Thursday, April 30, 2015

Where have you been??

Attempt #1 to see patient:

Me: "Sir, can you wake up?"

Patient: "I'm too tired. Come back later."

Attempt #2 to see patient, an hour later:

Me: "knock knock."

Occupational therapist: "I'm seeing the patient right now, can you come back later?"

Attempt #3 to see patient, four hours later:

Me: "knock knock."

Patient: "I'm on the toilet!"

Account #4 to see patient, six hours later:

Patient: "Where have you been all day, Doc? I've been looking for you."

Me: "I've been trying to see you. You've been busy."

Patient: "Hey, my sister is going to call any minute. Can you come back later?"

And they say doctors get respect…

Tuesday, April 28, 2015

Dr. Orthochick: Problems with EMR

So in our EMR (Electronic Medical Record), you can just copy and paste the note you wrote from the previous day and add or subtract as needed. Which means it takes 3 seconds to write a note, because generally not much changes over the course of the day. The downside to this is, if I want to read someone else's note, I'm stuck sifting through three weeks of respiratory culture results and discontinued pain meds until I actually get to the "plan" section, because all of that stuff carries over. Plus when the note is copy-pasted, I get the feeling no one else can find the stupid plan either, including the person writing the note, because it is not particularly helpful since it doesn't get updated all that often. Don't get me wrong, I love being able to see what everyone else is writing from my computer at home, but i would love it even more if reading all this gave me some grasp on the overall plan for the patient, instead of 5 days worth of sodium values.

Anyway, the other day I got paged down to the ER at 4AM to evaluate a lady who was having arm swelling and numbness after falling. I had pretty low suspicion for compartment syndrome but I had no idea what it actually was, so I checked her compartment pressures, they were normal, and I discharged her with a prescription for Norco. As luck would have it, she came back, (again while i was on call) and I still didn't know what was wrong, except by this point she was also having numbness and tingling in the other hand as well. I did a CT of her cervical spine (normal) and then gave up. She got admitted to internal med, I wrote a note saying I had no idea what she had but it wasn't a surgical problem.

I was on call on Wednesday and I got paged to do a consult. I spoke to the consulting physician and it turned out it was for the same patient during the same hospitalization.

Me: I've already seen her. Twice. We didn't really know what she had, but it didn't seem like a surgical problem since her nerve symptoms were diffuse and she didn't have compartment syndrome or a drainable hematoma or something like that.
Internal med doc: Oh, I'm sorry. I didn't realize Hand Surgery had already seen her.
Me: If you want, I can see her again to see if anything's changed.
Internal Med Doc: No, you don't have to do that if you've already seen her. I don't think anything's changed.

See, the thing is, everyone's note, from the initial internal med doc who saw the patient 4 days before that to the internal med doc who consulted me, contains the phrase (and I quote):

Hand surgery has evaluated the patient and feels no surgery is indicated. Appreciate hand surgery input.

Seriously people, you don't have to read my note, but you could at least read your own. I'm sure that was just carried forward from the last guy to write a note, and I know it's a pain to write your own note, but I'm not going to be too impressed if your own note acknowledges that I've already seen the patient you consulted me on.

I'm not saying the EMR is a bad idea, because I think it has a lot of potential, but I'm not sure it's working out quite the way it's supposed to. There's no point in having easier access to records if we're not reading them to figure out what they're saying. And i say this every month, but if we can't get two hospitals in the same city to use the same EMR, I'm not sure how we're supposed to get everyone in the country to use it.

Monday, April 27, 2015


When I was rotating through neurology as a medical student, one of the patients on our inpatient service was another medical student from the class above mine who was having a multiple sclerosis exacerbation.

I really have to question her decision to come to the hospital where she worked to be treated for her condition. But that aside, a lot of the things she told me about how she was treated sort of blew my mind.

Apparently, several of her attending asked her if she had ever considered switching to another profession. And honestly, it seems like it would be very hard to get through medical school and residency with multiple sclerosis, but that's her decision. It's not the job of her attendings to question her on that.

Apparently, one attending got very upset at her and told her she needed a psychiatric evaluation because she had attempted to hide her condition. In all honesty, I think it's fairly obvious why she tried to hide it.

Saturday, April 25, 2015

Weekly Whine: Malpractice

I really think there needs to be some tort reform in this country.

While I've never had a malpractice suit brought against me, several of my colleagues have been sued, and it's a really unpleasant process. Furthermore, every single one of the lawsuits were unjustified. I say this based on the fact that the suits were eventually dropped without any sort of trial or anything like that.

What appears to happen is that when a patient files a lawsuit, every single doctor who has ever said hello to the patient in the hallway or breathed their general air is named in the suit. Then eventually, they drop some of the physicians from the suit who are clearly not involved and didn't do anything wrong. Dropping the innocent physicians from the suit can take years, believe it or not. And during this time, the physician has to live with a lawsuit over their head, and every time they file any of the paperwork for license renewal or privileges at the hospital, they have to provide all the paperwork about the lawsuit.

