Weekly Whine: Rude

I make a lot of calls to doctors offices in the course of my job, and it surprises me how many receptionist answering phones are blatantly rude. Like, before I've even opened my mouth to say hello.

I understand that everyone has bad days and everyone can't be a bundle of personality, but if your job is to communicate with people, maybe it's better not to sound outright angry when you pick up the phone. Maybe you hate your job, but at least try not to sound like you hate the person who is calling. If you have the sort of personality where you cannot be pleasant to strangers, then you should not have a job where you have to communicate with people so frequently.

Why would anyone hire a receptionist who is so unpleasant anyway?

Grease, the tater tot

I bought some tater tots the other day at our hospital cafeteria. They don't have the best tater tots, but they are usually passable. Usually I eat a few of them and then bring the rest home for my kids as a snack for the car.

A few days ago, I got some tater tots and after eating one, I had to spit it out. It was so greasy! I complained about this to a friend at work.

"Aren't tater tots supposed to be greasy?" she asked.

I then took one tater tot and rubbed it in a paper napkin. Below shows the amount of grease that came out of a single tater tot. I think that's too much grease for one tater tot.

Dr. Orthochick: Dispo

On Wednesday when I was operating with Dr. Anal he admitted our last hand job patient of the day. She was an 88 year old lady who had fallen and fractured her patella as well as her distal radius, the patella was being treated non-operatively and she was allowed to weightbear as tolerated as long as she was in her brace, but the radius needed surgery. Dr. Anal had spoken to her for a while and decided she would benefit from being in the hospital overnight so that she could get placement in a nursing home and so she could get a formal consult for her depression. Normally distal radius is an outpatient surgery.

In theory, Dr. Anal is a great guy for understanding that the patient really did need to be in a nursing home right now because she couldn't take care of herself and that she was suffering from depression.

The reality is a little different.

So the patient was admitted around 11:00AM on Wednesday. The hospitalist saw her later on that day and started her on Zoloft before calling a psych consult. By 11:00AM Thursday, discharge planning still hadn't seen the patient. Psych then saw her and decided she wasn't suffering from depression and stopped the Zoloft. They then called a geriatric assessment, who determined that she was at a high risk for falls and should be in a nursing home temporarily. They also ordered physical and occupational therapy. Social work saw the patient at 16:00 and asked her about nursing homes before faxing a couple of referrals.

Fast forward to today, the patient has been in the hospital for 3 days and because she wasn't really admitted for anything legitimate, medicare isn't going to cover her hospital stay and even if they did, they wouldn't cover anything over three days. Which means it comes out of pocket, and these consults aren't cheap. And since it's Friday night and she still doesn't have placement in a nursing home, she's going to be here all weekend. Also, if anyone had talked to the patient for any length of time, they would have figured out that the reason she was depressed was because her husband of 65 years had died 2 weeks ago. Correct me if I'm wrong, but bereavement is a pretty normal thing and doesn't require medication, especially since most of the psych medications cause drowsiness, which increases the number of falls in the elderly. Speaking of which, I really don't think we needed a geriatric assessment to tell us that this 88 year old lady with a broken patella and a broken wrist is a fall risk. And when you're in a long-arm cast, it's hard to do physical therapy on your wrist.

I'm not trying to sound callous, but now the family is mad because they have to pay for this pointless hospitalization, the patient is mad because things have grinded to a standstill and she'll be here all weekend, Dr. Anal is mad that she's not in a nursing home already, psych is mad about the crap consult, and really, what the hell was everyone expecting? It's a hospital. By this point even I have figured out that simple things become big, long, drawn-out processes in a hospital. (if you don't believe me, try ordering FFP, STAT. Oy vey.) I tried telling Dr. Anal that I thought his plan was a bad idea since the patient wasn't suffering from depression and it takes longer than 12 hours to get a spot in a nursing home, but since he's my attending, I tried to be subtle and tactful about mentioning that. By which I mean, he said "admit her overnight and consult discharge planning for nursing home placement and consult the hospitalists for depression and discharge her tomorrow morning when that's all done" and I said "OK." In retrospect, I can see why he misinterpreted my answer and thought I was agreeing with him.

Personal statement

I recently dug up a copy of the personal statement I wrote when I was applying to residency. I've said before that I think these personal statements aren't worth much. But somehow, I now feel compelled to prove it by ripping apart my own personal statement. So here we go:

It was the same situation that I had been in dozens of times.

