Thursday, May 25, 2017

My census

At the end of my first month of intern year, I kept a pile of signout cards with all my patients' diagnoses on it.  This was my list of diagnoses for a month at a county hospital:

1) new onset DM
2) Trisomy 18 with aspiration pna
3) pancreatitis
4) alcoholic cirrhosis
5) inflammatory colitis
6) ascites and alcoholic cirrhosis
8) abscesses
9) pyelonephritis
10) UGIB
11) cardiomyopathy
12) gangrenous finger
13) CAD, here for PTCA
14) SOB/CP
15) diplopia
16) GB cancer
17) SOB
18) TIA
19) LLL pneumonia and UTI
20) CP and melena
21) pancreatitis
22) CP
23) CHF exacerbation
24) TIA and gout attack
25) UC exacerbation
26) gastroenteritis
27) N/V
28) herpes zoster. 

(Note that no non-standard abbreviations are used above :)

Monday, May 22, 2017

4 days

During my Medicine rotations during med school and also during my Medicine intern year, we had four days off per month.  I believe that's the minimum that residencies are forced to provide.

Maybe this makes me a delicate little snowflake, but I think 4 days off per month is nowhere near enough.  Especially when the other 26-27 days of the month, you are waking up super early, leaving super late, and sometimes spending the night in the hospital.  I remember one resident said she got a simple cold and it lasted for two months because she was so overworked that she couldn't shake it.

Is it any wonder residents are so burned out?

There was one month during internship when I was feeling really depressed and burned out, and I was going into a stretch of working nearly two weeks nonstop with two overnights wedged in there.  I asked my lovely (not) senior resident if there was any way I could have even a half day off in there.  In retrospect, I'm embarrassed I asked because the answer was so obviously no.  She let me have it: "If you get a day off, that means someone else has to cover for you!"  

The solution, in my mind, is that we need to train more physicians so the ones we have aren't so overworked and miserable.  Yet I doubt that the four days off per month policy will ever change.

Tuesday, May 16, 2017


One of the hard things about going from my pre-clinical years in med school to working on the wards was getting used to all the freaking abbreviations.  I remember my first medicine signout sheet looked like gibberish to me.

These days, I'd like to think I know MOST medical abbreviations.  But sometimes I'll get a discharge summary on a patient that makes me think that whoever dictated it got a little too abbreviation-happy.

These are all from a recent discharge summary:


I literally had no idea what any of these things meant.  Is it just me?

Friday, May 12, 2017

Dictation errors

From a recent dictation:

"He hasn't had a left thigh laceration which were featured by ophthalmology."

Really?  I understand that Dragon isn't the greatest, but if you're going to produce notes that say things like that, what's the point of even writing a note?

Tuesday, May 9, 2017

The literal price of health care

Recently my daughter sprained her ankle. Because she's a bit of a drama queen, I took her to urgent care after she refused to put weight on it for a day. The x-ray didn't show a fracture and they gave her a crutch and an Aircast, which she used for exactly one day before she was better.

 A couple of months later, I got a bill for $150 for the crutch and aircast that we barely used.

Because of large deductibles and other reasons, we end up paying a lot of our outpatient healthcare expenses out of pocket. But the problem with that is that you have no idea what you're going to pay until the bill actually arrives. If they had told me it was going to be $150 for that stuff, I never would've taken it.

Think about how crazy it is. You would never go to a furniture store, buy a sofa, and just wait a few months until the bill comes to see how much you ended up paying for it. But that's what I'm constantly doing with my healthcare bills.

I can give multiple other examples. Recently, my own doctor ordered a lab test which I didn't think was entirely necessary, but I decided to let them get it anyway. The test ended up costing a shocking $300. I never ever would've approved it if I had any idea it would cost that much. And the clinician has no idea what these things cost, so no help there.

Fortunately for me, $300 won't break me. But there are plenty of families out there for whom $300 is a substantial chunk of money. They may go to the doctor and blindly accept any recommendations and then end up with a gigantic bill.

