Sunday, March 31, 2013

Happy Doctor's Day!

Actually, Doctor's Day was yesterday, but I only found out about it a few minutes ago from reading another person's blog. So happy belated Doctor's Day.

I first learned about Doctor's Day in my PGY4 year of residency. I only found out about it because like ten physician recruiters emailed me to wish me Happy Doctor's Day. Since then, there have been only very peripheral reminders of this holiday's existence.

I think it's safe to say that nobody gives a shit about Doctor's Day. Case in point: this year it's on a Saturday. They would never dare have, say, secretary's day on a weekend day. Nurse's Day... well, that's not even something we have to worry about because they get a whole week. But obviously nobody cares about Doctor's Day, so why bother making sure it falls on a day when people are actually working? (Granted, a lot of doctors do work on weekends, but I'd say the majority are still likely to be home that day.)

I get it. Being a doctor is just so amazingly awesome that it's a reward in itself so why on earth would we expect anyone to acknowledge us on Doctor's Day? And we don't. And nobody does. I suspect 99% of people who work in medicine had no idea that yesterday was Doctor's Day.

Except then, seriously, why have the day? Who came up with Doctor's Day? Whoever you are, you're a moron.

Also, word to the wise: never, ever forget Nurse's Week. You may be shot.

Saturday, March 30, 2013

Weekly Whine: Time Travel Paradox

I like movies about time travel. In general.

But what bugs me is how time travel movies are rarely consistent. Like, I feel like a time travel movie can have one of two theories behind it:

1) Things you do when you time travel to the past change the future

2) Things you do when you time travel to the past explain the future

Either one is okay. But more likely, movies mix both. Which is just wrong.

To give a classic example everyone knows: Back to the Future. I love this movie, but it definitely mixes the two theories of time travel.

Obviously, things Marty does in the past end up changing the future: when he returns to 1985, his parents are completely different. And he has a really cool car.

But at the same time, things Marty does in the past explain the future, such as the etiology of his first name, inspiring Goldie Wilson to run for mayor, and inspiring Chuck Berry to write Johnny B Goode.

So which is it? Do Marty's actions in 1955 change the future or do they explain it?

Occasionally, a movie comes close to getting it right, or at least it's confusing enough that you're not sure. I think 12 Monkeys may have gotten it right. Ditto with The Time Travelers Wife (the book, not the movie). Also, I think Futurama did it well, if not perfect.

Friday, March 29, 2013


I had a patient in residency, let's call her Jennifer, who I didn't peg as a crier. She was my age and in business school. People in B-school don't cry, right? She seemed very business-like about her back pain. But when the attending asked Jennifer about her use of medications, she burst into tears.

Jennifer: "I've been taking Voltaren for pain and I need it. But I don't want to need it."

The attending handed her the box of tissues and she calmed down pretty quickly. After he left the room she apologized to me.

"I'm so embarrassed," Jennifer said. "I can't believe I started crying."

"Really, don't worry about it," I told her.

"I don't even know why I started crying," she said.

I shrugged. "It's really common. Believe me, as a doctor, I see it all the time."


"Yeah, you're not even the first person today. It's really really common."

I handed Jennifer the prescription I wrote for Mobic. She looked troubled when I handed it to her, and I said to her: "Look, this isn't even a narcotic. Voltaren and Mobic are just like Motrin, only a little stronger."

"Really??" She had no idea. I guess Voltaren sounds like a really powerful medication. (Voltaren: Defender of the Universe) "That actually makes me feel a lot better."

It's almost sweet that she was worried about taking a couple of NSAIDs when we have people popping Vicodin like they're tic tacs.

Thursday, March 28, 2013

Cool names

Whenever a patient has an interesting name, I always feel compelled to comment. My comments are met with varying levels of enthusiasm.

For example, I saw a young female patient who had the same name as one of the lead characters on a very popular TV show.

Me: [upon reading her name off the chart] "Oh, like in the TV show, right?"

Patient: "Yeah."

Me: "I'm sure people say that to you all the time."

Patient: "Yeah."

Me: "It probably gets pretty annoying, huh?"

Patient: "Yep."

