Dr. Orthochick: Misspeak

I was giving a presentation today and I accidentally said "patient was born full term via spontaneous vaginal deformity." (instead of delivery)

If nothing else, it killed some time while everyone tried to collect themselves. I think I got a bigger laugh than my co-resident did that time he wrote "interanal condyle" instead of "internal condyle" in his slide. Or that time another resident presented an article that not only contained the phrase "depth of penetration," but also discussed factors that influence the depth of penetration, such as reaming harder, faster, deeper thrusts...

Won't we all...

Conversation with patient being fitted for an artificial leg:

Me: "how are you doing?"

Patient: "I'll be feeling a lot better once I get my prostitute."

Weekly Whine: Happy Birthday, buy a car

I'm finding it more and more irritating to get birthday messages from my dentist, eye doctor, car mechanic, etc.

It's not that I don't appreciate that they have an automatic system that's considerate enough to remember my birthday. But it just makes me feel kind of like a loser when I get more birthday wishes from people who want to sell me stuff than I do from people who actually are my friends.

Comorbid

Me: "do you have any medical problems?"

Patient: "no."

Me: "do you have diabetes?"

Patient: "yes, but it's controlled."

Me: "with diet?"

Patient: "no, with two medications."

Me: "And do you have high blood pressure?"

Patient: "yes, but it's controlled."

Gah!

Dr. Orthochick: High school sports clinic

As luck would have it, since I'm this month's sports chick, I got roped into helping with high school student sports physicals on Saturday. Technically I didn't have to, but the way it was worded meant I sort of had to if I wanted to pass this rotation. Also, Dr. Douche kept on talking about how this would not only benefit my education now, it would also benefit me in the future so I could have a job doing sports physicals. I guess he doesn't think I'm going to be a very good surgeon if my best option is to do sports physicals for the rest of my life.

Back in the olden days, when I was doing high school sports, you brought the form to your pediatrician, he signed it, and you were good to do sports for the year. That does not fly anymore. Now you need a comprehensive examination by a medical doctor, a musculoskeletal specialist, and a cardiologist before you get cleared to play sports. And if anyone in your family has heart disease, you need a transthoracic echocardiogram for clearance. So our Ortho group organizes it so that you can get all of this done on one day for free, which is a pretty sweet service because otherwise it would take a lot of time and money. (and my parents were into us doing sports, but if mom had to drag us to a cardiologist every year, I think she would have told us to get fat and make daisy chains in the backyard for exercise)

Physical-a-palooza started at 8AM, I got there around 8:30 because I had to change a wound vac before leaving the hospital and it took a little while, and there was a line of high school students and parents that curled around and outside the parking lot.

I started out in the musculoskeletal section, which consisted of doing a scoliosis check, anterior drawer tests of the knees, moving the hips, and checking neck and shoulder range of motion. On anyone who had a specific complaint I did a focused physical, but for the most part that was alls I did. I did it at least 25 times before I got switched to the medical stuff because they had enough musculoskeletal specialists but you need to be a doctor to do medical exams. (MSK can be done by a physical therapist or PA) I guess "ortho resident" falls under the realm of "doctor," but I feel like if we're going to all the trouble of cardiac screenings, we might want to have someone who uses a stethoscope on a regular basis do these medical exams. Not that it's hard and G-d knows I did a trillion heart-lung-abdomen exams in medical school, but by this point I don't remember which murmurs radiate to the carotids and which ones increase with valsalva etc etc etc. Good thing no one had a murmur. I did at least 50 medical exams, except I made it very clear that I was only going to do medical exams on girls. For boys you have to do a hernia check and yes, I do know how to do that, but I don't want to be in a room with a teenage boy who's naked from the waist down without a chaperon. I feel like that's putting me in a potentially litigious situation and whereas I'd like to think no one would accuse me of anything, honestly, I don't want to put myself in that position. Plus I feel like most teenage boys would probably prefer a male doctor doing that. So I did the girl stuff which involved asking a lot of questions about menses (r/o Female Athlete Triad) but didn't require anyone to disrobe.