Another physician was telling me about a lawsuit that was brought against him when the malpractice law was about to change, so the firm quickly filed every suit that they had pending, just to see if any might stick. Again, this was eventually dropped, but it took years.

Being the subject of a lawsuit definitely affects how you practice medicine. It makes you extremely cautious and probably spend way too much ordering extra tests to double cover your ass. Even if you know you didn't do anything wrong, because you really never know until it gets to court.

I'm not a lawyer or in that business so I'm not sure how to change things, but something is definitely wrong with the way it is right now.

Thursday, April 23, 2015

Bad med student

One day during my OB/GYN rotation, another third-year medical student named Jenna was alternating with me to scrub in with an attending named Dr. Richards for his four surgeries (stretching from 7 AM to 5 PM). She scrubbed on the first one, then I was supposed to scrub on the next two, then she was to scrub on the last one.

When I walked into the room for the second surgery, Dr. Richards made the enigmatic comment to me: "When I ask you to do something, don't ask if someone else is supposed to do it."

I was sort of confused, considering I had just walked into the room, and as far as I knew, I hadn't done anything wrong yet. But he seemed fairly pissed off.

After the second surgery I did, he asked me if I was scrubbing on the next surgery and I said that Jenna was, and he said, "No, you are." And that was that. At least I had five minutes to grab lunch.

I asked Jenna about it later. Apparently, during the first surgery, she managed to piss Dr. Richards off. It was a laparoscopic surgery and he asked her to change the settings on the camera and she said, "Isn't someone paid to do that?"

In her defense, I think she was trying to be funny. She had the sort of sense of humor that some people just didn't get. And sometimes it's better not to make those kind of jokes around attendings you've just met.

Monday, April 20, 2015

Most boring surgery

Of all the surgeries that I did during medical school, the most boring one was probably the laparoscopic bilateral salpingo oophorectomy (BSO).

Most laparoscopic surgeries were less interesting than the open surgeries because you couldn't really tell what you were looking at half the time unless you're experienced, which obviously I wasn't as a medical student. And all you can really do to help is hold the camera, and in GYN they didn't even let you do that much. They just let you hold up the uterus and then yelled at you that you're not doing it right.

Believe me, it's not that fascinating to watch them trying to grab at the ovaries and dropping them for two hours.

I remember one afternoon, there was actually a very interesting GYN surgery that I wanted to see, but if I went, I would have missed labor and delivery sign out. So instead of telling me to read or do something else useful, they had me sit in on a BSO that another medical student was already assisting on. Basically, I just had to stand in the back of the room for two hours, watching the surgeon try to tie off a little tube.

I genuinely have to question the learning value there.

Saturday, April 18, 2015

Weekly Whine: Snooze

Back when I was in high school and college, I was addicted to the snooze button. When you first wake up, it feels so delicious to press the button and get to fall back into your cozy, warm bad.

Unfortunately, it's all a cruel trick. You get back in bed just to be woken up again 10 minutes later, feeling just as exhausted as you were when it first went off, except now you're running late. I've read that it's also very confusing for the body as well.

In college, sometimes I would press snooze six or seven times, and eventually end up snoozing through an entire class. Except none of it was restful sleep. If I just set my alarm for an hour later, I might've actually felt good when I woke up.

In retrospect, I don't understand the purpose of snooze buttons. I know it feels good, but nobody ever feels better after snoozing for 10 minutes. I remember in college, my roommate used to set her alarm for three in the morning to study, but she was so tired, she would just snooze it. She was not my favorite roommate.

Luckily, these days I don't have to worry about the snooze button because I have a child who wakes me up between 6:30 and 7 AM every day by punching me in the gut. It's very effective.

Thursday, April 16, 2015


Me: "This is Dr. fizzy. I'm trying to reach Dr. Jennings."

Receptionist: "I'm sorry, Dr. Jennings isn't available right now. She's on the toilet."

Me: "Uh. Well, please ask her to call me when she gets off the toilet."

Tuesday, April 14, 2015

Dr. Orthochick: Journal club

Dr. J: [That article you assigned to Dr. New for journal club] was terrible!

Me: Uh, I'm sorry...

Dr. J: It didn't tell us anything! It said doing a procedure that we know doesn't work won't work! Why would you select an article like that?

Me: Uh, sorry. Did you like the article I assigned you at least?

Dr. J: Well, it was an important article, it was significant, I've used [the concept] in my practice since you assigned it to me at the beginning of the month, and I think it was one that we should all read, but it wasn't very controversial. Try to do a better job for next month.

I must really be missing the point of journal club if "significant," "useful" and "one that we should all read" is still not good enough.

Monday, April 13, 2015

Too much!

At the drive-through at Burger King:

Me: "I would like a small french fries and a four piece chicken nugget."

Cashier: "would you like to upgrade to a 10 piece chicken nugget for only $.50 more?"

Me: "No."

Cashier: "but it's only 50 cents more and you get 10 of them!"

Me: "I only want four!"

For god's sake, no wonder everyone in this country is getting obese. McDonald's is even worse because you can upgrade to 20 piece chicken nugget from 10 piece for only 50 cents. Except what are you supposed to do with 20 chicken nuggets??? I'm pretty sure if I ate that many in one sitting, I would die instantly.

