Cute

70-year-old patient: "I love when you visit me, Dr. Fizzy. You're just so cute!"

Somehow I think when my elderly patients look at me, they see what I see when I look at my kids' friends.

Depakote

This is one for all the neurologists and psychiatrists out there....

Grading Med Students

I found this on the wall in a clinic and have no idea where it came from. If anyone knows where it comes from, please tell me so I can give credit.

How to Grade a Medical Student

99 Magnificent
98 Superlative
93 Extraordinarily strong
88 Notable
83 Wonderful
80 Teriffic, radiant, humble
78 Accomplished
75 Non-steroidal anti-inflammatory
70 Well-read
65 Capable
60 Intermittent
55 Well above mean
50 Strong
45 Hearty
40 Friendly
35 Well groomed
30 Attentive and respectful
25 Pleasant
20 Punctual
15 Imminently about to blossom
12 Present and fully continent of all excretory functions
10 Normocephalic and nonfelonious
8 Claudicative
6 English speaking
5 Ambulatory
3 Respirating and well perfused
1 Charmingly fresh in outlook
0 Eukaryotic and possibly diploid

Dr. Orthochick: Bad Reaction

Me: Well, I looked at your x-rays and you broke your shoulder--

Patient: Oh my G-d, really? I think I'm going to throw up.

She then threw up.

Never had anyone have that reaction before.

Pants

During one of my fluoroscopic injection clinics, one of the patients:

--Refused to take off her pants. Seriously, if you're going into an OR for a procedure in your lower back, you have to take your pants off.

--Her daughter handed me a bunch of disability paperwork she was insisting that I fill out, despite the fact that we had never met the patient before and all we were asked to do was stick a needle in her spine.

Thanks for that referral, ortho!

Weekly Whine: Same Love

Recently I took some flack for declaring on this blog that Same Love was one of my least favorite songs of the year. I'd like to defend that position.

First of all, I am extremely pro gay marriage and get furious at anyone who feels people should be denied rights due to their sexual orientation. I love the It Gets Better campaign--the commercials always make me tear up.

That said, I still hate the song Same Love.

Before I even knew exactly what it was about, I used to switch stations when it came on. I didn't like the hook and I didn't like the preachy, whiny tone of the rapper's voice. It just grated on me.

And if that were any other song, it would be fine. I don't like the song Icky Thump but nobody ever verbally attacked me for that. But because the song has a social message, now I am forced to like it. I'm a bad person if I don't like it, despite how crappy a melody I think it has.

Of course, when I actually listened to the lyrics, I liked it even less.

These are the first lines:

When I was in the third grade I thought that I was gay,
'Cause I could draw, my uncle was, and I kept my room straight.
I told my mom, tears rushing down my face
She's like "Ben you've loved girls since before pre-k, trippin' "

Aside from the obnoxious use of the word "trippin", I really hate when people precede a gay rights speech by establishing that they're not gay. Because I feel like if you do that, you must be bothered by it on some level. I mean, why say it otherwise? "Hey, gay people should have equal rights, and BY THE WAY I'M NOT GAY MYSELF. NOT AT ALL."

Plus what he says isn't even true. There's research indicating that little boys who play with girls early on are more likely to be gay.

The lyrics become increasingly heavy-handed after that. For example:

The right wing conservatives think it's a decision

That's an actual line from the song. Could we be a little less subtle? And anyway, he means the right wing social conservatives, not the fiscal conservatives. And I'm certain they don't all think that. I feel like grouping all conservatives into one bigoted little stereotype makes liberals look like jackasses.

Look, I will try to push aside my cynicism and say that maybe Macklemore had good intentions and didn't just write the song to make money from it and increase his fame. Maybe he meant well. But I still think it's an irritating song.

In any case, my real point is that if you want to get pissed off at me for my ideology, that's fine. But don't get pissed off because I don't like a song. That's just silly.

Lies

Patients lie. Constantly. It's frustrating enough to make a diagnosis without half the things the patient says being freaking lies. Or better yet, they intentionally omit things.

Sometimes it's due to embarrassment. Like I had one patient who didn't want to admit to me that his stroke symptoms occurred while he was having sex with his wife. That's understandable, I guess.

We assume everyone is lying. No matter what they tell us, we always get a urine tox. We always add few drinks to what the patients say their daily EtOH consumption is. Even if a woman claims she hasn't had sex in a year, we do a pregnancy test. I've heard the whole logic of starting pap smears on woman at age 21 regardless of sexual activity is that if a woman is 21 and says she's never had sex, she's probably lying.

It's sad that it's gotten to the point where if a patient asks for an excuse to stay out from work or a few vicodin, my radar goes up immediately... even if they very clearly need what they are asking for.

For example, a while ago, a quadriplegic patient asked me to fill out a disability form for him (for a few weeks) because he had fractured his leg and couldn't transfer into his car anymore to drive to work while in the cast, my automatic thought was, "Is he trying to sucker me into signing a disability form?" That's really and truly sad that I've been conditioned to think that way. It's not good to be a pushover, but I wish I weren't that skeptical.