Wednesday, March 27, 2013

The Cost of Training a Resident

In recent posts, I've talked about the obligation some physicians may feel to work full time, considering society has invested so much in training us. Yet it doesn't feel like we were handed anything on a silver platter. Many medical students go a quarter of a million dollars in debt during med school. When I was an intern, I worked about 80 hours a week and earned $40,000 per year. That's $10/hour, which is way less than I made doing math tutoring after school in high school.

This seems like a pretty good deal for hospital, actually. So I'm not sure why they don't just hire tons of residents? Why is there such a bottleneck in resident training positions?

I did a little online research into this, and if anyone wants to add their two cents, you're welcome to because I'm still a little confused. Here are the facts, as I understand them:

1) Residency positions are limited.

2) It costs upwards of $100,000 each to train a resident, including salary, benefits, and paying attendings to teach.

3) Private insurance companies WILL NOT pay for residents. Not even a dime, despite the fact that residents may be providing most of the care for their patients.

4) Medicare and hospitals mostly foot the bill for residents.

I suppose it makes a little more sense why more spots can't be created when you look at how much hospitals and the government must pay. Yet I still can't entirely fathom how residents doing a job that would cost literally ten times as much if an attending were doing it is somehow a loss. Yes, there is a supervising attending. But we all know attendings in academia get paid less. An attending would have to be paid WAY more (and they're have to be more of them) to handle the workload that residents take care of.

Also, there's the fact that a lot of primary care positions, FM, and IM positions don't even get filled.

So even though I understand the details, I still can't honestly say I understand.

Tuesday, March 26, 2013

Tell me about PM&R

A few times a month, I get an email from somebody who either reads this blog or more likely saw my post on Mothers in Medicine called PM&R: The Holy Grail? At the end of the article, I offered my email address if anyone had any questions.

The problem is, I wrote that article three years ago. Since then, I have answered the same five questions about PM&R like 200 times. Also, I have an extra child, and I don't have time to be answering these questions over and over again. I don't want to discourage people from entering my field, so I at least make an effort. But usually I end up postponing answering these emails for so long, that I just end up forgetting about them.

Eventually, I created a PM&R FAQ to avoid having to answer the same questions again and again. These days when I get an email, I mostly just refer people to the FAQ. And that satisfies most people.

Last week, I got an email from a person who read my FAQ and had a follow-up question about where I trained. I don't give out that information, and when I said that, the response was, "If you don't actually like to answer questions I am not sure why you posted 'if anyone has other questions about pmr I would be more than happy to answer them comment here or email me'."

So here's the deal:

1) Three years ago, I was happy to answer questions about PM&R.

2) Now I don't have time and/or interest

3) I don't enjoy being bullied into giving out personal information

4) I am willing to make my FAQ better, so I can just refer 99% of people to it and be done with it

So if you'd like to take a look at my FAQ and think of any other common questions, that would be great. And if you'd like to answer the question, that would be even more great.

Monday, March 25, 2013

At fault

When I see back pain patients who were involved in motor vehicle accidents,one thing I find interesting is that the patient is virtually NEVER the person at fault, or so they say. I can think of a few reasons for this:

1) The patient is lying.

2) The person who is not at fault for the accident is more likely to develop fake/semi-fake pain due to the possibility of litigation. (They are all in litigation.) Or maybe the pain is real, but they have no motivation to try to get better.

3) I do think there is a higher likelihood of getting hurt in a car accident when you're not the one at fault. Like of all the severe brain or spinal cord injury patients, when there were two people in the car, the passenger was much more likely to be the injured one. I think the person who is causing the accident might brace themself or something because they see it coming.

Saturday, March 23, 2013

Weekly Whine: Long Movies

I think there should be a rule that movies can't be longer than two hours. I'm looking at you, Peter Jackson.

If a movie is exactly two hours, it's going to be at least twenty minutes longer than that with previews. Do you know how I feel after sitting in a movie theater for over two hours?

1) I have a headache

2) My butt hurts

3) I have to pee like whoa

The last is a major consideration. I was recently at a movie with my husband that was three hours long with previews and he went to pee twice during the movie. And his bladder is much bigger than mine, if anatomy class is to be believed. Think how us women feel!

And who makes all these really long movies? Men.

I really don't believe that there's any story that can't be told in two hours or less. It's called editing. No matter how awesome you think every scene in your movie is, we're going to miss a bunch of it anyway due to having to run out to pee.