The solution? I'm not sure. We don't want people to forgo important task because they're expensive. But I also think that people have a right to know what they're paying before the bill comes in the mail.

Thursday, May 4, 2017

Kids and internet privacy

With a child reaching her tween years, my husband and I have been worrying more and more about what to do about monitoring internet and phone use.

I have friends who say they have passwords for all their kids' Facebook/email/whatever accounts and check them either nightly or at least periodically.  But my husband feels that this is an invasion of privacy and she'll find a way to circumvent it.  We should just educate and trust her.

I'm not sure.  I feel like there are a lot of creeps out there on the internet.  But at the same time, it seems impossible to be able to monitor everything.

What do you think?

Monday, May 1, 2017

What's a buttnose for?

I was listening to another doctor dictate a physical exam yesterday and I heard the following:

Doctor: "Patient has..." (mumbling) "butt nose..." (more mumbling)

Me: "did you just dictate that the patient has a butt nose??"

Doctor: "No. I said the patient didn't know the year, but knows the month."

Me: "Oh."

I thought it was this.

Monday, April 24, 2017

My two pens

When you have kids in your house, especially ones who can reach higher shelves, your stuff is not your own.

I have become irate in more than one occasion because I couldn't find tape when I needed it.  The kids can go through a roll of tape in an hour, then when I've got a present to wrap, I am tapeless.  So I keep one roll on a really high shelf (which they can still reach) and am very strict about anyone using that tape.

Pens are the other thing that drive me crazy.  I can never find a pen when I need one.  I used to keep them in my bookcase, but the kids would just take them.  They have a million crayons, markers, pens of their own, but somehow mine always get taken.  So again, I put two pens on the top shelf of my bookcase and said no one is allowed to touch them.  This is difficult to maintain though.

My daughter: "Can I use one of your pens?  I want to draw."

Me: "You have a million markers and crayons!"

Daughter: "No, I don't."

Me: "You do!"

Daughter: "Can I just borrow one of them?"

Me: "No."

Daughter: "Why not?"

Me: "You won't return it."

Daughter: "Why do you need two?"

Me: "In case one breaks." (or in case someone "borrows" one of them)

Daughter: "Ugh, fine!" [stomps off to her room and returns one minute later with gigantic bucket filled with ten thousand pens]

And don't even get me started on food.  Last week, I brought home an entire chocolate cake, and a day later it was simply gone.

Saturday, April 22, 2017

Last day

Today is the last day to buy a copy of Brain Damage for only 99 cents!

Also, I want to thank everyone who has bought a copy of 11 out of 10 over the last two years.  I just donated another $150 to Deworm the World for last month's revenue, and have been able to give nearly $10,000 from profits.  Please consider donating to this charity, which is one of the few highlighted by Givewell.  There are children in developing countries who can't afford medicine that costs pennies to treat parasitic infections causing illness and blindness.... this is the most bang for your donated buck.

Friday, April 21, 2017

Nurses week

I think the nurses I work with are really awesome.

They have a really hard job.  I think every single one of the nurses I work with does a really great job and is incredibly kind and considerate.

So here's my dilemma....

Nurses week is coming up and I don't know what to do.

In an ideal world, I'd get every nurse I work with a nice present or little gift bag and that would be enough.  However, I work with a LOT of nurses.  There are probably eight or nine regulars, then a few more nurse supervisors, then a bunch of nurses' aides that I also wouldn't want to leave out.  And then there are nurses that don't usually work with me but sometimes do.  All told, this could be thirty people.  And I suspect if I do individual gifts, no matter how hard I try, I'm going to leave somebody out.  And as somebody who has gotten left out in these situations, I know that's the worst possible thing.

Another dilemma is that each nurse only does three shifts per week.  So if I, say, bring in bagels or pizza one day, only half the nurses will get to partake.

In the past, I've bought two big cakes and done it two days in a row on days that as many of our regular nurses are around as possible.  I guess I could do that again.  I don't know... I just want to make sure I'm appreciating the nurses enough.  Because they deserve it.