. A pea sized amount? No way. And putting a bunch of sticky gel in my hair meant that I couldn’t follow Rule #2 of curly hair:
You can’t wash your hair every day.
By the end of college, I had sort of figured things out. I still hated my hair, but oddly enough, I used to get constant compliments about it. At least a few times a week, some complete stranger would tell me they liked my hair. That wasn’t what I wanted though—I just wanted to get control over my hair so that I could blend in.
I found a book called Curly Girl: The Handbook which was technically an advice book but just as much a support book. The women pictured in the book look really great, but then again, they’re models and actresses who have probably had their hair professionally done. It teaches you to identify your curl type and teaches you never, ever to shampoo your hair. Instead, you’re supposed to use something called “no-poo”. You can’t make this stuff up.
Ultimately, as a mother of two kids, I don’t have time to spend hours making my hair look awesome. I have a very short, layered cut, and I’m mostly focused on not letting my hair get too wild. I just use Frizz-Ease mousse, adjust a few curls manually, and I’m usually good to go. Or good enough. Like this:
(Actually, I don't think I've ever had a hair day quite that good.)
I don't usually get compliments anymore, but that's fine. Better than fine.
There are times when I’ve been tempted to try straightening it, just to see what would happen. But I can’t do it to my kids. My children love my curly hair in ways that I never could. My older daughter is constantly talking about “mama’s curly hair.” And every night before bed, she has to touch it. Literally. She runs out of her bedroom, comes to me and strokes my hair for a minute, then runs back to bed.
So I guess I’m stuck as a curly girl.
Monday, November 12, 2012
Good residents vs. med students
When I was a resident, we'd often have med students rotating with us, notably students who wanted to match with us. If the student was working with me, the program director or chief would usually ask me about them and whether I thought they'd make a good resident.
Often, I wasn't sure what to say. Even though sometimes they were kind of annoying, I wasn't sure if I should just chalk that up to wanting to make a good impression (but not knowing how).
It made me wonder about how (or if) the qualities of a good med student differ from the qualities of a good resident. I believe that there IS a difference.
For example, I think that a good med student is someone who is there to support the resident they work with. They are someone who is eager but can also sense when the resident is too busy to deal with them. They are somewhat knowledgeable, but more importantly, remember information you taught them and are able to apply it. If you give them a task to do, they do it without complaining or asking a hundred follow-up questions. Also, they're courteous to their fellow med students and don't make an effort to make them look bad.
In contrast, a good resident is someone who is diligent, independent, eager, knowledgeable, and dependable. They don't dump work on their fellow residents and are willing to pitch in for help when it's needed.
I think the main difference is that it's hard (and rare) for a resident to be overeager. I haven't experienced much in the way of "resident gunners," but maybe that's just me. I think the main two qualities that make a resident bad are:
1) Poor patient care (which includes anything from not following up labs to poor documentation/signout)
2) Dumping work on fellow residents
What do you think are desirable qualities in a resident vs. a medical student?
Often, I wasn't sure what to say. Even though sometimes they were kind of annoying, I wasn't sure if I should just chalk that up to wanting to make a good impression (but not knowing how).
It made me wonder about how (or if) the qualities of a good med student differ from the qualities of a good resident. I believe that there IS a difference.
For example, I think that a good med student is someone who is there to support the resident they work with. They are someone who is eager but can also sense when the resident is too busy to deal with them. They are somewhat knowledgeable, but more importantly, remember information you taught them and are able to apply it. If you give them a task to do, they do it without complaining or asking a hundred follow-up questions. Also, they're courteous to their fellow med students and don't make an effort to make them look bad.
In contrast, a good resident is someone who is diligent, independent, eager, knowledgeable, and dependable. They don't dump work on their fellow residents and are willing to pitch in for help when it's needed.
I think the main difference is that it's hard (and rare) for a resident to be overeager. I haven't experienced much in the way of "resident gunners," but maybe that's just me. I think the main two qualities that make a resident bad are:
1) Poor patient care (which includes anything from not following up labs to poor documentation/signout)
2) Dumping work on fellow residents
What do you think are desirable qualities in a resident vs. a medical student?
Sunday, November 11, 2012
Weekly Whine: Children's clothing
Why the hell is children's clothing so expensive? This bugs me to no end.
When I went out to buy my daughter her first pair of shoes, I found a pair at some crappy Marshall's type store that fit her okay. And they were $30. $30! For shoes for a kid that could barely walk! That she would outgrow in like two minutes.