Friday, March 22, 2013

Intern pages

One important piece of advice I got on my first week of intern year from an attending: "Write your order correctly the first time. You will waste massive amounts of time correcting each order if you don't."

That said....

Most popular reasons for an intern to get paged about her order:

“Doctor, you forgot to sign your order.”

“Doctor, you forgot to write down the dose of the medication.” Followed by: “Doctor, this is a really high dose. Why is it so high?”

“Doctor, you forgot to put the date on your order.” Followed by: “And now you forgot the time.”

“Doctor, did you really mean to give the patient 10 grams of Tylenol each day?”

“Doctor, the medication you ordered interacts with another medication the patient is on and will probably kill him. Do you still want it?”

“Doctor, the medication you ordered doesn’t actually exist.”

(In each case, “doctor” is said in sarcastic tone of voice.)

Thursday, March 21, 2013


Dr. Attending: "You know who you look exactly like?"

Patient: "Who?"

Dr. A: "Danny DeVito!"

Patient: "..."

Dr. A: "Has anyone ever told you that before?"

Patient: "Yeah."

Dr. A: "Well, you really do look an awful lot like him."

Patient: "Gee, thanks."

Dr. A: "Maybe it's your accent."

Patient: "Back when I had a goatee, people used to tell me I looked like Andre Agassi."

Dr. A: "..."

(I didn't think the guy looked all that much like Danny DeVito. Or Andre Agassi.)

Wednesday, March 20, 2013

People who shouldn't go to med school

Only so many people can be trained in medical schools every year, and many applicants must be turned away. Considering there’s a physician shortage and it is so costly to society to train doctors, I suggest we henceforth become more selective in the applicants we accept. The following candidates should not be accepted to medical school any longer:

1) Women

Well, obviously. Is there any worse payout on the money our government spends on training physicians than women? Not only do they take long maternity leaves, but they tend to work part-time, contributing to the physician shortage. This one is a no-brainer.

2) Age > 28

When there are all these young 22-year-olds interested in being doctors, why on earth would we accept a 30-year-old, who has eight full years less time to contribute prior to retirement? I mean, I guess we could force them to sign a document promising not to retire before age 70, but what if they die or have a stroke before then? Where will we be then, huh?

3) BMI > 30

Obesity is a leading cause of morbidity and mortality. An obese physician is much more likely to die earlier or have more medical conditions that will take away from time they could be spending taking care of patients.

4) Smokers

Again, smoking is a leading cause of morbidity and mortality. And we all know how hard it is to quit smoking. If we’re really trying to get the most bang for our buck, the safest choice is not to take people who have a higher risk of early cardiovascular disease, lung cancer, COPD, and other conditions that will pull them out of the work force early.

5) Chronic medical conditions

We definitely shouldn’t admit anyone with diseases like diabetes or lupus. We had a diabetic in my class and she couldn’t even make it through the surgery rotation without having accommodations made. How is this person going to be able to work as hard as a healthy person?

If we stop admitting these five kinds of candidates to medical school, I am certain that the physician shortage will improve and patients will be happier with their care.

Tuesday, March 19, 2013

Chest film

A conversion I had during residency:

Resident: "Do you notice anything wrong with this chest film?"

Me: "Um, there's a GIGANTIC effusion on the left side?"

Resident: "Yeah, obviously. But what else?"

Me: "I'm assuming it's what that arrow on the right is pointing to."

Resident: "Yes."

Me: (squinting) "Oh, it's a pneumothorax, right?"

Resident: "Yeah, I mean... would you have seen that? It's practically invisible. That's why I could never be a radiologist."

Me: "Well, you might notice it if you were looking for it. What was the film done to look for?"

Resident: "Pneumo."

Me: "See, there you go."

Resident: "Do you want to hear a terrible story? The team tapped this patient's lungs to try to get at that effusion. But they tapped the wrong side. So not only is there still a huge effusion, but now the patient has a pneumo on the other side."

Me: "Haha... that's funny. Well no, it's not really funny. But it's... well, it's ironic."

Monday, March 18, 2013

Movie theater bitch

I was at a small movie theater with my daughter the other day to see Oz (loved it!). It was a surprisingly crowded theater, and we arrived exactly when the movie was supposed to start.