Saturday, April 11, 2015

Weekly Whine: Buffet

My aunt asked for my advice on an issue, and she asked me to seek another opinion, so I'm taking it to the masses:

My aunt and uncle migrated to Florida after retirement, but her two children still live up north, in the same city. She goes to visit them once or twice a month, and since they both have small apartment with roommates, she springs for a hotel. She stays at the same hotel each time, which costs maybe $100 per night.

The hotel has a free breakfast buffet every morning. It has the usual smorgasbord of scrambled eggs, potatoes, muffins, fruit. My aunt got into the habit of taking two or three containers of food to go from the buffet, and using that as both her breakfast and lunch.

Recently, the hotel removed all the to go containers, and my aunt is convinced that it was because of what she was doing. Because of that, she felt offended and started staying at a different hotel.

Apparently, all her friends told her what she was doing was horrible, and the hotel's response to her was appropriate. I'm the only one who disagreed. She was spending about $10,000 a year at that hotel. What's the difference if she took a couple of containers of scrambled eggs that they were probably going to throw out anyway? Is it really a smart business move for them to antagonize their steady customer and lose all that money?

Thursday, April 9, 2015

If the shoe fits

This is a mystery I have yet to solve:

About five years ago, I bought a pair of loafers. They are brown, which is not my favorite color for loafers, so they've sort of gone unused. Recently, I rediscovered them in my closet and put them on my feet.

Actually, I didn't put them on my feet because they were too small. I couldn't squeeze them on, whereas presumably when I bought them, they fit comfortably.

What's up with that? How could a pair of shoes fit me perfectly five years ago, and now not even go on my foot at all? Did the shoe shrink or did my feet grow?

Wednesday, April 8, 2015

$20 bill

In case you haven't heard, there is currently a campaign underway to replace Andrew Jackson on the $20 bill. It's been noted that not one piece of paper currency in this country has a woman on it, and a $20 bill seems like a good place to start, considering it turns out Andrew Jackson wasn't such a nice guy. (Trail of tears and all…)

So this is your chance to vote for the woman you would like on the $20 bill. Initial voting has narrowed it down to Eleanor Roosevelt, Harriet Tubman, Rosa Parks, and also, Wilma Mankiller.

While I think it would be completely awesome for a person named Wilma Mankiller to be on the $20 bill, I'm not sure if this is a great idea. I'm not sure if we know enough about this woman to know if she is worthy of this honor. We may put her on the $20 bill and then later something will come out about her life. Possibly something about killing people. Possibly men.

My vote would be for Harriet Tubman, who risked her life repeatedly to help bring slaves to freedom. I mean, that's pretty awesome. Not that Roosevelt wasn't an important woman, but it sort of bugs me that we're going to put yet another privileged white person on money. Worse, a woman who we probably would never have heard of if not for her husband. I'm getting a little tired of women who only become president because her husband was president.

As for Rosa Parks, if we're putting people on money for refusing to get up out of their seat because they're "too tired", I think we could definitely consider either my daughters for the honor. (I'm kidding, obviously.)

Anyway, everyone should vote. Even though this will definitely never happen.

Tuesday, April 7, 2015

Dr. Orthochick: Hobbies

Dr. Mellow: So what kind of hobby are you going to get for next year?

Me: What do you mean?

Dr. Mellow: All chiefs get a new hobby. Mine is CrossFit

Me: What's Dr. Carson's?

Dr. Mellow: Being a dick.

Me: Ok...what's Dr. Schnoz's?

Dr. Mellow: I don't think he has one.

me: I see.

Monday, April 6, 2015

Name that injury

Everyone seemed to enjoy the last round of "name that injury", so I figure we can try again.

What is this brilliant drawing attempting to explain:

Saturday, April 4, 2015

Weekly Whine: Windows

In the past, I have always used Windows on my computer, and I've been relatively happy with it. But lately, I've been less and less happy with it.

I think it might be partially because I've gone from mostly using my computer to mostly using my phone for all Internet stuff. So I only use my computer maybe every other day, if that.

Now basically every single time I want to use my computer, it insists that I need to install an update. It doesn't even give me a choice a lot of the time. So basically I have to wait 20 minutes to half an hour to use it for the update to install. The other half of the time, it needs to restart some program or the entire computer. Again, it doesn't give me a choice.

That's why I'm writing this post on my phone right now while I'm waiting for my computer to reboot. Using my computer now requires a tremendous amount of patience on my part.

Next time, I'm going to buy a Mac.

Thursday, April 2, 2015

Going gray

I am starting to worry that I have an abnormal number of gray hairs for my age. I am in my mid-30s, and I started to notice them right after I had my younger daughter. Now I have at least 20 of them! Of course, matters aren't helped by the fact that I've always had random blonde strands of hair mixed in with my natural darker color. Sometimes I pull out what I think is a gray hair and notice that it is brown at the root.

People tell me it isn't noticeable, although my kids love counting them, especially when other people are around. It makes me feel so freaking old.

When did you first start getting gray hairs? When is it the right time to start dying your hair?