Dr. Orthochick: Unnecessary tests

Me: I don't think we need to order an MRI. He probably has a meniscus tear, but he has so much other stuff going on that it's not like we're going to do anything about it.

Dr. Douche: What are the drawbacks to getting an MRI?

Me: Cost

Dr. Douche: Are you paying for his MRI?

Me: Not directly...

Dr. Douche: Does he have to pay for his MRI?

Me: Uh, I think so.

Dr. Douche: No, it's covered in the copay. So the only person who has to pay for this is the taxpayers. So there are no drawbacks associated to getting an MRI. Order an MRI.

...and that's why healthcare costs are so high. Because there's no downside to ordering expensive and unnecessary tests.

What's that noise?

Me: "Oh my God, what's that beeping noise? It's so annoying! Where's it coming from?"

Husband: "Isn't that your pager?"

Me: "Oh. You're right."

What can I say? I don't get paged a lot.

Review

If you read and enjoyed Suicide Med, please consider leaving a review on Amazon! I would be incredibly grateful.

If you read and did not like it, please consider keeping that information to yourself!

Weekly Whine: Daycare, Part 3

I mentioned last week about how I felt the daycare wasn't feeding Babygirl enough. That was bad enough, but what ended up happening is they became completely obsessed with her clothing.

I have to admit, Babygirl did not have the best clothing. A lot of it was used, some stained. But seriously, they grow out of clothing so fast, I couldn't bring myself to buy new, beautiful clothing for her. I'm just not that kind of person.

Anyway, one time the director of the daycare called me at work, and said she had to talk to me about something important. Apparently, Babygirl’s teachers had complained that the outfit she was wearing that day had stains on it.

I assure you, the outfit was 100% clean. I guess the stains did not come out in the wash and my husband, who dressed her, didn't care. I really didn't think it was that big a deal, but they said it had happened before, and were acting like they were going to call child protective services. They didn't say that, but it was how I felt.

Later, I got a similarly ominous phone call from the daycare director, complaining that I dressed Babygirl in a onesie for daycare. It was the middle of July and I didn't think that was inappropriate. But apparently it was.

Meanwhile, they weren’t even feeding her.

I was actually crying over the whole thing. In retrospect, I think it was ridiculous. But at the time, it made me feel like a terrible mother. I started buying new clothes just for the daycare.

I especially didn't like the fact that the teachers didn't tell me directly and instead reported me to the director. The director claimed it was because they didn't want to damage their relationship with me, but it really made me hate them. Finally, I said to one of them, “If you have any issues with Babygirl, please talk to me directly."

And the woman said to me, "OK, now that you gave me permission, I can talk to you directly."

Honestly, I felt like I was on crazy pills. What kind of daycare is this where your teacher needs permission to talk to you about your own child?

Profile of a First Year Med Student

Dr. Orthochick: Self-defense

I was palpating a guy's biceps tendon today in clinic when he grabbed my hand, twisted it behind my back, and put me in a headlock.

Patient: Oh, sorry, Doc. I should have warned you about that.

I guess that counts as a positive test. Also, never do a physical exam on a military guy without backup.

(It actually kind of hurt my wrist, but that wrist has been hurting for around a week now. I reduced a hip last Friday and I must have been positioned wrong because i felt a pop in my wrist and it's been sort of sore ever since. I was worried I tore something (TFCC came to mind) but I have full motion and almost full strength, so I don't think I did. But it's been clicking nonstop since then and having it forcefully twisted behind my back really didn't help the situation)

Cursing at work

Colleague: "I can't believe we lost the fucking nursing home bed for this patient."

Me: "..."

Colleague: "Please excuse my language."

I don't mean to look so offended when somebody curses at work in my presence. I'm not actually offended.

But it does seem out of place to me. I don't curse at work or at home or really anywhere. At home, I don't want my kids to pick up that habit. And at work, I just don't think it's appropriate.

But on the other hand, I don't want a reputation as the prude who doesn't like it when people curse. Hey, it's not like I complain out loud or anything.

