Respect

Time and again, I vow not to get involved in childish namecalling fights on my blog. And while I've gotten better, I'm still sometimes sucked in.

I welcome arguments. I genuinely do. I think they're fun (although if you say something ridiculous, I do reserve the right to make fun of you a little). But when it becomes clear that the other person doesn't want to argue (or maybe is incapable) and is really just trying to make me feel bad, then what's the point?

For example, on the recent post I made about smoking, people wrote in with general arguments about why it's hard to quit, and I respect that. Some of them were angry but at least the arguments were focused. I could respond like an adult and I even learned a few things. Even when a couple of people overreacted to my tongue-in-cheek Women Rock post, they at least used real arguments. Whereas when I made my most recent Nannygate post, I encountered a person who apparently felt the only way to respond to my arguments was to condescendingly say I was going to get in trouble for writing about the topic! That's not productive and certainly doesn't prove your point. Essentially, you are saying you can't win the argument so you are going to personally attack me instead.

So I've created a page to link to whenever an argument degenerates to that point.

Hopefully I can avoid temptation with this...

Guest Comic: Happiness Scale

Cartoon contributed by The Health Scout

Women Rock

I think after taking my ob/gyn rotation, I had huge respect for females.

Women do things willingly that men could never ever do. They have babies, which is enough in itself. Women also wax, pluck, pierce (OK, men pierce too, but there's no accounting for masochism), and wear high heels.

What do men do? Nada. Well, tattoos, I guess.

I've seen too many women in excruciating pain while their husbands/boyfriends looked on with total lack of understanding. Men are babies.

Dr. Orthochick: Stabbed in Eyeball

Scene: Outpatient Clinic

Me: Do you want me to see the new patient?

Dr. Attending: It depends. How much do you feel like stabbing yourself in the eye with a stick?

Me: Uh...

Dr. Attending: No, I'm serious! How many times do you feel like stabbing yourself in the eye with a stick?

Me: Well, when you phrase it that way...

Dr. Attending: So you don't want to stab yourself with a stick?

Me: Not especially.

Dr. Attending: Then we'll see the new patient together.

I'm not sure what the correct answer to that line of questioning was.

Add ons?

This isn't worth being a Weekly Whine, but WTF is up with Amazon Add-ons?

When I started paying for Prime, I thought I was done having to get to $25 to get my free shipping. Now there are these add on items that I can't get AT ALL unless I buy $25 in other products. Seriously??? So lame, Amazon.

Nannygate revisited

In my recent Nannygate post, about the danger you put yourself in just by the act of hiring a nanny, some people complained that the examples I used were people who were less than sympathetic. Because if you break the law and you're rich, that is not okay.

I could give the example that inspired this post, a lovely colleague of mine, but I feel it's not my place to do so.

Therefore, I will link to this article. It's about an average couple who tried to pay their nanny taxes and screwed it up multiple times in spite of expert advice, resulting in large fines, and ultimately resulted in them losing their nanny. They also mention Nancy Killefer, who had to withdraw from her nomination for chief performance officer due to an error in nanny taxes (she tried to pay but made a mistake). Their final words of advice are to use a daycare or hire a professional company to do your taxes.

In summary, people who don't pay under the table are triply screwed:

1) They have to go through an overly complicated process to figure out the taxes, essentially equivalent to that of a real company

2) This process is highly susceptible to error and therefore fines

3) There's a lower selection of nannies since many refuse to be paid this way and there are plenty of families happy to comply for the above two reasons

Please don't say this isn't an incredibly broken system.

Weekly Whine: Smoking

I'm sorry to say this, but I think smoking is the most horrible, disgusting habit in existence.

And I'm not saying that in a judgmental way, that I am a better person than you because you smoke. And that you're going to die earlier and drive up health care costs for everyone. Let's put all that aside.

I hate cigarettes because of the smell.

When you smoke a cigarette, even if you go outside, even if you spritz yourself after, you stink. And then if you are in an enclosed room with me, like because you're my patient or I have to deal with you in some other way, I can't breathe. The smoke clinging to your clothes interferes with the oxygen I'm trying to breathe in. And if I have a cold (which I almost always do), then nothing brings on a coughing fit like being in a small room with someone who was just smoking.

And obviously, actual smoke is a million times worse. Prior to current laws, I've had meals completely ruined because someone was blowing smoke on me the whole time. Also, there are the times when someone's been smoking right outside my car, and somehow when I get in the car, it smells like cigarettes.

If you're a smoker and you're offended by this, I'm sorry. But you should know that everyone around you thinks that you stink.

Transcription Errors

What transcription heard:

This patient is taking up too much room.

What was actually said:

This patient was taken to the Operating Room.