Anyway, after circling the theater, I was appalled that there were actually no double seats free, only singles left. I was starting to wonder if we'd have to leave and get a refund, but then I saw a group of four women together, with a single seat on their right, and a single seat on their left.

"Excuse me," I said, and I pointed to the two seats. "Are these seats free?"

"Yes," one of the women said. "Do you want them?"

"Well," I said, "I was wondering if you might be willing to scooch over so that I could sit with my daughter? She's only six."

The woman glared at me like I just asked her for her firstborn. "Well, we could. But it's a hassle."

I didn't know what to say. I mean, did she really expect a six-year-old to sit alone through a two hour movie? "I just want to sit with my daughter," I finally said.

She didn't answer right away, so I just stood there. Then she snapped at me, "Okay! I said, just a minute!"

(She had not said that.)

Instead of scooching, they got one woman at the end of the row to move three seats over. And I was allowed to sit with my child during the movie.

I mean, was it SO wrong of me to ask that? I know it's a huge hassle to have to move one seat to your left, but seriously, we're living in a society here. I don't think it's too much to ask.

Sunday, March 17, 2013

Part time

Recently, KevinMD reposted my post about the reasons why I have chosen to work part time as a physician, even though some people think doctors who work part time are doing damage to the health care system in that we contribute to the physician shortage. Mostly, there were a lot of really supportive comments. This was not one of them:

18-40 million new patients coming into a health care system and many of today's medical physicians what to be PT mommies & daddies?

I'm sorry, I don't tolerate that!

Doctors knew that this is NOT an easy job when they were in college. So I guess you knew that if you have children, its only going to slow you down. In today's economy and how health care is changing so quickly, your career has to come FIRST! Especially in this profession.

So yes, you should think that your ruining medicine! Because when your children are sick and stay home, you stay home as well. BUT if we want our doctors and us patients are sick........WELL?!....I WANT YOU!!! THE DOCTOR!!!

Now of course others will disagree. But this is my opinion. That's all I have to say!

I think it's sad that there are patients who actually think this way.

So you don't have to go through all the 100+ comments, I'll copy and paste a few other choice nuggets:

It is great that you know who you are and what makes u tick. However, it is true that your med school spot could have been utilized by a "full time" md. Primary care does lend itself to part time work. As a surgeon, that is not feasible. My surgical partners count on me pulling my fair share of call, sports coverage, lecturing etc. maybe u should have considered your constitution before entering med school. Physician assistant or nurse practioner lifestyle may have suited u better. I'm an ortho surgeon, a man, and work about 60 hrs per week. I have been at it for 10 years, I make time for my kids, see all their games, and am home for dinner 95% of the time. It's all about time management and setting up a good support network.


I know many excellent, caring, male and female, physicians who have not only taken care of countless patients, but have advanced medicine and changed the way that we treat disease. These people work 80 hours a week, and love the work that they do. You choose to demonize them, saying that because they are not "well balanced" they are not able to "contribute to society". Guess what? You are not more well balanced than them. They just handle stress better than you do.

Saturday, March 16, 2013

Weekly Whine: Moar Cartoons!

When I first started this blog, I posted almost exclusively cartoons. While I enjoyed drawing them, I have an extra child now, and I just don't have the time to do that, so I've expanded the blog to share some humorous anecdotes and talk about some issues that are meaningful to me in some way. If I didn't do that, there wouldn't be more cartoons--there would simply be fewer posts. But there are some people out there who don't seem to appreciate this shift.

If you want a person to show a particular behavior, there are two ways to encourage them to do so:

1) Give them positive feedback when they show the behavior

2) Give them negative feedback when they don't show the behavior

(Or 3) Do nothing and just hope they'll show the behavior)

I would say that the vast majority of people who want more cartoons have chosen #2 or the secret option #3. A lot of people take it upon themselves to complain about the lack of cartoons when I don't post them. But if I do post a cartoon? Crickets. Often just one or two comments, not even a "funny cartoon, I liked this."

For those of you who have complained about the lack of cartoons but fail to say anything positive when I post one, what is your motivation here? Do you think I owe you? Do you think my entire motivation for posting cartoons should just be to keep people from complaining? No, sorry. Not going to work that way.

Friday, March 15, 2013

You give me fever

Me: "Have you been having any fevers?"

Patient: "Yes, every night."

Me: "How high have your temperatures been?"