Weekly Whine: Daycare, Part 2

Our previous daycare worked really well for my older daughter, but I ended up having a lot of problems with my younger one. I was constantly unhappy, yet hesitant to switch because we had been with them for a while and I trusted them to at least keep the kids safe. Plus they had the best hours in town.

Babygirl has always been a picky eater. When it came to breastmilk from the source, she was eager, but not so much for bottles. And not so much for real food now.

Anyway, I would bring four 5-ounce bottles to daycare every day for Babygirl to drink. At the end of the day, two of them would usually still be completely full.

Of course, being a pumping mom, my main gripe initially was that I had to throw out the milk in those two bottles because they were defrosted. But then it became clear that my daughter was not getting anywhere near the amount of nutrition she should have. I suspect that even the two bottles she was having were not being finished because they didn't have the patience to sit with her while she took her time.

In any case, I watched Babygirl’s weight drop from 25% to 10% and then below 5%. The pediatrician was concerned.

I did complain, but things didn't improve until she was eating solid foods. And even then, her weight was low for a while. Now she's back up to a healthy 50%.

I guess this problem is a side effect of having a baby in daycare, where they can’t get one-on-one attention as much. But I was annoyed that the daycare didn't seem to be making any effort. For example, when she was one year old, during snack time, all the kids got water. I brought a note for the pediatrician saying that she should get milk during snack time, but they continued to give her water. It was like they really just didn't care about her at all.

Help?

I'd like to try to get a little bit more exposure for my new book Suicide Med. For that reason, if you have a blog or something similar and are willing to do a review, I'd like to send you a free Kindle copy. Also, if you have a really popular Twitter or Facebook account, I'd be happy to give you a copy in exchange for a positive mention of the book.

Read an excerpt here.

Any takers? Email me at fizzziatrist(at)gmail.com.

Fender Bender

Say the following happened:

Two cars are involved in a fender bender in which one car was clearly at fault. It was a relatively slow-moving collision in which the cars were hardly damaged and 99% of the time, nobody would be hurt.

However, the passenger in the car that was hit has a bleeding disorder. She gets a mild bump on the head and as a result has significant bleeding in her brain. As a result, she has such severe cognitive deficits that she can never work again.

Should the person who hit her now be sued for financial responsibility for her care for the rest of her life, when it was a minor accident that would have caused no injury in the vast majority of people?

Lunch fail

Now that we're at a new daycare, I have to start making lunch every day for my picky three-year-old. Unfortunately, there are two rules we must follow:

1) food can neither be refrigerated nor heated

2) food cannot contain any sort of nuts

My daughter likes ham, so most days I've been sending her to school with ham and cheese sandwiches. She seems pretty unwilling to eat any other sort of lunch meat, so it must be ham. I put in a frozen go-gurt in order to keep it cold for lunch. Anyway, the last few days, we've been getting back the leftovers from her lunch: two pieces of bread and a piece of cheese. So essentially, she's just eating the ham and the yogurt.

I'm using massive quantities of bread lately, so it's tempting to just give her a big stack of ham. But that seems like bad parenting. I have no idea what to do for lunch now.

Any ideas would be appreciated.

Dr. Orthochick: Foley?

Dr. Alcoholic: I did a 9 hour surgery yesterday.

Me: Wow. Did you have to pee at all?

Scrub tech: Did she really just ask you that?

Dr. Alcoholic: I think she did

Scrub tech: She asks you one question about the surgery and it's that?

Dr. Alcoholic: I guess that's the only thing she cares about.

(For those of you who care, the answer is yes, he did have to scrub out to pee. And I actually do think that's an important question. I mean, what if I do a 9-hour surgery? Then is it OK for me to leave to pee or do I have to plan ahead and wear a diaper?)

Pain Tolerance

I think it's every doctor's pet peeve when the patient says that they have a high pain intolerance.