Nannygate

Do you know who Janet Reno is?

Of course you do. She was attorney general under Bill Clinton.

Do you know who Zoe Baird is?

Probably not. She was Clinton's first nominee for attorney general. But she was withdrawn from consideration because she hired an illegal immigrant to be her nanny and did not pay taxes on them. "Her husband filed sponsorship papers at the time and sought the advice of counsel on paying taxes. She paid $2,900 in fines for the infractions."

Do you know who Kimba Wood is?

She was Clinton's second nominee for attorney general. Who also ended up having hired an illegal immigrant to be her nanny. Finally, Janet Reno, who was childless, got the job.

Maybe Baird and Wood were really immoral people. Or maybe this is just something that a LOT of women do.
After all, nanny's are very very expensive. Far out of a lot of working women's price range. Immigrants make the impossible affordable. And the taxes are a baffling ordeal that the government makes as confusing as humanly possible and only adds to the exorbitant cost.

As I've mentioned before, I paid 40K for daycare last year. It's pretty messed up that you have to earn well over 40K after taxes to make working financially worth it. I think we should examine that system before we vilify women who use alternative pathways to try to make it work.

What the dean says....

Please welcome guest blogger Orthochick, a friend of mine who is currently an orthopedic surgery resident. I'm hoping she's going to do a regular spot on the blog, so let's all make her feel real welcome!

In medical school we had the option of going to a monthly "dinner with the dean." At first they really filled up, then people figured out that it was just sitting around listening to the dean talk about how wonderful he was and how many articles he had published and we stopped having them for a while due to low turnout. In my last year of medical school we had one that was supposed to be about how to improve 3rd and 4th year clinical rotations.

Anyway, the meeting was between the dean, a couple of associate deans, and a pile of students. As is the case with everything in medicine, it came down to communication. Communication is a big deal. So while listening to the deans, I noticed that there were a lot of subtle nuances to the med student--dean relationship.

What Deans Say and What They Really Mean
(what they mean is bolded)
We are the only school in the country that does this-->The rest of them understand that it's pointless
We've had a good response so far-->No one's complained out loud
You received a lecture on this topic-->Someone talked at you for 5 minutes right before we let you go for lunch
We'll give you the email address of someone you can contact-->This will guarantee that it will never get done
We're always available to talk with you-->At these carefully structured hour-long meetings
It would be a good idea for you to-->Why the hell did you not think of this on your own?
I understand that this is difficult-->I don't understand why this is so hard for you

That being said, deans are not the only ones that require a little decoding. When you're in a room with a bunch of deans, you have to keep it tactful.

What Med Students Say and What They Really Mean:
(what they mean is bolded)
I don't think I'm the only student with this problem-->Whenever a group of us gets together, we complain about this
I know they mean well, but-->They're heartless creatures but they're in charge of my grade
I think that would be a great solution-->That's the worst idea I've heard all month and clearly you have no idea what it's like to be a student here
One thing I've heard of them doing at other schools-->In my dreams
I'm confused about the expectations-->I spent 8 weeks standing around looking and feeling dumb
I realize this might sound insignificant, but-->This has been an ongoing problem that's bothered me for the past 4 years
Thank you for your time-->I got nothing out of this

As you can probably guess, not very much was accomplished during this meeting or any other meetings. At the end of the meeting the dean started getting snippy and said it was up to us to take responsibility for our actions and our future already, and the other deans spent the whole time on his iPhone, and the other 3 didn't really say anything. So after 2 hours we called it a night and to the extent of my knowledge, they never had one of those again.

(and I left the state a few months later)

Stages of reading an ECG while on call

Stages of reading an ECG while on call:

1) Walk all the way across the length of the hospital to read ECG on patient so that I could rule out MI and let him finally eat

2) Arrive on ward only to be told by the clerk that the ECG never happened... she thought I wanted it for the morning.

3) Write a NOW order for ECG and walk all the way back across the hospital to admitting

4) Arrive at admitting and immediately get paged by patient's nurse, saying that there was a mistake and the ECG had been done

5) Go back across hospital to read normal EKG

6) Go back to admitting, collapse into a chair, and drank about a bottle of water.

Weekly Whine: CMEs

For those of you early in your training or not in medicine at all, CME stands for Continuing Medical Education. Basically, you have to earn a certain number of CME credits each year (each credit = 1 hour) in order to maintain your medical license.

The number of yearly CMEs you need varies from state to state. Some loser states, like Wyoming, only require 20 per year. (Just kidding, Wyoming! You're not really a state.) Other more awesome states like mine require up to 50 CME credits per year (in my case, it can be averaged over three years). Some states have crazy requirements for the CMEs, like you have to take 20 credits while, like, balanced on your head.