Patient: "Sometimes it's normal... around 98 degrees. But sometimes it's like 117 or 120 degrees."

Me: "!"

Patient: "Is that very high?"


I had a recent post on KevinMD, explaining why I work parttime. It got a few comments (over 130, actually). It was written as a very delayed response to the op-ed piece by Karen Sibert from 2011. (I always jump on bandwagons about two years too late.)

To my surprise, I received a response from Dr. Sibert herself on the post, which kind of irritated me:

Good grief. So much emotion. I really don't recall saying that anyone who works part time is "ruining" medicine. What I said is that no one's medical degree is entirely his or her personal possession; society contributed a lot to that degree in terms of dollars and resources. Accepting the degree confers some obligation--how much, obviously, is a matter of debate.

When my children were small, I did indeed always work full time. I found the time to "blog" once the last one left for college.

The format of the commenting on there is such that it's difficult to have a discussion on there. So I've decided to write my angry reply here. And I'll make a funny post later, just to lighten the mood. I swear.

My piece-by-piece response:

Good grief. So much emotion.

You tell female physicians that work part time that they don't have an appropriate level of "commitment to the profession" and that they owe society to work harder.... and these women get emotional??? Imagine that!

I really don't recall saying that anyone who works part time is "ruining" medicine.

Right, only that our decision to work part time has "serious consequences for patients and the public." Enough so that you felt a need to write an op-ed piece in the NYT.

I said is that no one's medical degree is entirely his or her personal possession; society contributed a lot to that degree in terms of dollars and resources.

So if society didn't contribute so much, how much in loans would we have then? It's already like $300,000. If society didn't contribute, would we have a jillion dollars in loans? Because that's not even a real number.

I love it. We accrue massive loans, we work like a dog in training for at least a decade, yet somehow we are the ones who owe society.

When my children were small, I did indeed always work full time.

Classic physician attitude. "I did it, so you should be able to also." Well, if I worked 42 hours in a row with no sleep, I don't get why the interns can't do it anymore. Bell Commission? What? No, you don't get it. I did it. So everyone else should be able to also. Nay, they should have to. What? It causes burnout and unhappiness? No, but I did it. And I was fine. Everyone else is lazy.

I found the time to "blog" once the last one left for college.

Okay, she's convinced me. I'm shutting this blog down. I'll return in 16 years. And I'll also save everything else I enjoy doing for then too. I'm off to repay my debt to society!

Even if I disagree with Dr. Sibert, I genuinely respect her courage in voicing a somewhat controversial opinion under her own name in a public forum. But then she writes a passive-aggressive response like the above. I'd respect her far more if she stuck to her guns, even if I didn't like what she was saying.

Thursday, March 14, 2013


Today is my fake anniversary (long story). Happy anniversary, sweetie!

One thing I truly don't understand is how people spend so much on weddings. Seriously, I think my cousin's wedding cost $50,000. How is it in any way worth that kind of money for a ceremony that lasts like an hour? Who started this ridiculous precedent???

We had a civil ceremony, which I was very happy with. It cost under $100 and it was just about us... which made sense, considering WE were the ones getting married. We later had two separate parties to celebrate, one for family at my parents' house and one for friends in Vegas, but they were reasonably priced and relatively low stress, considering I didn't have to worry about any details of actually getting married.

For those of you who have had the big ticket weddings, do you think it was worth it?

Tuesday, March 12, 2013


For those of you who have kids in daycare, you probably know that the daycare will sometimes leave some pictures for you that your child drew during the day. Now I am fine with this when the child is older and the picture has some sort of content (or at least, the child would be insulted by seeing the picture thrown in the trash), but it's a little more questionable when it comes to younger kids.

For that reason, I'm never particularly pleased when I see artwork left for me in my toddler's cubby. Occasionally, it's something really cool like a handprint. But more often it's something like this:

Yes, this is an actual drawing that was left for me in my child's mailbox. Because I couldn't have lived without seeing this expression of her artistic ability.

Monday, March 11, 2013

Baby names

This is the story of the very stupid reason why we couldn't name my second child what I wanted to name her.

We agreed very quickly on a name for our first child. When it came to the second, I wanted her name to start with the letter L, because my grandmother's name is Louise and we promised to name one child after her. But Louise is really old-fashioned, so I suggested the name Lauren. My husband liked the name, so we were set: Lauren.