My Life

"Hi, this is Dr. McFizz from physiatry."

"Podiatry?"

"No, physiatry."

"Podiatry?"

"No, physiatry."

"Spell it."

"P-H-Y-S-I-A-T-R-Y."

"Oh! Psychiatry!"

Dr. Orthochick: Meaty

Me: I just got paged down to the trauma unit to check out a patient's hand because, and I quote, "the meaty part looks funky."

DP: They're not even trying anymore, are they?

I also tried asking what was so "funky" about it, but the answer involved some repetition of the phrase "the meaty part looks funky. I can't describe it. You have to come down and see it" so eventually I gave up and went down there.

To my (actually very trained) eye, there was nothing funky about the meaty part of the hand. The patient agreed with me.

For bonus points, anyone feel like guessing where "the meaty" part of the hand is?

Would you do it again?

Apparently, less than half of physicians would choose medicine as a career if they had it to do over again.

If you are in medicine, would you choose it again if you had it to do over again?

I wax and wane. Right now, I guess I would. I have a pretty easy job that pays pretty well. I'd probably be less satisfied if I were working twice as many hours and earning the same salary.

SDN and Twitter

I finally sold out and made a Twitter account. Follow me! Or tweet me. Or whatever you do to people on Twitter.

Also, I have a guest post today on SDN. Check it out.

Kitchen Disaster

Today I had to throw out our entire dinner for the first time in a long time because it was DISGUSTING.

I bought raw chicken tenders.

Marinated them about 5 hours in a store-bought honey-mustard marinade.

Put them in oven at 350 degrees for 15 minutes on a small bed of rice.

The texture of the chicken was horrible. They were juicy and cooked through (not pink), but tasted raw... almost jelly-like in texture. Inedible. So much wasted food.

What did I do wrong?

Also, I have some of the raw chicken leftover that I was going to fry up tomorrow but now I wonder if I should just toss it. It smells okay.

Weekly Whine: Red Velvet

I like red velvet. I really do. But seriously, enough already.

I first heard about red velvet about ten years ago. I was working with this guy who said that his girlfriend loved red velvet cakes and he was trying to figure out how to either make her one or order one.

I don't think he'd have that problem these days.

Seriously, everything seems to be red velvet. You can't see a dessert platter anymore without at least one red velvet dessert on it. Red velvet cakes, cupcakes, muffins, cookies.... you name it. I haven't had red velvet ice cream yet, but I'm sure that's next.

I like red velvet, but I liked it way better when it was something special.

Sweetie

Lately, I've been calling my female patients "sweetie" a lot.

It's mostly because I call my kids and their friends "sweetie" sometimes. And sometimes my patients really remind me of kids.

Do you think that's offensive? It doesn't bother me when people call me that... actually, I sort of like it.

Top 4 Fears in the OR

Dr. Orthochick: Critical

Me: ...and he had 5 degrees of dorsiflexion. So the xrays showed--

Dr. Critical: Do you mean "radiographic analysis depicted?"

Me: Yeah

Dr. Critical: You mean, "yes."

*sigh*

--

Thanks to everyone who helped promote The Devil Wears Scrubs yesterday! It's still on sale for only 99 cents for a limited time. Also, if you were supposed to get a free copy but haven't received it yet, please send me an email because they should have been all sent out!

Promotion tomorrow

There will be a 99 cent promotion of The Devil Wears Scrubs which starts tomorrow, Monday, Jan 13 at 3AM PST.

Remember, if you put up a link to the Kindle book with the discount price on any media (Twitter, a blog, Pinterest, Facebook, Tumbler, etc.) then I will gift you a free Kindle copy.

(If you are interested, please put up the link on Jan 13 and email it to me before midnight (PST) that night. You must include the link in your email as well as the email address you use to access Amazon so that I can gift you (or a friend) the Kindle book. I'll send it to you the next day.)

Or just consider buying a cheap copy!

Primary Care Complaints

I had a young patient in primary care clinic who ALMOST made me laugh out loud at him. Like I was just barely holding it in. He came to me with a list of complaints:

1) He wanted to know where to buy jujubes

2) He had toe fungus (OK, reasonable)

3) Every time he turned on his computer, he felt tired all over his body. Maybe the electricity is causing it? (his suggestion)

4) He can't hear very well out of one ear. He'd like me to refer him to a surgeon who can operate to "replace his nerves"

5) He thinks that he swallowed a piece of metal somehow. "Like a staple, only bigger". He doesn't remember doing it, but he's pretty sure he did because now his stomach feels strange (not painful, just strange) and he thinks the metal is lodged in his stomach. Also, he thinks he might have organ failure in his stomach. He wanted to know if someone punches him in the stomach and it doesn't hurt, if that means he has organ failure.

Me: "Uh, are you saying that someone punched you in the stomach and it didn't hurt?"

Him: "No, I just want to know if someone punched me in the stomach and I have organ failure, it would hurt."

Me: "Um... it will hurt. Don't punch yourself in the stomach, okay?"