Dr. Douche must have been bored because he kept on wandering over to my examining room to talk. He asked me repeatedly if i was learning about the importance of the physical exam and OK, it is important, but checking neck range of motion on 25 asymptomatic high school students is not going to convince me of that. Also, I'm not sure what he thinks I do all day if asking about menses is going to prepare me for the future.

So yeah, not sure I really got out of that what i was supposed to get out of that but I guess it's good to know that if this surgery thing doesn't work out in the future then yes, I feel very comfortable doing high school student sports physicals and I can make my living doing that.

Last chance to contribute!

A long time ago, I posted about putting together an anthology of humorous medical stories, and donating the proceeds to Red Cross. Well, as I mentioned in a prior post, I have collected enough stories to start putting together the anthology:



It is nowhere near complete, but I have enough stories that I can definitely make the book. However, the more the better, so...

If you would like to contribute a humorous medical story to this anthology, send it along to me at fizzziatrist@gmail.com. This is a great opportunity to have your work published in a book, and also to make a contribution to what I consider a really worthy charity! This is the last time I'm going to solicit stories.

Specs: It must be at least a little bit humorous and also at least 1000 words. Other than that, go crazy. Deadline: July 31!

Weekly Whine: Birthday rules

A few simple rules for people who get invited to a child's birthday party, especially if it is at a paid location rather than at somebody's house:

1) RSVP prior to the RSVP date. Not the day after the date, not the day before the party. Just let the parents know if you're coming or not with enough time to plan!

2) If your child is invited to the party and you want to bring your other children along, ask if it's okay. Don't just assume you can bring your other three kids and nobody will care. Many locations have an upper limit on the number of children that can come to a party.

3) If you RSVP that you are going to the party, go. If you RSVP that you're not going (or not at all), don't go.

4) Don't say something like "we might be able to stop by." Are you aware that these places charge $20 per kid sometimes and need to know in advance?

5) Just bring one present. Who started this precedent of every family bringing like three presents? My kid has enough toys already.

6) Do not leave your kid at the party unless you are explicitly told it is okay. If your kid is under five years old, it is probably not okay. The last thing I need to deal with when running a party is your kid sobbing because he can't find you.

I hope kids appreciate how stressful these parties are for the parents…

Was I wrong?

One day when I was in the middle of a vacation, it was the last day at work for a friend of mine and they were having a special potluck breakfast for her at the nurse's station. So I decided to come by for an hour in the morning with cinnamon buns and my toddler to bid my friend goodbye.

I was glad I came to see her, and also my daughter had a great time, plus I got to show her off. But when I was there about half an hour, a nurse came up to me holding some pills and said, "Can I ask you a question?"

I said, "No, I'm on vacation. I'm not really here."

The nurse said, "It's just a quick question about a patient."

Then about three other people said, "No! She's not here! She's on vacation!"

The nurse gave me an exasperated look and said, "You're really not even going to answer a question?"

Then someone told her to go page the attending on the floor.

I mean, was I wrong? I was sitting there with my two year old child, chatting with friends, on my freaking vacation. Why should I have to answer non-urgent medical questions about patients I hadn't even seen in several days? But she seemed so irritated I wouldn't do it. It made me wonder if I should have just been nice and helped her.

(For the record, two of the people chatting with me were practitioners AND were working, and somehow she only asked me.)

Dr. Orthochick: Whoops!

I scrubbed in for bilateral knee multiligamentous reconstructions with Dr. New the other day. I figured he would appreciate having a more senior resident help him since his options were me or an intern and I'm better at holding the arthroscopy camera, I like to think.

In the first 5 minutes of the surgery, one of us broke both the patient's tibias and one of us broke sterility.

Alls I can say is, glad those two weren't reversed. Because whereas it was an accident, it would have been less of an accident had I been the one who broke the tibias.

I scrubbed in again. We then spent the next two hours putting plates on the proximal tibias.