Now I do appreciate the importance of continuing medical education. I just don't see the importance of CMEs. I think it's important for doctors to constantly be reading and learning, but I question whether CMEs really contribute to learning. Here's why I think so:

1) I think you learn best when you read about something right after you see it. Seen a case of Klinefelter's Syndrome? Read about it! But you might not necessarily find something that gives you a CME for doing that, so instead you have to read about, like, Turner's Syndrome. Which is totally different.

2) CME courses are rough. I don't know about you people, but after being out of a classroom setting for close to ten years now, I find it very hard to sit in a lecture hall for eight hours straight several days in a row. By the end, it's less about Pain Management and more about Words with Friends.

3) It's WAY too tempting to cheat on online CMEs. Just sayin'.

4) I think I read a study somewhere that said CMEs don't contribute to doctor knowledge.

But I guess if we got rid of CMEs, there would be a very real risk that older doctors would be running around, trying to cure pneumonia with leeches or something, so I guess CMEs are here to stay.

Cirrhosis rumors

Me: "How do you know you have cirrhosis?"

Patient: "They told me I did."

Me: "Who told you?"

Patient: "Oh, you know."

Me: "Did you ever have a liver biopsy?"

Patient: "No..."

Me: "Well, the ultrasound and the CT in the computer actually just show that you have some liver inflammation, not cirrhosis, so I'm just wondering who told you that. Was it a doctor?"

Patient: "No."

Me: "Then who told you?"

Patient: "A friend told me she thought I had cirrhosis because my eyes are yellow."

And then it goes on her problem list FOREVER.

Mini-lectures for primary care

Things I Loved As a Kid But Now Hate

1. Being tickled

2. Roller coasters

3. Slides, especially long twisty ones

4. The 'Burbs (and mostly Tom Hanks)

5. Cotton candy

6. Twister, Operation, basically any board game

7. Care Bears

8. Play-dough

9. Bunk beds or anything other than a normal bed

10. Trampolines


Possibly yet to come:
Things I loved as a kid and still love
Things I hated as a kid but now love
Things I hated as a kid and still hate

Purposeful?

Do you think if someone gives their child a name where both their first and last name are other words for "penis", that is likely to be purposeful? I'd think it sort of has to be.

(e.g. Peter Johnson)

Many emotions

I recently discovered this collage I made:



Hmmm, guess whether I made this for my first or second kid...

Weekly Whine: Steamers

I really hate all the bags of vegetables in the supermarket that you are supposed to steam in the bag.

1) They're twice as much money as normal vegetables

2) You can't decide how much of the vegetable you want--you are essentially forced to use the whole bag. I prefer to use a little bit of several different vegetables rather than a whole giant bag of, say, asparagus.

I know, I could just not buy it. And I don't, believe me. But when 75% of the vegetables in the aisle are taken up by the steamfresh bags, then there isn't much room left over for the frozen veggies I actually want to buy. So I'm constantly unable to get the vegetables I really want.

Surgical knot

Yesterday my daughter found a piece of long string and I decided to see if I could still tie a surgical knot. It took one or two tries, but against all odds, I was able to do it! Unbelievable what you can still remember after so many years. I guess it's like riding a bike. (Except that I can't really ride a bike anymore.)

My husband was unimpressed: "What's so great about a surgical knot?"

Me: "Well, when you tie someone's stomach closed, you want a knot that won't come undone, right?"

Actually, during one of my first surgeries, the surgeon let me tie the knots. I had not yet mastered the technique and as the patient was waking up, two of the knots came undone. The chief resident looked like he wanted to murder me as he quickly retied them with the tiny ends.

Husband: "Is a surgical knot really so much better than a regular knot?"

Me: "Yes."

He tried tying some regular knots in the string, which we were able to undo easily. Then I tied some surgical knots, which could not be undone, thus proving my point and thereby, the superiority of the surgical knot.

Butt Balm

Do all hospital have "butt balm"? It's an ointment that the nurse or whoever rubs over the buttocks for a rash.

I feel like I've written so many orders lately for Butt Balm qShift that I don't even giggle anymore when I write it.

I Quit

I just received the following letter from my ENT (I went to him once, when I had labyrinthitis):

To all my patients,

After over 46 years of practicing otolaryngology I have decided to retire. I have enjoyed my medical life and leave it with some regrets. Although I am still in good health, the economics of medicine today leaves me with little choice.

All business costs steadily increase, but much of our reimbursement is fixed by our government at a level it considered reasonable 15 years ago and is going down this year.

A recent statement by the St. Mary's Hospital Chief of Staff is very true: "Federal and state laws and imposed regulations have made doctors wage slaves of the federal government and insurers, medicine a public utility, and patients victim of an unjust system of health care delivery."

