Friday, October 24, 2014

Interviewing

There are many irritating things about the interview trail for medicine. You interview for medical school, then four years later you interview for residency, then 3-5 years later for fellowships, and eventually for jobs.

The question most programs seem to ask is "why this program?" I suppose it's a fair question, but they seem to expect some profound answer. Sure, if they have some state of the art something or other that no other program has, it would make sense to expect applicants to know about that and praise them for it. However, most don't. Most programs are the same as most other programs with tiny differences that don't really matter much in the long run. You most likely applied because A. they have a program and B. they are in a desirable location for you.

For some reason location isn't enough. I was at an interview where I answered location, the interviewer looked unimpressed, and then later reworded the question to ask me what specific things I had read or heard about the program made me want to come there. They weren't a stellar program. They were a perfectly adequate program. Would I want to go to their program? Of course! Was there some specific reason that they stood among any other program? No!

Programs in general, and this program in particular, can't even come up with reasons why we should go there. They always brag in their pre-interview powerpoint about how they have lectures, and simulation, and hands on experience! Then you go to the next interview and they tell you about their lectures, and simulation, and hands on experience!

I would love a world where we can cut the crap and the answer "well, you have a spot in a decently desirable geographical location" would be sufficient. But it never will. Let the bullshit continue!

Saturday, September 6, 2014

Need to get this blog "off the ground"

I don't post enough. I read blogs fairly often that I love, but I don't post myself. It's too bad really. I have a lot of interesting things that have happened in my life recently. I guess I'm just so busy that I haven't been keeping up with it. I'd like to change that. Right now things are hectic as I am doing a VERY involved Anesthesia/ICU rotation as well as filling out ERAS (to apply for residencies...EEEKK). But the more I get involved in others' blogs and the more I post on my own blog I would really like to become a more solid part of the blogging community. I think it is important.

In other news, I have started volunteering with a Pet Rescue. My hours are minimal now because I don't have the time and although it only involves cleaning the cages where cats are held to hopefully be adopted out, I still feel like I am helping. I would love to do more, however.

I was wondering if there were any way to use my soon to be medical degree to help animals in need. I'm not a veterinarian, but I do have medical experience and there are many similarities between animals and people. That's research for another day.

Saturday, May 24, 2014

These things are not the same.

Hello? ...... N-No I'm sorry who are you looking for? Who is this? No I am a psychiatrist not an ophthalmologist. You're IN the hospital? How did you get this number? Well no you need to talk to your medical team in order to call a consult, first of all. Second of all, I'm still a psychiatrist.

Hangs up. Dials another number.

Hello can I please speak to the nurse for Ms. Smith? (pause) Yes hello this is Dr. Psychiatrist and I just received a call from Ms. Smith asking me to see her. She told me you told her to call me and gave her my number. Patients do not call for their own consults. Yes, well although they are both inside the skull they are unrelated. Goodbye.

Hangs up. Looks at us.

Welcome to my life.

Sunday, March 16, 2014

So very poor

At the free health clinic:

Doctor: Patient came in the other day with anal pruritis (itchiness). What is it?

Student: Well the only thing I can think of is from pediatrics and it's Enterobius infection.

Doctor: Okay, well if you wanted to test that theory what would you do.

Student: Scotch tape test. Would you do that here in the clinic?

Doctor: No. We don't have any scotch tape here.

Saturday, March 15, 2014

Difficult patients

I was working with a doctor who was obviously quite jaded and angry, but rightfully so. I have become more jaded working in the hospital just from the people we have to deal with every day. It's one thing that they aren't compliant and have no desire to help themselves, but it's another thing entirely to then blame the doctors for trying to help them. Nevermind the fact that just trying to illicit a decent history or explain something to them is impossible. Also, being in a spanish heavy area is difficult. Most of them get upset that you don't speak spanish. This particular doctor had no problem saying exactly what was on his mind. I still felt uncomfortable standing next to him as he said it.

Patient: My back hurts so much.
Doctor: I sent you to ortho. They wrote here that you refused physical therapy in the hospital.
Patient: No. They said to me that I had to go to this other hospital for shots in my back and I don't know where that hospital is and they don't take my free health care there.
Doctor: I'm reading the note right now from the ortho doctor. It says that you refused to go to the physical therapy right here in the hospital.
Patient: No I did not.
Doctor: Okay. Fine. We will just assume ortho is lying then. You will go to physical therapy?
Patient: Yeah, ok. What did my MRI show? My back hurts so much.
Doctor: It showed some minor arthritis in your spine that I would expect any 70 year old to have.
Patient: But it hurts so bad! You don't know what this pain is like!

After the doctor told me that he gets upset when patients tell him he doesn't know what the pain is like. Who are they do assume he hasn't felt pain?

(Through a spanish translator)
Patient: I need a referral for ophthalmology.
Doctor: I gave you a referral last time you were here, you made an appointment, and you didn't show up.
Patient: No no no. I called and called and called and they never picked up the phone.
Doctor: That isn't the issue. What I'm telling you is that you had an appointment and you didn't go to it.
Patient: No. I called and called and called. Finally someone picked up the phone and I tried to speak a little english, but they didn't speak spanish and that is not my problem.
Doctor: First of all, you didn't need to call anyone. All you needed to do was show up to your appointment and you did not do that. Second of all, them not speaking spanish and you not speaking english is not their problem, it is your problem. How long have you been in this country?
Patient: 20 years
Doctor: Twenty years?! And you haven't learned any english?? Where are you from?
Patient: Peru
Doctor: If I went to Peru, I would learn Spanish.

These conversations are not unique. The way this particular doctor dealt with it is, but a lot of patients feel entitled. It's difficult not to be hostile when you are being attacked or getting false information or being lied to. Doctors are only human also.

Friday

Chief resident: Ok residents, now that we have just presented the case, any idea what this is? 

(Silence)

Chief resident: Anyone? Any ideas at all? 


(Silence)

Chief resident: Is this some sort of revolt against me? 


(Silence)

Resident: What was the summary again?

Saturday, March 8, 2014

Gonna have to be more descriptive than that

Daughter: She is having pain in the front and the back.

Me:  Can she point with one finger where the pain is on her front?

(Daughter and mother exchange looks)

Daughter: She went to the ladies' room and it hurt her.

Me: Ah, so she is having pain when she goes to the bathroom?

Daughter: Yes. In both the front and the back.

Me: Ok, so when did she start having pain with urination?

Daughter: Oh dear! We don't use that kind of language!

Psychogenic polydipsia

Me: So what brings you in to the emergency department today?

Patient: I drank a lot of water. I have been vomiting all day. I feel so sick.

Me: When did you start vomiting?

Patient: After I drank a lot of water.

Me: Uhh, ok how much water?

Patient: Like a gallon and a half.

Me: And why did you drink this much water? Do you feel really thirsty?

Patient: No I felt sick to my stomach and wanted to throw up.

Me: You made yourself drink water to throw up?
 
Patient: Yes

Me: Why did you feel sick to your stomach?

Patient: Because I drank a lot of water!

Tuesday, February 18, 2014

What patients want

I recently spent some time with a doctor. In the few short days I spent with him I noticed a few trends. Every new patient got AB index done by the nurse with the doppler. Every new patient got a full lab workup with everything from Lyme titers to ESR. Most patients got PFTs. Every patient was either given an ultrasound and a joint injection or given a perscription of whatever drug the rep serving us food in his office was pushing.

Examples:

Woman with diabetes comes in uncontrolled on her current drug regimen. She isn't taking the drugs at the prescribed time. She admits to feeling "low blood sugar" every day after she takes her medication so she eats whatever is in the vicinity such as cookies to bring it back up. Her A1C was like 15. No diet or medication counseling was done. Instead he grabbed the rep that was in his office pushing some drug class I never even learned in med school (it was that new) and had him explain the drug and then gave it to the patient.

Woman with hypothyroidism gaining weight. He sends her for gastric sleeve at her request.

Guy with outrageous uncontrolled hypertension on 4 different medications. He decides those aren't working (none of them are maxed out, or the correct combination of medications you are supposed to put patients on) and switches him to the newest combination hypertension pill that I have again, never heard of.

Guy with abscess. He drains it and then proceeds to give him a few specially formulated tubes of stuff to put on the wound that he has specially mixed and delivered to his office. It was basically flavored neosporin. I bet you anything he's charging a good bit for that.

The kicker? He's one of the highest rated doctors around. Patients LOVE him. They eat this crap up. He practices the worst medicine I've seen, but he makes the patients all feel like they are celebrities. He profits from a bustling practice built by robbing these patients not only of their health, but their money.

Patients love expensive medicine. If you go to your doctor feeling really crappy and he tells you that you have a virus and don't need an antibiotic what will you do? Well, most people will whine. "My last doctor would give me an antibiotic". "I had this a few months ago and I took the antibiotic and it helped." "I got this from my husband and he got better on an antibiotic." Everyone thinks they are doctors. And most doctors will cave. Otherwise they get bad reviews online and their practice tanks. No one can trace antibiotic resistance back to that doctor, but they sure as hell can trace crappy reviews. I can make the same argument for pain medication, lab tests, etc. The list goes on. Patients want what they think they need.

If you go into an office and get told you have this and that wrong with you, but don't worry it will be fixed with a knee injection and this brand new medication, you're elated. This doctor is so smart he found things wrong with me other doctors didn't! And he hooked me up to this crazy machine and measured my blood flow! No other doctors do that! And he checked every single one of my labs (including PSA and all the other ones no longer recommended) because he really cares to make sure I don't have cancer or liver disease or kidney failure! And he has all these new medications that work better than the old ones! And he fixed me all up by doing an ultrasound in his office and injecting me with medication right there!

And people complain that medicine is too expensive. It's a vicious cycle. People want to be validated for going to the doctor. They think they know what's best for them and want a doctor who just gives them what they want. They don't want good, efficient, smart medicine. Then what happens to the good doctors who only order the necessary tests, only give the generic medication, only practice evidence based medicine? Patients don't read the literature, but they do watch the TV and read the internet and listen to their friends.

Monday, February 10, 2014

The ED is a nutty place to be.

Ms. Demented: Doctor! Doctor! Doctor! Doctor! Doctor! Doctor! Doctor! Doctor! Doctor! Doctor!

(This went on for a while to a pretty regular beat that the nurses broke into song)

Med student: Hi, I need to take off your bandage.

Ms. Demented: No oh no doctor! Oh doctor! No! No! No! No! No! No! No! No! Oh doctor. Doctor! Doctor! What is your name?

Med student: Sam

Ms. Demented: Oh Sam! Oh doctor! Just like that! Yes! Yes! Yes! Yes! That's good! That's good! That's good! That's good! No! No! No! No! No! No!

(Sam leaves to get supplies)

Ms. Demented: Sam come back! Sam! Where is Sam! I only want Sam! Samuel! Samuel! Where are you? Come back! Doctor! Doctor! Doctor! Come back!

(Sam re-enters)

Ms. Demented: Samuel. I only want you Samuel. Oh Samuel. Oh doctor! Doctor! Doctor! Doctor! Doctor! Oh Samuel yes. I love you I love you I love you I love you I love you Samuel. I love you. Oh push me up Samuel! Oh jesus god push me up! Oh my god! Push me up! Oh Samuel! Oh doctor doctor doctor doctor doctor!!

Sunday, February 9, 2014

The reason we ask your history is because, well, it's important

We recently had a patient who came in with a whole body reaction to a medication she had received a week ago. Her skin looked terrible. All over discoloration, thickening, swelling, painful lesions. Certainly she was having a reaction, but just how much was acute was difficult to discern. She was also African American and that makes it much harder (especially for me) to tell the extent of erythema.

We asked her if she had any other medical conditions, had ever had anything like this happen before, what her skin usually looks like. She pointed to an area on her wrist that was smooth and much lighter in color than the rest of her skin and said that her skin always looks like that. We admitted her for fear of SJS/TEN (really bad necrotic skin conditions that can be due to drug reactions).

Later we called her primary care doctor to find out that she has a chronic skin condition and has been seeing a dermatologist for years.

........

So you just happened to forget that you have a chronic skin condition and see a whole separate doctor for YEARS to treat it? That just happened to slip your mind when we specifically asked you what your skin normally looks like and if you have any other medical conditions??

Monday, February 3, 2014

:yawn: I'm a 10/10

For every patient in pain you are expected to ask them to rate their pain on a scale of 1-10. It's annoying because it's completely subjective and I have yet to meet a patient who understands this scale. Yet we still are forced to ask them, and to record it.

As far as I'm concerned, a 10/10 pain is excruciating. It means you should be screaming in nonstop agony. A 10 would be like having your arm ripped off or someone stabbing you over and over and over. You can't be asleep and in 10/10 pain. If you have 10/10 pain, you better be screaming. Or at least moaning...even a LITTLE. I get that your pain hurts a whole lot. Give it a 7 or 8. Or hell, even a 9. But it's always 10. Always.

I walk in the room of a patient who I already had a feeling was going to be annoying so I guess I had a bias. He was sleeping so I woke him up. He said he had horrible pain in his leg. I asked him to rate the pain out of 10 and prefaced it, as I always do for the hope that maybe one day a patient will understand, "...with 10 being the most horrendous, awful, terrible pain you can think of." And of course, he was a 10.

Later when we went in to see him he was watching TV with his hand behind his head, lounging in the bed and when asked the question again he drowsily looked up at us and said., "What? Yeah it's a 10."


Tuesday, January 28, 2014

Grad school vs. career

At this point in my life, everyone my age has made a huge decision. They either are part of the work force or going to grad school. The unfortunate thing about this is there is a huge rift between these two life choices. My boyfriend told me a story of how he was talking to someone who, when he asked what he did, got really sheepish and told him he was in grad school. Joseph of course then told him he was in med school and the conversation became happy again. It's annoying. Why can't both be acceptable life choices to each other?

In discussing this with others, there are a lot of reasons for discomfort on either end. Some in grad school feel like they are missing out as they watch all their friends have money, and they feel weird when people make a big deal that they are going to be a doctor, yet they also feel entitled because they will one day be making more money. Some in the work force feel bad about themselves for not continuing their education and know that those in grad school will be in a better financial position in 10 years yet they feel like real people and look down on those who are still in school wasting money.

It seems to me like a grass is greener sort of thing. You made your decision, others made theirs, so just stick to it and hold your head high. And the decisions that others have made are no better or worse than yours, just different. No one should have to feel lesser or more for it.

Thursday, January 16, 2014

Criteria for admission: Should be able to talk on phone

The updating hasn't been as much as I'd like. I'll try harder.

Anyway, today's entry will focus on awkward medical students. Yes folks, they exist. Sure they come out better on the other end of medical school than they went in, but for the most part will still be pretty awkward doctors. For example:

Dr. Psychiatrist: I need someone to call Mr. Crazy's landlord and find out if he is, in fact, getting evicted or having issues with his housing situation.
Student Bob: I'll do it.
Student Jake: Okay make sure you introduce yourself, explain who you are, who you work for, and why you would like this information. I would even say Dr. Psychiatrist's name.
Student Bob: Yeah, yeah.

Ring ring
Landlord: Hello?
Student Bob: (REALLY loudly) Hello? Hi. Hi. Uuhhhhhhhhh. Do you have, ummmm, a tenant named Mr. Crazy? I was wondering if you could just tell me a little bit about him....and......what you know.
Student Jake: Tell him who you are!!
Student Bob: Oh yeah, uhhhh, I'm sorry. Let me start over. Um. I'm a medical student from This Hospital. Can you tell me about Mr. Crazy?