It's probably mostly because patients who say that almost invariably have a very low pain tolerance. Patients who say that are always the worst babies and always the ones constantly begging for pain medications. I don't know if the patients are lying or just have so little insight into themselves.

I don't think I have a high pain tolerance. I think I actually have a pretty low pain intolerance, and that I am sensitive to even small amounts of pain. But on the other hand, I'm not much of a complainer in general. When I was in labor, the nurse kept yelling at me that I had to tell her when my pain level was high. She said to me, "You're too quiet! I can't tell if you're having pain or not!"

How about you? What's your pain tolerance?

Paperback!

Suicide Med is now available in paperback!!!!!!

Weekly Whine: Daycare

It's been my contention that three things that it's a mistake to complain about online are your current job, your childcare, and your spouse. I feel like all these things are just asking for trouble. That's why I only talk about previous jobs and my residency, and did I mention my husband is absolutely wonderful?

However, I recently switched daycares. So now I feel completely at liberty to go to town complaining about my previous daycare. After all, what are they going to do?

This first story took place when I was about seven months pregnant with my second:

We pay for five days a week of daycare, even though Mel didn't go on Tuesday, my day off. It's was the same price for four and five days, so we paid for five days and I just kept her home most Tuesdays. We brought her in maybe 2 Tuesdays since she started close to a year ago.

Anyway, I was very sick with a cold one Tuesday, so we decided to bring Mel to daycare so I could have a break.

Unfortunately, when my husband brought her to the daycare, they told us that she wasn't signed up for Tuesdays and they were full that day.

My husband was SO angry, rightfully so. We were paying for five days a week, but because she wasn't there on Tuesdays, they sold the day to another kid, I guess. They kept saying she was on a 4 day rate,resulting in this ridiculous conversation:

Me: "I'm paying for five days."

Daycare: "You're on the four day rate though."

Me: "How much is the four day rate?"

Daycare: "$300 a week."

Me: "And how much is the five day rate?"

Daycare: "$300 a week."

Essentially, because they noticed we weren't coming five days a week, they sold that extra day to another student, even though we were still paying for it.

Anyway, my husband lost it and started yelling at them, which made me feel even worse. I mean, this isn't people we're buying a toaster from. These are the people taking care of our kids. And I was counting on them to take the new baby too. I was almost crying.

So I later called them back and apologized for him yelling. I said it was a misunderstanding and they said they'd put her down for the five days again (same price as four days) once there was room. We actually had to go on a waiting list for the day we were already paying for.

It took about a month, but then they told me that I had the day back. And from then on, I brought her in every Tuesday so that I wouldn't lose the day. I needed it in case I was in labor that day.

I guess it's good we sorted this out before I brought her there while in labor on a Tuesday or something.

The 4 Types of Confused Patients

New book!!!!!

So guess what, I wrote another book! Man, I've got to get a life.

It's called Suicide Med, and is available now on the Kindle exclusively. (Paperback is still in the works.)



As opposed to the last one, this is more of a medical school thriller. But it's not your typical (medical school) thriller. I call it an offbeat medical thriller. Whatever that means.

Back cover blurb:

There’s a reason Southside Medical School has been nicknamed “Suicide Med.” For the last six years, every year one student has taken his own life.

Except for last year. Last year was a murder-suicide.

The press has pointed to the heavy workload as the culprit in the high suicide rate. Some students believe that the school is cursed. And others believe that the deaths may not be suicides at all—that it’s no coincidence that Dr. Conlon, Southside’s quirky but beloved anatomy professor, joined the staff on the very year that the suicides began.

Either way, the same question echoes through the minds of every first year student at Suicide Med:

Who will be next to die?

Read an excerpt here.

It's nearly twice as long as the last book, but I kept it priced at only $2.99 because I'd really like you all to read it. And hopefully not hate it. Possibly even enjoy it.

Buy it now!

Dr. Orthochick: What's the problem?

Dr. Nice: How was conference?

Me: The usual. Dr. Douche got mad at me.

Dr. Nice: What happened this time?