End of story, right?

So there was this guy I was very good friends with in high school and college named Joseph. Joe was actually one of my very best friends. We never hooked up or anything--we were just friends, I swear. Anyway, Joe was a huge math nerd, and during the summers in high school, he went to this math camp where he was apparently a huge Casanova. It's sort of like being Superman. When you're in the real world, you're ordinary or even a nerd, but then you go to math camp and suddenly you're the only guy who's heard of a shower and doesn't have facial hair in weird places. So yes, Joe managed to get some math camp action in the form of two girlfriends during his two summers there.

And very coincidentally, the name of one of Joe's girlfriends was the name of our first daughter. And the name of his other girlfriend was Lauren.

And even more coincidentally, my first daughter's middle name is Josephine. Can I help it if my grandfather's name was also Joseph and I'd promised my mother for ages to use that name?

Anyway, my husband didn't know any of this stuff, and I actually didn't even realize it myself. But one day, it did occur to me and I said it to my husband, like as something that was pretty funny. And you know what? After that, he refused to name the baby Lauren!

I thought that was a little over the top. I mean, how could we not choose a name we both like for our kid based on the math camp girlfriends of some guy that I hardly ever talked to anymore?

We did eventually pick another name we both liked, although I'm still a little nostalgic for Lauren. I was chatting with Joe online recently and I told him the whole story, and he said he was totally shocked my husband wouldn't use the name based on that. Although he admitted his wife (who I also went to school with) probably would have noticed and commented on it if I used that name.

Sunday, March 10, 2013

80 Hours

I was recently in an online argument about work and people were making some wild statements about 80 hour work-weeks. For example it was said that:

1) Many attending physicians work 80-hour weeks

2) Many people in other professions such as high school teachers work 80-hour weeks

Let me just say that it is not easy to work an 80-hour week. Yes, I often did this in residency, but that's because I took night call. If I did two 30-hour shifts that week, it wasn't that hard to reach 80 hours. That's why physicians can work that many hours fairly easily. Because we work nights.

As far as I know, high school teachers do not take overnight shifts. Yes, they do grading or lesson plans at home, but probably not through the entire night. So that would require working roughly 12 hours a day, every single day, including weekends. So in real time:

If you arrived at school at 7:30AM every morning and had maybe 30 mins of commuting time, you would have to work straight until 8PM every night. No playing with your kids, sitting down for dinner, television, just come home at work till 8PM. And same deal on both Saturday AND Sunday, working from 8AM to 8PM with no breaks. Are there high school teachers that do this? Because I highly doubt it.

Saturday, March 9, 2013

Weekly Whine: Open your mind!

One thing that I find baffling when I argue with people online is when they complain that I'm not being open-minded.

I happen to think I'm a fairly open-minded person. For example, even though I'm very pro-choice, I can absolutely see the point of view of a person who is pro-life. I mean, they think we're murdering babies! I would actually find it very hard to argue with such a person (unless they said abortion is okay in the case of rape and incest, because that totally is inconsistent).

But being open-minded doesn't mean that you have to agree with everyone else who argues against you. I consider what the other person is saying, and sometimes I concede some points, but sometimes I still disagree. That's my right. And sometimes the other person will acknowledge this and say, "We'll have to agree to disagree." Because you can't always expect the other person to come around to your point of view.

(If you say that to me and I say, "I don't agree to that," it's not because I don't agree, but because it's a favorite Simpsons quote of mine.)

But sometimes people go off the deep end and start yelling at me for not being open-minded. I find this entirely hypocritical. One person actually said to me, and I quote:

"I would be very happy to debate this with you, if you are open-minded enough to admit it when (not if) I prove you wrong."

A true sign of open-mindedness, don't you think?

Friday, March 8, 2013


I wrote a post recently about how much guilt I have over saying no, even when I feel I'm justified in my decision. The example I gave was of a time a couple of years ago when there was a hurricane bearing down on us. I planned to only be in a few hours and then be able to leave with plenty of time to beat the worst of the storm, but then a fellow consultant asked if I could help out doing a few of her (non-urgent) consults. And I said no, that she should leave when she felt it was safe, and to save anything she couldn't do on her own till after the hurricane and I'd help then (which I did).