That's my big argument. When it comes to my own clothing, I'm okay for spending a little more for an outfit I really like because I know I'll be able to wear it for a long time. (I'm still wearing shirts I bought for medical school.) But for an older kid, the best you'll get is maybe a year of wear. And for a baby, it's more like a few months.
Yet there are still tons of outfits for babies/toddlers that are like $20+. Stuff that the kid will probably only have occasion to wear once before it is outgrown. And it's not like I shop at high end stores. These are the prices at, like, Target. I'm sure a nice shirt for a one year old is $40-50 is a good store.
Who is paying these prices?? Don't you people know there's a recession??? This is why you can't afford your mortgage... because you've spent it all on baby clothes!!
When I went out to buy my daughter her first pair of shoes, I found a pair at some crappy Marshall's type store that fit her okay. And they were $30. $30! For shoes for a kid that could barely walk! That she would outgrow in like two minutes.
That's my big argument. When it comes to my own clothing, I'm okay for spending a little more for an outfit I really like because I know I'll be able to wear it for a long time. (I'm still wearing shirts I bought for medical school.) But for an older kid, the best you'll get is maybe a year of wear. And for a baby, it's more like a few months.
Yet there are still tons of outfits for babies/toddlers that are like $20+. Stuff that the kid will probably only have occasion to wear once before it is outgrown. And it's not like I shop at high end stores. These are the prices at, like, Target. I'm sure a nice shirt for a one year old is $40-50 is a good store.
Who is paying these prices?? Don't you people know there's a recession??? This is why you can't afford your mortgage... because you've spent it all on baby clothes!!
Saturday, November 10, 2012
Friday, November 9, 2012
Not alone....
Resident: "Are you like the rest of us and regret going to medical school?"
Me: "Huh?"
Resident: "Me and [senior resident] are always talking about how much we regret going to med school. What a mistake that was, right? Do you regret it too?"
Me: [glances at our attending, who is sitting right next to us] "Uh, no?"
Me: "Huh?"
Resident: "Me and [senior resident] are always talking about how much we regret going to med school. What a mistake that was, right? Do you regret it too?"
Me: [glances at our attending, who is sitting right next to us] "Uh, no?"
Thursday, November 8, 2012
Time = value
One thing that's nice about being an attending is that my time now has some amount of value. In residency, that's less true.
When I was an intern, I came into an attending's office to present some consults to her. She was on the phone and waved me to sit down.
That attending stayed on the phone for thirty minutes while I sat there, staring at the wall, waiting to talk to her.
Finally she got off the phone. I started presenting my patients, and then someone else called. She then spent another ten minutes on the phone with that person. By the time she hung up, I was almost shaking with anger.
What struck me about it was that how, if situations were reversed, she wouldn't wait for me even thirty seconds, much less nearly an hour.
When I was an intern, I came into an attending's office to present some consults to her. She was on the phone and waved me to sit down.
That attending stayed on the phone for thirty minutes while I sat there, staring at the wall, waiting to talk to her.
Finally she got off the phone. I started presenting my patients, and then someone else called. She then spent another ten minutes on the phone with that person. By the time she hung up, I was almost shaking with anger.
What struck me about it was that how, if situations were reversed, she wouldn't wait for me even thirty seconds, much less nearly an hour.
Wednesday, November 7, 2012
Failed lab
When I was in college, I did a summer in a research lab doing something with mice. What, I don't remember. All I know is that by the end of the summer, my hands were covered in little mouse bites. Probably because when they were under anesthesia, I'd cuddle with them in my hands and not be vigilant enough of when they were waking up.
One of my coworkers was a 25 year old graduate student named Elaine. She got engaged that summer and was totally excited about it. At the time she seemed really old, but in retrospect, she seems really young.
Another of my coworkers was a 30-ish post-doc named John. (At the time he seemed really old, but in retrospect, he seems really young.) He was not super happy there, mostly for monetary reasons.
During that fateful summer, two things happened:
Elaine quit her grad program to get a job teaching science at a high school.
John quit his post-doc to get a job "in industry" that paid twice as much.
It never occurred to me that this was a little bit odd that two people quit a lab in one summer. I mean, maybe it isn't odd, I don't know. Maybe people quit grad school and post-docs all the time? The lab itself wasn't particularly horrible. The boss was pretty nice. I found it really boring working there, but I had no idea what I was doing.
One of my coworkers was a 25 year old graduate student named Elaine. She got engaged that summer and was totally excited about it. At the time she seemed really old, but in retrospect, she seems really young.