Well, not really. I mean, I was only a third year medical student on my second rotation. Dozens = Possibly more than once before. But by the time I wrote this, I was already an expert at pretending I had done something many more times than I'd actually done it.

I was on night call during my medicine clerkship and was sent to the emergency room to see a possible new admission to our team.

Everyone else on the team had something better to do and they were sick of babysitting me.

The patient was a man in his forties with severe abdominal pain who had first been seen by the Surgery and GI services and judged to not have an acute abdomen.

The guy had just been dumped on us.

By the time I saw this gentleman, he had been in the emergency room hallway on a stretcher for over fourteen hours, in terrible pain. In my short white coat and clutching my notebook of H&P’s and progress notes, I tentatively approached him.

This was my poetic way of saying that I knew I was going to annoy him and I assumed he was going to get pissed off.

I could see the dread on his face, and it was very clear he had no desire to have me ask the same questions he had been asked repeatedly by people who were unable to give him any answers.

"Are you kidding me?" the guy snapped at me. "Now they're sending a high school student to ask me more of the same questions? Don't you people know what you're doing?"

While I tried to think of what I could say that would not upset him further, I knew that I, as a medical student, had fewer answers than anyone.

"Um," I said. "Can you tell me when your belly pain started?"

The guy stared at me a second, then rolled his head away and refused to look at me.

I consulted my little notebook. "What makes the pain better?"

"When you go away and leave me alone."

I managed to take his history that evening

It was brief.

and I followed him while he was on the medical service. His abdominal pain turned out to be benign,

"Sorry," I told him. "We're still not sure what's causing your abdominal pain but we don't think it's anything serious."

"Why am I not surprised?" he retorted.

but his labs were suggestive of Type 2 Diabetes. We started him on an insulin regimen with scheduled follow-up appointments as per routine.

We spent $20,000 of hospital bills to diagnose him with something his primary care doctor should have diagnosed him with in one office visit.

Also, in retrospect, why were we giving him insulin for early type two diabetes?

On the day of his discharge, I came to his room to ask if he had any questions, but instead of asking me questions, he thanked me. He said that he had been ready to walk out of the emergency room when I had arrived. He brought tears to my eyes when he said that my attention made him feel that someone really cared and was working to get him better.

That part really happened.

But I never actually explained the cause of the patient's abdominal pain aside from saying that it was benign.

One morning during the patient's hospitalization, I walked into his room and he was smiling. "My belly pain is gone," he told me.

"That's wonderful!" I said.

His wife, who was by his bed, told me, "I went to the store and I bought this laxative, because I remembered the night before he got sick, he ate a lot of steak and I thought maybe he was backed up."

"I pooped so much last night," the patient informed me.

"The toilet was clogged when I came in here this morning," the wife added.

"And now I feel completely better," he said.

"That's… great!"

In summary, my personal statement was about a patient who had a $20,000 work up for constipation, which was only cured by his wife bringing him a laxative from the local drugstore.

And that's why I want to be a doctor.

Weekly Whine: Fat Shaming

A bit ago, I made a post about how some women can be very hostile towards other women just for being skinny, even if they are not at all obsessed with looks. I'm probably asking for trouble here, but there's more I'd like to say on the topic.

First of all, I want to apologize if I did not seem sensitive enough. I genuinely think women look good at any size, unless they are at some extreme, and I would never in a million years consider making a negative comment to another woman about her weight and I can't imagine the mindset of a person who would, so perhaps I don't realize how much crap overweight women have to endure. In that sense, when I make posts like these, it is eye-opening for me. Some people accuse me of always thinking I am right because I don't immediately change my opinion when someone disagrees with me, but I do genuinely listen to everything people on here have to say.

For example, one woman told about how she underwent chemotherapy and experienced severe nausea. She said, "for a while, I couldn't eat much without getting nauseous. I had that condition for over a year. It sucked. But would take that over the easy weight gain any time. Hands down. Not even a close call." It is definitely a commentary on how obnoxious people must be to overweight women if someone would rather lose weight from being horribly nauseated from cancer therapy than be healthy and overweight. Of course, women do unhealthy things to lose weight all the time. The commentor then went on to say that she "cried with joy", not because of a cure for her illness, but because she lost weight.