I posted about this situation mostly because I felt it was an example of a time when I was truly ridiculous for feeling guilty. Rehab consults are never things that can't wait a couple of days. And while I had a few hours before the really bad weather started up, it's not like at noon there's no hurricane and at one there's a raging hurricane. It's a progression of increasingly bad weather and there's proportionally more danger the later you leave. Most people didn't come to work at all that day, as I noticed when I was nearly the only car on the road in the morning.

Yet several people commented on the post that I should have felt guilty. That in an impending hurricane, I should have gone and done these non-urgent consults, and if I didn't, I wasn't a team player.

Is that really what people think? Is it really important to literally risk your life to be a team player?

Honestly, I'd hate for somebody to have to tell my children that their mom died in a car accident because she stayed in the hospital during a hurricane evaluating a guy with chronic knee pain impeding his therapy.

Thursday, March 7, 2013

Eccentric attendings

One thing I always found really obnoxious in residency was how you have to bow down to your eccentric attendings' little quirks.

For example, I had one attending who made us always put the plan FIRST in our H&P, rather than last, like every other doctor on the planet does it.

I had another attending who never let us call drugs by their brand name. If we said Ambien, he'd look at us like we just said something in a Martian language.

If you want to do some aspect of your job in a stupid, pointless way, that's fine. But I think it's ridiculous to impose that on other people, just because they're temporarily your underling. I mean, the point of residency is to learn how to be a doctor. And being forced to write the plan first in an H&P does nothing to get you closer to that goal.

I always said that as an attending, I would never do that. But the truth is, it's a little hard not to impose your will a little bit and make the residents do things the way you think is best.

For instance, one thing that drives me crazy is when people make their assessment and plan one big paragraph. I hate big paragraphs. It ought to be numbered! How can anyone understand it if it's not numbered?? Being numbered makes it so much easier to read!

But that's not too anal, is it?

Wednesday, March 6, 2013

Talking Smack

When I was in residency, it seemed like every day was a chance to talk smack about other people. Any time I'd get in a private space with another resident, we'd immediately go at it: what residents were slackers, what attendings were assholes, what med students were annoying and we hoped they wouldn't match here.

And then in fellowship, it was even worse. There were three other fellows, and sometimes I would just waste an entire afternoon with each of them coming into my office one by one to diss on everyone else. (I had a great education.)

When I got to the real world of work, I told myself I would not do that anymore. It's one thing to gossip when you're still a trainee, but I felt that it was unprofessional to do so as an attending.

And you know what? I have stuck to that. I make a point to never, ever say anything negative about my coworkers behind their backs.

That said, sometimes people will say negative things to me about coworkers. My response is generally to say one sentence to defend them, then if that doesn't work, just nod my head politely. For example, I had the following conversation:

Attending: "The Dr. Smith is so lazy. I asked him to see this patient and he said that he was off duty. But it's only 4 o'clock!"

Me: "Well, maybe he had to leave to pick up his kids on time."

Attending: "That is such bullshit! I have kids too and I'm still here!"

Me: [nods politely]

I really, really hate the idea of saying anything negative about a coworker. I haven't done it in so long, the idea just sits badly with me. But you know what bothers me most about it? There are a few people who are always insulting coworkers to me, and I just KNOW that they must be insulting me to others. Because why would I be the exception? I'm not that great.

Tuesday, March 5, 2013


I understand the purpose of giving pretests before a lecture, to gauge how much the students have learned. But if it's a lecture on a fairly obscure topic, it starts to seem a little more pointless...

When I was in residency, we had a lecture on SSEPs. SSEP stands for Somatosensory Evoked Potential, which is probably more than I could have told you about them prior to that lecture. Anyway, before the lecture, we had a "pretest" that asked us a bunch of multiple choice questions about SSEPs and how they're used in prognostic testing.

Me (whispering): "Have you ever heard of SSEP?"

Resident next to me: "No."

Me: "So how are we supposed to take a test about them?"

I looked at the first question and it was asking what sort of response in an SSEP is a poor prognostic sign in brain injury. I looked over at the resident next to me, who appeared to be filling in answers.

Me: "Uh... what are you basing those answers on then??"

Apparently I wasn't alone in my cluelessness, because when they graded the pretest, the residents actually scored WORSE than we would have based on chance alone.

Monday, March 4, 2013

Why so busy?