At this point, I was beginning to feel like I was being punk'd or something. I was like, is this guy for real? I thought any moment the hidden cameras were going to come out. Then he came up with this one:

6) He went to the bathroom and wiped himself with some newspaper (god knows why). He's afraid the newspaper might have had diseases on it. He'd like to be tested for any chlamydia, gonorrhea, or HIV that he might have gotten from the newspaper. Also, he doesn't want to have the test here. He'd like us to give him a kit to test himself for chlamydia, gonorrhea, and HIV in the comfort of his own home.

I couldn't even present this patient to my attending without cracking up.

Weekly Whine: Mushrooms

I was at the supermarket the other day and I reached for a package of fresh sliced mushrooms. This random old guy standing next to the mushrooms gets my attention.

Man: "Can I ask you a question about mushrooms?"

Me: "Uh. Okay."

Man: "Doesn't it make more sense to buy whole mushrooms rather than sliced?"

Me: "Well, this way I don't have to slice them or wash the dirt off."

Man: "It's not like they're hard to slice."

Seriously??? I can't even buy mushrooms in peace without some busybody criticizing me?

I think if buying sliced mushrooms makes my life a little easier, I'm entitled.

Want to be a clown?

An actual email I once got:

Would you like to give the healing gift of laughter to sick an orphaned children?

Have you always wanted to be a clown?

The Gold Foundation is sponsoring a medical student to accompany Patch Adams on his annual Clown Trip to Russia (November 2004).

Each year, Dr. Patch Adams brings a group of clowns, who also happen to be healthcare professionals, to Russia for two weeks to clown for children in hospitals and orphanages. Through the Jonathan Aaronson Memorial Fund, the Gold Foundation is sponsoring one medical student to participate in this extraordinary trip.

Each GHHS Chapter is being offered the opportunity to submit a student for consideration. No previous clowning experience is necessary. The GHHS Chapter Advisor should forward to the Gold Foundation the selected student’s statement of interest no later than July 30th.


I still regret not taking the opportunity to be a clown. I mean, I already went to clowning college. (I mean, Princeton.)

Lab Results That Make Me Smile

1. When it turns out the Staph aureus growing out of your patient's blood is not methicillin resistant

2. A second set of cardiac enzymes that is negative

3. Electrolytes that don't need to be repleted

4. A bacterial culture that is initially read as gram positive cocci, but turns out to be skin flora

5. A positive U/A in an elderly altered mental status patient

Dr. Orthochick: Calculus

Patient's wife: We're worried he might have a brain injury from falling off the ladder

Me: Well, the CT scan didn't show anything but just to make sure, we'll do a cognitive screen on him

Patient's wife: What if he has a brain injury that's so severe that he can't work again?

Me: Sir, what is the derivative of 3x squared?

Patient: 6x.

Me: I think he'll be OK.

For the record, I was the only person in the room who knew he was right. Thank you, premed calculus requirement. You finally came in handy for something.

(Fizzy says: You should have asked the integral of 6x and dinged him if he left off the constant.)

Sick vs. vacation

So here's a question:

Say you get sick unexpectedly and have to take several days off from work. Like, a whole week off. Which come out of your sick days, but still, you're out for a week and everyone has to cover for you.

A couple of weeks later, you have a week of vacation time scheduled, during which time you don't have any travel plans. Should you cut back on your vacation time, due to inconveniencing everyone when you were sick?

I say you shouldn't. But other people I know seem to mumble under their breath differently.

Weekly Whine: Don't get sick in July

Does every single medical blog on the planet have to have an entry about why you shouldn't get sick in July?

Yes, we get it. Everyone moves up in their training in July and is therefore incompetent. And yes, it sucks.

But since nobody can actually control when they have a heart attack, I don't understand the point of 10 billion posts on this topic.

Dictation error

One thing our transcription service does is expand abbreviations for us. So for example, if I said, "The patient had a CVA," the dictation would read, "The patient had a cerebrovascular accident."

That's all fine and good. Unless the transcription gets it totally wrong.

What I said: "Following her CVA, the decision was made to give the patient TPA."

From the transcription: "Following her cerebrovascular accident, the decision was made to give the patient total parenteral alimentation."

Really? That's the abbreviation that gets put in for a transcription service used by a stroke service? I've never even heard that abbreviation before.

Top X lists of 2013

I like making lists.

Top 5 Favorite Books of 2013:

--Gone Girl by Gillian Flynn
--Inferno by Dan Brown
--Wonder by RJ Palacio
--What Alice Forgot by Liane Moriarty
--The Racketeer by John Grisham


Top 3 Least Favorite Books of 2013:

--Size 12 is Not Fat by Meg Cabot
--Life of Pi by Yann Martel
--The Cuckoo's Calling by JK Rowling


Top 7 Favorite Songs of 2013:

--Feel This Moment
--Blurred Lines
--Counting Stars
--Heart Attack
--Can't Hold Us
--Just Give Me a Reason
--Radioactive


Top 4 Least Favorite Songs of 2013:

--Love Somebody
--Demons
--Gone Gone Gone
--Same Love

Top 5 Favorite Movies of 2013:

I had time to go to the movies 5 times in 2013??

Anatomical Cartoons