Another of my coworkers was a 30-ish post-doc named John. (At the time he seemed really old, but in retrospect, he seems really young.) He was not super happy there, mostly for monetary reasons.
During that fateful summer, two things happened:
Elaine quit her grad program to get a job teaching science at a high school.
John quit his post-doc to get a job "in industry" that paid twice as much.
It never occurred to me that this was a little bit odd that two people quit a lab in one summer. I mean, maybe it isn't odd, I don't know. Maybe people quit grad school and post-docs all the time? The lab itself wasn't particularly horrible. The boss was pretty nice. I found it really boring working there, but I had no idea what I was doing.
Tuesday, November 6, 2012
Side Effects
As an intern, I saw a guy in urgent care with seizures who was on Tegretol. The attending asked me, "What are the main bad side effects of Tegretol?"
"Agranulocytosis," I said. (One of the few things I remembered from med school pharm class)
"Right, what's the other side effect?"
"Um..." She's pretty much reached the limits of what I know about the side effects of Tegretol. "Nausea? Dizziness?"
"Look it up."
I went into epocrates and I get the list of common adverse reactions. I read it to her: "Agranulocytosis, syncope, dizziness, nausea, vomiting, hyponatremia, anemia, thrombocytopenia, elevated liver enzymes, photosensitivity, pruritis, edema, arrhythmias, urinary retention, uh... it's kind of a big list. Which one were you thinking of?"
"Elevated liver enzymes."
"Oh."
So somehow my guesses from the list was less correct than her selection from the list. It's nice to be an attending and always get to be right.
"Agranulocytosis," I said. (One of the few things I remembered from med school pharm class)
"Right, what's the other side effect?"
"Um..." She's pretty much reached the limits of what I know about the side effects of Tegretol. "Nausea? Dizziness?"
"Look it up."
I went into epocrates and I get the list of common adverse reactions. I read it to her: "Agranulocytosis, syncope, dizziness, nausea, vomiting, hyponatremia, anemia, thrombocytopenia, elevated liver enzymes, photosensitivity, pruritis, edema, arrhythmias, urinary retention, uh... it's kind of a big list. Which one were you thinking of?"
"Elevated liver enzymes."
"Oh."
So somehow my guesses from the list was less correct than her selection from the list. It's nice to be an attending and always get to be right.
Monday, November 5, 2012
Chlorophyll
When I was doing a pediatric brain injury unit, I noticed that the attending had put several of the patients on chlorophyll tablets. About half the kids on the unit were getting chlorophyll.
Without cheating and looking it up, do you know why this might be?
Hint: It wasn't because they weren't eating and he was hoping they'd start making their own food.
(Answer will appear in the comments by the end of the day.)
Without cheating and looking it up, do you know why this might be?
Hint: It wasn't because they weren't eating and he was hoping they'd start making their own food.
(Answer will appear in the comments by the end of the day.)
Sunday, November 4, 2012
RS3PE
One day in EMG clinic, we had a patient with wrist pain and intermittent wrist swelling. His workup for rheumatological disease was negative and his EMG only showed mild carpal tunnel.
Attending: "So do you think he has RS3PE?"
Me: [thinking: "Am I supposed to know what that is??"] "Uhhh...."
Attending: "That's Remitting Seronegative Symmetrical Synovitis with Pitting Edema."
Me: "Um."
Attending: [points to bulletin board, where article is pinned up] "We saw a really interesting case of it last week. I'll bet that's what he has. Was his sed rate elevated?"
Me: "No."
Attending: "Maybe that's because he got prednisone."
Me: "It was normal before the prednisone."
Attending: "Well, it could still be RS3PE! We should put that diagnosis in our report!"
Me: [thinking] "Just because you have an article about something on the wall, that doesn't mean every patient has it."
I guess the diagnosis is possible. I love the fact that instead of calling it RSSSPE, they call it RS3PE.
Attending: "So do you think he has RS3PE?"
Me: [thinking: "Am I supposed to know what that is??"] "Uhhh...."
Attending: "That's Remitting Seronegative Symmetrical Synovitis with Pitting Edema."
Me: "Um."
Attending: [points to bulletin board, where article is pinned up] "We saw a really interesting case of it last week. I'll bet that's what he has. Was his sed rate elevated?"
Me: "No."
Attending: "Maybe that's because he got prednisone."
Me: "It was normal before the prednisone."
Attending: "Well, it could still be RS3PE! We should put that diagnosis in our report!"
