Here comes the blood

Med student: So what brings you in today?
Mr. Ejaculation (slurring and reeking of booze): Last night I came blood.
Med student: I'm sorry, how did you come...?
Mr. Ejaculation: Out of my pecker! I was on my computer and you know and then I you know and it was blood!
Med student: How much blood?
Mr. Ejaculation: I don't know I didn't measure it!
Med student: Has this ever happened to you before?
Mr. Ejaculation: No! Never! And I was so worried because I thought this is serious! So I sat down and drank all night long. I couldn't sleep because I thought, you know, this is serious! And then I came in this morning.

Decent

Overheard by a resident in the lounge:

"We make decent physicians. We aren't great physicians by any means, but we make responsible physicians."

Made me chuckle.

The emergency room is for.....emergencies

Working in the emergency room I've seen a lot of things that do not constitute emergencies even a little.

Sarah: So what brings you to the ER today?
11 y/o Kid: I had a fever.
Sarah: When did you have a fever?
Kid: Yesterday.
Sarah: How did you know you had a fever?
Kid: My mom felt my head and it was warm.
Sarah: Did she take your temperature with a thermometer?
Kid: No.
Sarah: Why did she feel your head?
Kid: I felt like I was hot and so she felt my head and it was warm so she gave me advil.
Sarah: How do you feel right now?
Kid: Good.

The kid didn't have a temp in the ER. He had subjective temp yesterday morning. No other symptoms. Nothing was wrong with this kid. At all.

I don't understand.

Did you do anything fun?

People don’t seem to understand what being in medical school entails. You can explain it to them frontways and backways over and over, but they still won’t get it. I remember when we were studying for the boards and my boyfriend had a conversation with his cousin while we were studying for Step 1. This is the most important exam you take in medical school. You study for around 5 weeks straight for it (and by straight I mean morning to night, every day, no breaks) and the score essentially determines what kind of residencies you can apply to and what kind of specialty you can do.

Cousin: So what are you up to now?

Joseph: Studying for the boards every day. It’s pretty rough. I have a few weeks left and then freedom.

Cousin: Oh that sounds rough. So like what else have you been up to?

Joseph: Well, nothing. I just study all day every day.

Cousin: Yeah, yeah, I get that. Did you do anything fun this weekend?

Joseph: No. I just studied. All weekend.

Cousin: Did you see that movie that just came out?

Joseph: No I haven’t seen any movies because I have been studying. I also haven’t watched TV so I don’t know what movies are even out now.

Cousin: Oh yeah, that makes sense. Doing anything fun this weekend?

Med students are so boring.

Iatrogenic

Today I heard a story at lunch. I wouldn't believe it if I hadn't seen things happen like this before. A woman came into a trauma and was pretty much gone. The details I don't know, but there really was no saving this woman. Yet the family wanted the doctors to "do whatever is necessary to save her." That opens up the biggest and worst can of worms.

One of the residents thought she had a pneumothorax. So he went to perform a needle chest decompression and there actually was no pneumothorax. Instead, with his intervention, he then caused a pneumothorax. So they decide to put in a chest tube. The resident was pushing it in and hitting some resistance so the chief resident grabbed it and shoved it in with force. They take the x-ray to look at the placement and see that the tube had been shoved in so hard it went across the mediastinum, into the other lung, causing a pneumothorax on the other side.

Yeah.

Everyone hates everyone else

I've noticed that, unfortunately, every field of medicine seems to really hate every other field of medicine. In addition to the hatred comes the stereotypes. Pediatricians and family med doctors are stupid, surgeons are callous douchebags, anesthesiologists are lazy, neurologists are useless, psychiatrists are crazy. And really, these stereotypes (like all stereotypes) are based upon an observation that then gets built upon. Pediatricians and family med doctors have some of the lowest board score averages. Surgeons do very quick exams and often are unreachable in the OR (which other specialties don't seem to understand). Everyone has looked over at an anesthesiologist at some point to see them on their phone or reading a book. The list goes on.

I'm not going to say I disagree or agree with the stereotypes. It is, however, detrimental to patient care when specialties bicker with one another or can't work together because one of them has a superiority complex. It also makes for a negative experience when everyone is always talking about how they hate someone else.

You know what? We are all the best. We are some of the smartest individuals in the nation. Yet for some reason, doctors still feel the need to define themselves as best, others as worst, and create a hierarchy within the medical field. It's annoying. It's like being back in high school again. You get sucked in so easily. You feel insecure because you aren't the best anymore like you were in college. Your potential field of medicine is being made fun of. So you make fun of other fields. Or you have someone standing in front of you who thinks they are so much better than you (and says it).

You hear the familiar statements. "Of course he did a CT when it wasn't necessary, he's an ER doc." "These pediatricians are incompetent." "Radiologists are so lazy." "Don't call the neurologist, there is no point." "Of course surgery won't come see him, they can't be bothered." "Don't become an anesthesiologist, they don't help anyone."

My personal favorite was when the pediatrician said, "That website is idiotic. It doesn't give any information at all and it's written in 4th grade english. That site is made for family medicine docs, not us." Uhhhh, you guys are both primary care and reaalllyyy similar. How can you guys hate each other?

My friends and I had an interesting discussion once. There must be ONE field that everyone sort of respects and leaves alone. I thought maybe cardiology. My friend thought hem/onc.

Thoughts?

Please just answer the question.

One of the biggest problems I have with history taking is that no one answers the question. I am unsure if it's because people are stupid or if the questions I ask don't make sense. Or something in between. I am not the only one who has this problem though because I have heard mention of it many times before. How difficult is it to answer "how often do you have the abdominal pain?" or "when was the last time you took tylenol?"

I had to work with this doctor for two straight weeks and he was, to put it nicely, an unpleasant person to be around. His bedside manner was crude, his personal interactions were awkward, and many of his patients switched to the other doctor he worked with for their care. I even had one patient in the hospital recently refuse the consult if he was the one on service that week. However, he did not let patients get away with not answering the question. He would say to them "No. That is not what I asked." and restate the question.

I have observed many interviews where the doctor lets the patient go on a tangent and things get muddled and the interview took three times longer than it had to. Obviously we learned in our "how to be a doctor" courses to ask open ended questions and not cut the patient off. That's another discussion for another day. In general, I have learned that while you should let the patient talk, you also need to be in control of the interview.

As an example, myself and another medical student were interviewing a patient and her mother. This patient had asthma and we had to figure out how often she was using her rescue inhaler to see how bad her asthma really was.

Sarah: How often do you use your inhaler?
Mother: It's only when she coughs a lot.
Sarah: Yes, but how often would you say that is?
Daughter: I only use it when I cough a lot and then I have to use it.
Other student: Right, but how many times do you cough a lot and have to use your inhaler? Once a week? Twice a week? Every day?
Daughter: It's really only when I cough. If I'm not coughing I don't use it.
Mother: She doesn't use it that much. Only when she starts coughing.

I give up.

Narrowing it down?

Based on my experiences so far (a lot of bad ones, some good ones) I have narrowed down my focus to two probable specialties: GI or anesthesia.

Discuss.

(Pro/con list to follow)

Rules of medicine

I think I'm going to start a little something I like to call "the rules of medicine." Maybe I'll change the title eventually. It's a working title. Anyway, here's one for now....

If your child is able to run around and play in the play room at the hospital, they are not sick enough to need to be in the hospital.

I should start posting again

I have a million stories from third year so far. The problem is I'm often too busy and too tired to want to update. I want to try to change that. I can't update you on the past 3 months. It's too much. I can, however, try to be better about posting even a little something every day.