Circulating nurse: Should I call the family [in the waiting room] and tell them what you're doing?
Dr. New: No...I don't think they'd understand.
Me: I bet they'd get it if we said "hey, sorry, we broke both your daughter's legs and now we need to fix them."
Dr. New: You should let me be the one to talk to the family when we're done.

So yeah. It added about 2 hours to the surgery, but I was so busy being relieved that I hadn't done it that I didn't really mind too much.

Squeaky Wheel

Recently I was wondering if more difficult patients get better care.

We recently had a difficult patient. Every day, a doctor would have to spend over an hour talking to the patient about her many concerns. There were meetings about how everything needed to be carefully documented for this patient so that she would not throw a fit. Considering how much time we spent on this patient, it seems like she was getting better care than any other patient.

But is that really true?

I'd like to think that every patient we treat receives good care. Just because that care was being meticulously documented to avoid a lawsuit doesn't mean that the care was better. Just because the doctor spent time arguing and discussing the same issues with the patient over and over doesn't mean the care was better.

But I did notice that nurses and staff would avoid going into the patient's room if remotely possible, unless they absolutely had to. Nobody wanted to see that patient because they didn't want to get yelled at.

What do you think? Does the squeaky wheel gets the most grease or the least?

Weekly Whine: Pool etiquette

It was so hot yesterday that I took the kids to the pool, which I never do because our community pool is so freaking cold. The water in the pool is so cold, it makes my feet go numb. But because it was so hot, the water temperature was almost tolerable. Almost.

So while I was at the pool, there was this man throwing the ball around the pool with his son. He was standing at one end of the steps into the water, and his son was at the other end, and they were whipping the tennis ball back-and-forth. At one point, the ball hit the table where his wife was sitting, and she yelled at him, "What's wrong with you?? Stop throwing the ball around!"

I expected lifeguard to say something to him, but she was apparently on another planet. It was really upsetting me that they were throwing this ball back-and-forth pretty hard. I don't think it would've seriously injured anyone, but it would've definitely caused a bruise. I was afraid to even go near the pool because I didn't want to get hit.

Finally, I said to the guy, "Would you mind not throwing the ball around the pool? I'm afraid somebody's going to get hit by it."

The guy seemed upset. "It's just a soft tennis ball."

Tennis balls are not that soft if you're throwing them really hard, which it looked like they were. I thought the whole thing was ridiculous. Isn't it obnoxious to be throwing a ball around in an area where people are swimming?

Anyway, his wife yelled at him again to stop, so he stopped. I don't think I overreacted...

Stages of getting older

Dr. Orthochick: Help

I had a really bad call the other week of the variety where I couldn't do anything right. And it was busy so I kept on having to double back because I was redoing a lot of stuff. Around 1 in the AM I got consulted for a guy with a finger infection, he had been bit by another person and some genius in the ER had sewed it up so that the infection brewed deep to the sutures and ravaged his pinky. I looked at it and he seemed to have infection diffusely--the whole finger was swollen and he couldn't move it and he had erythema and lymph nodes tracking past his elbow. So I didn't really feel like I could handle the situation on my own in the ER, and I say this as the chick who once washed out a septic wrist in the ER. (Disclaimer: Even at the time I knew that was a bad idea)

The problem was, the hand surgeon on call that night was Dr. Ortho. I don't like Dr. Ortho, he doesn't like me, I spend a decent amount of time and effort trying to stay out of his way. So I really didn't want to call him to tell him I needed help, but since the alternative was make a mess out of everything, I gritted my teeth and told myself it was in the patient's best interest.

