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??

: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."

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.

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?

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.