The cost to practice medicine will continue to increase, even without the gigantic outlays expected for implementing electronic health records, yet the federal government plans to continue to decrease physician reimbursement annually.

Of course, this is a guy who spent about ten minutes talking to me, looked in my ears, and charged about $300 for this.

Chief complaint

Patient: "Doctor, my toe hurts."

Me: "Which toe?"

Patient: "My big toe."

Me: "Which foot?"

Patient: "Oh, I don't know."

Me: "You don't KNOW???"

Patient: "Well, it doesn't hurt right now. It just hurts sometimes. Also, I was worried about it because my grandmother had... uh, goiter."

Me: "You mean gout?"

Patient: "No, I think she had a goiter. What's the difference between goiter and gout?"

Me: "Gout is what you get in your toe joint. A goiter is in your neck."

Patient: "Yeah, she had a goiter."

Career Killers

I've talked a lot on this blog about my decision to work part-time (although still quite a lot of hours per week). A lot of young female physicians with small kids make this decision nowadays.

Recently I've been offered opportunities to work more hours and take on more responsibilities. The opportunities seem plentiful, waiting for me when I'm ready. But I don't feel ready.

When my youngest is in kindergarten, I'll still be under 40, which is the age some of my colleagues are graduating from residency. Maybe at that point, I'll be ready to expand my career. Here is the question though:

Have I done permanent, irreparable damage to my career by taking these early years as part-time?

It's my feeling (and hope) that no, I have not. The accomplishments I might have made by age 45 may have to wait till I'm 50 or older, but that's okay. I feel like the time with my kids is fleeting, whereas my career can be expanded at any time.

I think there is an impression out there that once you go part-time, you can't go back. You have permanently labeled yourself as not serious about your career. And considering at least half of new physicians are female and may want to cut back when their kids are small, I think it's a huge mistake to say these women are permanently out of the game. I know there are plenty of women who would love to embark on a more serious career once their children are in school. Unfortunately, I think it becomes a self-fulfilling prophecy. These women get labeled as not caring as much about their career, so they may start to really believe that's true.

It's also a shame because I think that some women who would like to go part-time for a couple of years are scared to do so because they feel it will permanently wreck their careers.

Impressions

Patient who canceled appointment 3 times prior: "So we finally meet. You don't look anything like I thought you would, Dr. McFizz."

Me: "Oh, really? How did you think I'd look?"

Patient: "Oh.... I thought you'd be about... 80 years old. Instead you're this young, cute little girl."

Me: "Uh........ thank you?"

Weekly Whine: Handshakes

I'm not going to complain about shaking hands in general, even though I probably could. Considering I work in a health care field, shaking hands seems like an excellent way to spread viruses.

No, this is about how every now and then, I shake some guy's hand and he feels a need to completely crush my hand in his. My hand is literally in agony for several minutes after the handshake.

I understand wanting to have a strong handshake, guys. I'm sure it asserts your dominance and is more hygienic than peeing on your territory. But if you're going to shake hands with a small woman with a tiny hand, maybe you could tone it down a notch, huh? What is the point of squeezing a woman's hand to the point of causing pain?? Do these guys simply not realize what they're doing and do they enjoy doing this?

Seasons

My daughter asked me the other day why the day is so long in the summer.

It actually surprises me sometimes how many adults don't understand the real reason why we have seasons.

Without looking it up or at the other comments, do you know why we have seasons?

Worst smells

The worst smell in the hospital (and definitely at home) in my opinion is vomit. Of all smells, I find that the absolute most detestable. I think I'd rather be in a room of C diff diarrhea than a room of vomit. (Sadly, there have been situations where I've essentially been given that choice.)

What do you think? What is the worst smell in the hospital?

(P.S. Isn't this the best topic EVER??)

Just a thought

Most annoying 5AM page:

"Hi, I'm calling from [Random Hospital miles away]. Does your rehab service do outside consults?"

The answer was no, but it was such a bizarre call, so I though maybe I was missing something. "Do you have an acute spinal cord admission?" I asked.

"I don't know," the person said.

Huh? "Well, what's wrong with the patient?"

"There's no specific patient. I just wanted to find out if you do outside consults."

Huh?????? So it's 5AM and this person decides to page our hospital and wake up the on call person to ask a general question of whether or not we do outside consults?? WTF?????????????

"Everybody told me you don't do outside consults," the person added, "but I wanted to make sure."

Honestly, I wish I hadn't been so tired and disoriented, because I would have liked to grill this person on what they were thinking by calling us. You're asking for a consult from another hospital and you don't even have a patient in mind??? But in an attempt to actually get some sleep, I just told them we don't do outside consults and hung up.