That sort of attitude, valuing pants size over health, speaks volumes about how difficult it must be to be an overweight female. Although I genuinely hope most women would not rather be sick than overweight. If they did, there are a few hot dog carts in New York that I think would be getting a lot more business.

The truth is, I think women are always going to judge other women (as a mother, I have received a very large amount of unsolicited judgment and critique on my parenting), and weight is something that is very visible, and easy to critique people on since it seems like it should be changeable, although any intelligent person would realize that that's not often the case. I don't know if society can change how we think about weight, or be less judgmental. However, I feel strongly that we should help women to realize that is never acceptable to make an unsolicited comment on another woman's body. (Or her parenting, for that matter.)

Things I've Done on the Toilet

Inspired by Dr. Orthochick

Dr. Orthochick: Miss Boobs

Me: You know what I like about you? You're one of the few scrub nurses around here who doesn't remind me that everything blue is sterile every time I walk into the operating room.
Scrub Tech: You know what i like about you?
Me: No, what?
Scrub Tech: Your boobs.

The next 4 years have potential to be awkward.

Also, I was in clinic with Dr. Sportsfem and we walked into the [female] patient's room together and the patient said to Dr. Sportsfem, "wow! Look at her boobs! Can I call her 'Miss Boobs?'"

...and that is why Dr. Sportsfem and I will never be friends. Because she said that was fine.

MLK

At preschool:

Me: "Aren't you happy that you get to have Monday off for Martin Luther King Day?"

Four-year-old child: "You mean Dr. Martin Luther King day."

Sheesh.

Relations

One thing I have learned is that if you see a patient with a family member, never assume any sort of relationship, no matter how much the family member looks like their wife, son, whatever. Always ask how the person is related, so you can avoid interactions like this:

Nurse: "Wow, your mother looks young for her age and in pretty good shape."

Patient: "She's my wife!"

Weekly Whine: Too much food!

It drives me crazy how much food there is around during the holidays. Most of the year, there's no treats around, especially during times when it would really lift your spirits in the dead of winter.

However, for the one week before Christmas, there are so many cookies and cakes and other treats around that I walk around feeling sick almost all the time.

Maybe there needs to be a more minor holiday once a month so we can spread out some of that Christmas cheer and not make ourselves sick on December 24.

Dr. Cutie

A while ago, I was working with a doctor who was supposedly particularly handsome. He was the sort of guy who was good looking enough that everyone would comment on him, and all the patients universally nicknamed him Dr. Cutie, or something equally inane and objectifying.

So here's the weird thing about Dr. Cutie. He didn't flirt. Not with me, not with nurses, not with anyone. I know what you're thinking: "how is that possible?" Considering a large number of male doctors flirt with nurses, and an even larger number of cute male doctors flirt with nurses, this was extremely unusual behavior.

After Dr. Cutie moved on to greener pastures, I had a discussion with a female colleague about him. Her main commentary on Dr. Cutie was, "He's a total asshole."

"Really?" I said. "What did he do that made him an asshole?"

Interestingly, she couldn't name one thing.

"Do you think it's possible," I said, "that Dr. Cutie is a nice, shy, introverted guy who happens to be very good looking, and is therefore perceived as being kind of an asshole because he's aloof?"

"It's possible," she admitted.

So I guess being a really good looking male doctor isn't necessarily always fabulous. Although I suspect mostly it is.

Dr. Orthochick: Upscale

I was in sports clinic yesterday afternoon so I picked up the chart for the next patient and started reading the progress note from the previous visit to see what we were seeing him for.

Mr. [Patient] is a 39 year old gentleman who sustained several anterior dislocations of his right shoulder when he was involved in martial arts as part of an underground fighting group. He did not seek treatment for these and the problem worsened after he lifted heavy weights while in prison. He presents today with his caretaker, who states that because of his impulsive and self-destructive behavior secondary to bipolar disorder with psychosis, it is difficult for him to follow any sort of treatment plan.

We definitely attract the classy sort over here.

Well my throat hurts too!

7AM:
Page: "Doctor, Mr. R is complaining that his throat hurts."
Me: "Okay, we'll see him on rounds and we'll take a look at his throat."

8:30AM:
Nurse: "Doctor, Mr. R says that his throat hurts."
Me: "Well, we're rounding now and we'll see him very soon."

9AM:
Me: "How are you feeling, Mr. R?"
Mr. R: "Oh, I'm fine."
Me: "The nurse told me that your throat hurts."
Mr. R: "Oh yes, well.. ever since the surgery, it's been hurting a little bit. But it's not bothering me that much."
Me: (after looking in this throat) "Do you want anything for it?"
Mr. R: "No no, I'm fine."
Me: (shrugs) "Okay."

The next day, 7AM:
Nurse: "Doctor, Mr. R says his throat hurts."

Read more?

If your New Year's resolution is to read more, I recommend starting with The  Devil Wears Scrubs. Even the slowest reader could probably get through it in a day, and it's on sale in the E-version tomorrow for only $.99. You can read it on your Kindle, iPad, or even computer.

Weekly Whine: Jeans

I think I have written before about the skinny jeans fad, and how I don't think those kind of pants look good on anyone, except possibly for young girls with perfect legs. I think anyone older then college-age looks better in boot cut jeans, but these days, finding boot cut jeans can be a challenge.

This rant, however, is about sizes for jeans. I recently was at the mall and experienced something very baffling.

A friend told me about a going out of business sale at a store in the mall. All the jeans were discounted 70%, and I've been having trouble finding jeans I liked for the above reasons. So I decided to check out the sale.

I like to wear jeans that are sort of on the loose side because I prefer comfort to style. About 90% of the time or more, size 4 or 6 fits me pretty well.

I went to the store, and it seemed like at least half the jeans were size 0 or 2. I finally located a pair of size 4 and a pair of size 6 to try on. Except when I got into the dressing room, they were too tight. And the petite length, which is usually a bit long for me, was way too short. My daughter was with me and she informed me that the jeans did not look good.

I returned those two sizes and found a size 8 pair. Unfortunately, it was still too small. At least, it wasn't the fit that I wanted.

I tried to locate a pair bigger than eight but I couldn't find any. Eight was the largest size they had in jeans in the entire store. Isn't the average size for a woman 10 or something like that? How could they not have any jeans bigger than a size 8??? Who is this clothing made for???

And then I went to target, and I couldn't find anything smaller than a size 12.

There's something seriously wrong here.

Useless pages

I love nurses. A good nurse is worth her weight in gold, and I've worked with some of the best of them. Sadly, I have also learned that a bad nurse can really make your life miserable.

When I was a resident, I worked with some nurses who seemed sometimes bafflingly incompetent. They would page me about the most ridiculous things. This was one of my favorite pages I got from one of them:

A nurse paged me at seven in the morning. She was calling because she need to get the phone number for a patient's mother, so that neurosurgery could get consent to do surgery on him.

Except…

1) I already given neurosurgery that phone number (more than once)

2) consent had already been obtained last week

3) the patient was already in surgery

Nice.

Top 10 songs of 2014

I love giving top 10 lists, so these are my top 10 favorite songs of the year, in no particular order:

All about that bass

Habits (stay high)

Happy 

Me and my broken heart

Still into you

Take me to church

Don't 

Maps

Rude

Blank space

Hopefully, this list is less controversial than my list last year. Although my daughter hates the "church" song, so she wouldn't like this list very much.

Dictation error

I know our dictation system relies on an automatic dictation program, which is  then edited by a human being. But sometimes I see an error that does not seem like it could have been made by either the dictation program OR a human being:

"Patient will be seen for blood pressure management technique that would management blood pressure management."

How did that error get made?

Nose ring

We were at the mall yesterday and saw a sign for getting a free beanie baby with your piercing. My husband thought that was crazy because they shouldn't be trying to attract children to get their ears pierced. But I pointed out that a lot of babies have their ears pierced. It's not like it's a big deal or something sexual.

This evolved into a conversation about when we should let our daughter get her ears pierced. I said that she could get it done anytime she wanted, but my husband said she should wait until 12 or 13.

Then I asked him about nose piercing or eyebrow piercing. He said the same, age 12 or 13. While I basically said that she wasn't getting it done under our roof, that she'd have to wait until college.

I basically feel that being a high school kid having your nose or eyebrow pierced is telling teachers and other students that you don't care about school. Maybe it's not true, but I don't think that's the first message you want to give to teachers. I suspect many of them are biased against students with nonconventional piercings.  I don't want her to walk into her classes with a strike against her.

My husband told me I was being silly.

What do you think?

Where is your missing medical student?

How to answer a nurse's question