Me: [thinking] "Just because you have an article about something on the wall, that doesn't mean every patient has it."
I guess the diagnosis is possible. I love the fact that instead of calling it RSSSPE, they call it RS3PE.
Saturday, November 3, 2012
Weekly Whine: Tootsie Rolls
My kids went Trick or Treating this week. What did they dress up as? They were both Rapunzel. Oh, the humanity!
They collected a fair amount of candy, a significant portion of which was tootsie rolls. Observe:
After the kids were asleep, my husband started yanking them out of the candy basket in a fit of anger, ranting about how tootsie rolls are the absolutely worst candy, nobody likes tootsie rolls, and why do they even bother to make this disgusting candy anymore?
Then he made me take a photo of the tootsie rolls and insisted I make it a weekly whine.
I sort of agree. I think tootsie rolls aren't that great (although I do like the new fruit-flavored ones), but I don't think they're the absolute worst candy. I think the worst candy is probably Snickers. Objectively. I only say that because when people bring in their Halloween candy on November 1st, it's always the Snickers that are left over at the end of the day. I'd definitely eat a tootsie roll over a Snickers bar.
They collected a fair amount of candy, a significant portion of which was tootsie rolls. Observe:
After the kids were asleep, my husband started yanking them out of the candy basket in a fit of anger, ranting about how tootsie rolls are the absolutely worst candy, nobody likes tootsie rolls, and why do they even bother to make this disgusting candy anymore?
Then he made me take a photo of the tootsie rolls and insisted I make it a weekly whine.
I sort of agree. I think tootsie rolls aren't that great (although I do like the new fruit-flavored ones), but I don't think they're the absolute worst candy. I think the worst candy is probably Snickers. Objectively. I only say that because when people bring in their Halloween candy on November 1st, it's always the Snickers that are left over at the end of the day. I'd definitely eat a tootsie roll over a Snickers bar.
Friday, November 2, 2012
Rugged masculinity
I was reading the note on a patient I was going to see in clinic tomorrow and this is how the orthopod described him:
The patient is a "pleasant gentleman standing 5'11" and weighing 175 pounds who has a muscular, rugged, mesomorphic body build. He appears to be in excellent general medical condition and has well-developed muscles throughout his entire body."
I thought that sounded kind of funny. I mean, it almost sounds like a description from some romance novel. Sort of. Anyway, the guy sounds hot.
The patient is a "pleasant gentleman standing 5'11" and weighing 175 pounds who has a muscular, rugged, mesomorphic body build. He appears to be in excellent general medical condition and has well-developed muscles throughout his entire body."
I thought that sounded kind of funny. I mean, it almost sounds like a description from some romance novel. Sort of. Anyway, the guy sounds hot.
Thursday, November 1, 2012
Names and transcription
I suspect every transcription service handles patients' names differently.
For example, in my current transcription, I always start my transcriptions by saying, "Mr. Smith is a 45 year old man..." and then when I read over the transcript, it's always been changed to "The patient is a 45 year old man..." I have no idea why this is.
At another clinic where I worked, I would always spell out the entire name before transcribing, since I thought the transcriber might not have the patient's name automatically available, so having the spelling might help.
One day, I found out differently:
The patient's last name was really long. Like, a long name hyphenated to another long name. So long that in the printout, the patient's first name, Catherine, got cut off. So it looked like:
NAME: Longname-Secondlongname, Catheri
Then all through the dictation, every time I referred to Catherine, it was written as Catheri:
Catheri is a 12 year old girl with a history of....
So obviously the transcriber does not care that I spelled out CATHERINE and even said it during the dictation. They just took whatever first name was printed out for them and inserted it into their transcription.
Good to know.
For example, in my current transcription, I always start my transcriptions by saying, "Mr. Smith is a 45 year old man..." and then when I read over the transcript, it's always been changed to "The patient is a 45 year old man..." I have no idea why this is.
At another clinic where I worked, I would always spell out the entire name before transcribing, since I thought the transcriber might not have the patient's name automatically available, so having the spelling might help.
One day, I found out differently:
The patient's last name was really long. Like, a long name hyphenated to another long name. So long that in the printout, the patient's first name, Catherine, got cut off. So it looked like:
NAME: Longname-Secondlongname, Catheri
Then all through the dictation, every time I referred to Catherine, it was written as Catheri:
Catheri is a 12 year old girl with a history of....
So obviously the transcriber does not care that I spelled out CATHERINE and even said it during the dictation. They just took whatever first name was printed out for them and inserted it into their transcription.
Good to know.
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