I have to be honest, I don't get why everyone is so busy.

In my book club, it seems like many months, several people don't read the book. And it's not like they didn't like it. They just didn't have time to finish it. Sometimes they never even got around to starting it.

I don't ask them this question, but it's always going through my head: what do you DO with yourself?

If you have small kids, I get it. You have to watch the kids. But a lot of these people have grown kids or no kids. So I'm just wondering what they've been doing with themselves every night for a month that they didn't have time to read one 300-page book?

Have they been watching TV every night? Going out every single night? Really, what?

I honestly never understood this, because whenever there's been a task or project or assignment, I always finished it with plenty of time leftover. Even with small kids, I don't have any problems reading the book club books. I just don't get it. Is it just that I'm the only person who doesn't have any social life?

Sunday, March 3, 2013

How to write a history

There was one attending I worked with in residency who had a kind of different way of writing histories.

For those of you who are used to presenting patients, the usual way you would present a patient who comes in to be assessed for ulnar neuropathy and also has diabetes would probably be something like this:

Patient is a 58 year old man with a history of diabetes who presents with one year of worsening numbness in the last three digits of his right hand. He also has pain in his right elbow and... etc etc

But my attending hated this. He said he liked us to get right to the problem in the first sentence. So he kept changing my histories to something like this:

Patient is a 58 year old man with a one year history of worsening numbness in the last three digits of his right hand. He also has pain in his right elbow and..... etc etc.... pain wakes him at night. He also has a history of diabetes.

The diabetic history is pretty important in any nerve exam so it definitely needs to be in the history, but to me that seems a little sloppy. But what do I know?

Saturday, March 2, 2013

Weekly Whine: Honk

It pisses me off so much when people use their car horns to signify anger. Acceptable reasons, in my opinion, to use a horn include:

1) Someone is in danger and you want to warn them.

2) You need someone to move and they are not aware of this.

Even #2 is a soft call, but I honestly don't mind so much if I'm, say, at a light and the person behind me honks to get me to move forward a foot so they can slip by to make a right turn. That's fine. Or if I zone out and the light changes... I don't love being honked at, but I can understand it and feel it serves a purpose. I've done it before and I try to honk very gently so they know I'm not angry.

But when someone does something you don't like and you honk just to show them you're pissed off when you're not in any danger of hitting them? That really stinks. And I feel like it makes people less likely to respect horns when they really need to be respected.

Friday, March 1, 2013


I had to put back word verification for posting. I was literally having to go through about 50 spam comments per day and it just seemed to be getting worse.

Fun with Pain

I could fill a book writing about all the patients from my residency Pain Clinic.

One of the most bizarre patients I had was a little old lady who I'll call Granny who had intermittent tingling in her arms for the past several months. And when I say intermittent, I mean that the tingling occurred twice a month for two minutes at a time. How out of your mind do you have to be to go to a doctor for four minutes of discomfort per month?

Anyway, just to be safe, we ordered some C-spine films on the woman. My attending Dr. Green told her to come back in a week and we'd review the films. I filled out the follow-up slip for her.

Me: "OK, so we'll see you back here in one to two weeks after the X-rays."

Granny: "Dr. Green said one week."

Me: "Yes, well... this isn't urgent, so one to two weeks is fine. Whatever time that's convenient for you."

Granny: "But he said one week."

Me: "Okay, whatever."

So I sent Granny on her way. About an hour later, I looked into one of the examining rooms and saw none other than GRANNY sitting in the room. A very harried-looking Dr. Green was talking to her with thinly masked exasperation. Apparently, she went and got her X-rays right now in radiology and now she wanted to be seen again and have the X-rays reviewed. I think Dr. Green told her something along the lines of "too damn bad" and sent Granny on her way.

(We were already booked and overbooked and Dr. Green had to go to the university for a meeting right after clinic.)

Me: "Geez, what is wrong with her?"

Dr. Green: "She wanted everything done NOW. She wanted me to fax a copy of the X-ray report to her primary doctor. She literally just got the films five minutes ago. The X-rays aren't even up in the computer yet and there definitely isn't a report that can be sent."

Me: "I swear, I told her to come back in a week."

Dr. Green: "Well, apparently, she thought you said to come back in five minutes."

Honestly, I can't even imagine doing some of the kind of shit our patients pulled.