Me: I was presenting a case of a patient who had bilateral clavicle fractures and toward the end Dr. Douche said "well, wouldn't you not have done the surgery if he had only one clavicle fracture?" So I said "yes, if he had a different problem, we would have treated it differently."

Dr. Nice: He didn't like that, did he?

Me: Not so much.

Bad discharge summaries

I just read a discharge summary that was so wrong that it got me angry. Among the grievances I had with it:

--alternated between calling a bleed in the brain a subdural hematoma and subarachnoid hemorrhage

--did not say what side any of the patients fractures were on

--at one point, it just said the patient had a compression fracture, but didn't ever say where

--wrote that patient got fresh frozen plasma in the middle of her hospital course but did not say why

--said that the patient needed a lumbar brace at all times when the patient did not need it at all

--got the patient's weight-bearing status wrong, and failed to even say what side they were talking about

I don't expect for everyone to document everything like a medical student would, but at least put in a seed of information that I can use to treat the patient. There ought to be a place where you can report somebody writing such a terrible discharge summary.

Weekly Whine: OSH

There is nothing more annoying than when the discharge summary says that a patient came from an "outside hospital". It just seems pointlessly lazy.

I mean, how hard is it to just put in the name of the hospital in case we need more information? Is it really that difficult?

Doctor of Patientology

I had a patient who is kind of confused and I was hoping that he was getting better. I told him I one day that I was the doctor and I wanted him to remember who I was. The next day I asked him about it.

Me: "Do you know who I am?"

Patient: "Yes. You're the physician, and you specialize in.... caring for patients."

Actually, I did my fellowship in caring for patients.

Shame on you, Hobby Lobby!

I'm sure by now everybody knows about the Supreme's court decision to allow Hobby Lobby to not provide birth-control for their employees, due to their religious beliefs that some forms of birth control cause abortion.

I'm not even going to get into how angry this decision makes me. And how anti-women it is. That's a whole other discussion.

But what I think makes me angriest is that hobby lobby doesn't want to provide birth-control for religious reasons, yet what do they do for their employees that do get pregnant? Do they provide paid maternity leave for their poor female employees who can't afford to take time off to be with their babies, like a good Christian should?

Of course not.

They have religious beliefs when it suits them. When it's financially beneficial to them.

Hobby Lobby, man up and give your female employees the paid maternity leaves they deserve, like the good Christians you claim to be!

Dr. Orthochick: Are You Smarter Than the ER Attending?

OK, time for a round of "Are You Smarter Than the ER Attending?"

A guy has right shoulder surgery and immediately afterward, he gets a right shoulder nerve block for post-op pain management. He presents to the ER 12 hours later (at 3AM) with complaints of continued decreased sensation in his right arm. He denies any shortness of breath/chest pain/headache. He is still able to move his right arm but it is weaker than his left. Do you:

A. Order a head CT
B. Order a neck CT
C. Consult the ortho resident to rule out compartment syndrome
D. Ask the ortho resident to admit the patient for observation
E. All of the above

If your answer was F--reassure the guy that this is what is supposed to happen when you get a nerve block--then congrats, you are smarter than the ER attending. You are also equally smart to my sister, who was able to get the answer even before she heard all the options. You are also equally smart to the patient, who correctly predicted that was what was going on but just wanted to make sure because he didn't realize it was going to last that long. I don't fault him for going to the ER, although I think he probably just could have called the surgeon or the anesthesiologist and gotten an answer as well as decreased radiation exposure.

I would say the two hardest parts of that consult were dragging my butt out of bed and down to the hospital at 3AM and trying to explain to the ER doc that this was totally normal and I didn't need to bring the guy back to the OR for some sort of nerve exploration. Finally I said to him, "you know, we see this every now and then. Patients have nerve blocks and then they come back to the ER because they're surprised it lasted as long as it did."

My ortho attending thought it was kind of funny, but he wasn't the one who had to deal with it at an unG-dly hour of the morning.

Go go modern medicine.