What I wanted to say was, the reason why I was scared to do this was because i had a similar patient with Dr. Pregnant at the beginning of the year and I tried washing him out on my own in the ER. I made a small incision in the base of the finger the way you're supposed to and tried flushing out the sheath, but the infection seemed a little too diffuse for that so I wound up flaying open his finger. I made zigzagging cuts across the palm of the index finger and created flaps. At some point in all that, I must have hit one of the digital artery and nerve bundles (you have 2, one on each side of your finger) and knocked them out. I remember a lot of bleeding and trying to get it under control. Anyway, because he had reduced blood supply to his finger, the antibiotics couldn't get to his finger and the tip died off from lack of blood and infection. The flaps I had created on his palm turned black and fell off because they didn't have enough blood. We took him back to the operating room to try and save something, but we saw pus dripping off his other digital nerve and artery. We couldn't clean them off because we wanted to save at least one in the hopes that his finger wouldn't die, which meant that we left pus to rot in his finger. He lost his index finger. He was 35 and a laborer.

So I wanted to tell Dr. Ortho that story, but I didn't want to admit that it was my fault that a healthy young guy lost a finger and even though I have a better idea of what to do now, I was scared. So he came in to do it with me, after berating me over the phone for a good 10 minutes for not knowing how to do a flexor tenosynovitis/septic arthritis washout by this point in my education. He came in to the ER at 2AM, washed out the guy's finger without talking to me, turned to me at the end of the hour and said "write admission orders and dictate this procedure," and then walked out without looking back.

I know I should know how to do this by now, and it's not that I don't per se, but I really don't think it's the worst thing in the world to ask for help.

White coat burnout

After diligently shrugging on my white coat for pretty much every single day throughout my entire residency, I abandoned my coat the minute I graduated. I haven't worn one at all since I've been an attending. Here's why:

1) No other physicians I work with wear a white coat, except for the weird ones

2) They get dirty so easily. And of course, they show every speck of dirt because obviously they are white. Duh. My white coat from residency retired with a layer of indelible grime on the sleeves and hemline. I have to believe white coats are incredibly unsanitary.

3) If you are a female, you cannot pee while wearing a white coat. If you keep it on, you risk dipping it in the toilet. That is a fact. If you take it off, where are you supposed to put it? On the nonexistent hook on the stall door? On the floor??

4) While it was nice having the pocket space, I think the sheer number of things I always kept in the pockets was contributing to neck pain.

5) The white coat does absolutely nothing to decrease the number of patients who call me "nurse"

I do keep my white coat around, mostly in case the air-conditioner goes crazy and I need an extra layer of clothing. But I can't really see going back to wearing it regularly.

What do you think? Should doctors wear their white coats?

Weekly Whine: Profanity

One thing that irritates me both as a writer and reader is that Amazon does not have a good way to denote how much profanity there is in a book. There ought to be a clear rating for every book saying how much profanity or sex there is.

Personally, the profanity does not bother me. But I have had many people give my books a bad rating with no other explanation other than "there was cursing." Obviously, it doesn't take much profanity to upset people. If you read my books, you'd recognize that I hardly swear like a sailor. Any profanity is few and far between.

And as a reader, I've noticed that there are certain books that may have lower ratings and I have to read through all the readings to realize that the books just got dinged for having profanity. I don't get it. Do people just go around giving bad reviews to books that have any profanity in them? This upsets me both as a reader and a writer. I use the ratings on Amazon to decide whether to buy a book, so a bad review that has nothing to do with the quality of the book misleads other people.

And I guess it sucks for the people who hate profanity too. If they are still bothered by a few curse words and have no way to tell if a book is going to offend them until they are immersed in it.

Transcription errors

Take a guess what this transcription error was supposed to be:

"DVT prophylaxis is to be done with Betadine."

By the way, we don't use any sort of automated transcription program. The transcriptions are done by human beings. Who apparently have very little medical knowledge.

Dr. Orthochick: Eval

Dr. Jameson: Mid-cycle evals are tonight and I can't go. I also couldn't figure out how to fill out the form online. So how about I just tell you what i would have written on your evaluation.

Me: OK...

Dr. Jameson: You're doing fine.

As far as my evaluations go, that's probably going to wind up being one of the better ones.

What does this mean?

I spent like ten minutes puzzling over what this order meant, and had to ask someone before I figured it out: