Tuesday, March 31, 2015

Dr. Orthochick: Language

From a journal article i was reading on Gender Crap in Orthopaedics:

Both male and female students perceived orthopedics as an “action”-packed, procedure-based profession, providing instant gratification, time in the operating room, high income, and the option for private practice. Female medical students considered it boring.

I don't know what female medical students want if "action"-packed is still boring. No wonder i was unpopular in med school.

(seriously though, isn't that a weird juxtaposition of sentences?)


From my attending's operative dictation:

The bone was placed in the bone mill to mill the bone

(That one I can't argue with)

Monday, March 30, 2015

Lil Woodzees

This is one of the most hilarious toys I have seen for a number of reasons:

1) it's called Lil Woodzeez

2) The box advertises that you should "turn it around for even more fun"

3) The side of the box says that the treehouse is called "honeysuckle hollow" which also sounds kind of bad

I swear, they must do this on purpose.

Saturday, March 28, 2015

Weekly Whine: Psychiatrists

I'm writing this from the perspective of somebody who has a close family member who is a psychiatrist, and is great at his job. However, I have to say, pretty much every psychiatrist that I have worked with has been terrible at psychotherapy.

I am not ashamed to admit that I have seen therapists intermittently in the past. I believe the talk therapy can be really helpful during stressful periods, or when making important life decisions. My understanding is that therapists can be either psychiatrists, psychologists, or social workers.

The worst therapist I have ever seen by far was a psychiatrist. This woman had the worst interpersonal skills I have ever experienced, and had no business being a therapist, in my opinion. Maybe she was good at medication management, I don't know. But every time I spoke with her, I felt awkward and uncomfortable.

Since then, I've talked with some patients who saw psychiatrists for talk therapy, and they all had similar experiences. Sometimes they just went for a medication adjustment, and they were frustrated that they felt the psychiatrist didn't understand them.

It makes me think that psychiatrists don't get enough training in how to do psychotherapy, and most of their training is just focused on medications. Which means that they're about as qualified to give talk therapy as I am.

Thursday, March 26, 2015

Rejection Letter

Despite being so completely awesome, I did get my fair share of rejection letters when I was applying to medical school. However, there were a few times when the tables were turned, and I had to tell a medical school that wanted me that I wasn't interested in them. I crafted the following letter to send them:

Dear Medical School:

With sincere regret, I am writing to share what I believe will be disappointing news. I have considered with care your school for admission. Unfortunately, because of the rigorous competitiveness of the medical schools that have accepted me this year, I am unable to attend your school.

I very much appreciate the time and effort you have spent crafting and compiling your brochure and application materials, and the interest you have shown in me. The fact that I am only one person dictates that I must limit my enrollment to a frustratingly small proportion of those seeking my enrollment. I can assure you that your school was considered with thoroughness and care despite this disappointing outcome. I commend you for your patience during this interview season, and I am aware that my words may do little to assuage your disappointment.

In closing, I wish to express my regret that all medical schools can't be allowed to fulfill their aspiration of educating me at their fine institutions. Because of your excellent medical facilities, it is my hope that you will find the students you seek for your class of 20xx and beyond, be it as a medical school, or else maybe as a dental school or clown college or something.

Yours sincerely,

Feel free to use it if you need to.

Tuesday, March 24, 2015

Dr. Orthochick: Ice

Nurse: Your patient in room 222 has a temperature of 43.5 Celsius and the computer notification went off that I need to tell you about that.

Me: Yeah, I'm sure it did because the computer is trying to tell us that there's no way that's possible.

Nurse: Well, he just got done with surgery and we took his temperature and that's what it was.

Me: Yeah...but that's over 110 degrees Fahrenheit.

Nurse: Oh. Maybe we should retake it.

Me: Yeah, let's start with that.

Lo and behold, it was a normal 98.6.

To quote "Player Piano":
He who lives by technology, dies by technology. Sic sempre tyrannis.

Monday, March 23, 2015

Where are my patients?

When patients are acutely ill, finding them is usually not so hard. Usually they're in bed. But at the point that I get consulted, patients are usually a little bit more mobile, which means sometimes I have to search for them. These are some of the places that my patient usually are when I try to see them to do my consult:

Saturday, March 21, 2015

Weekly Whine: Donations

Sometimes I will see some article online about some poor family whose home burned down on their child's birthday and that on that same day, their other child was diagnosed with cancer, or something horrible like that, and donations from strangers poured in and now they have half a million dollars to buy another home. And I feel guilty that I never give money to these unfortunate strangers because their stories are so compelling.

But when it really comes down to it, I think these donations are a little ridiculous. For every sob story on the Internet that gets way too much money, there are probably thousands of other families in a similar position who aren't as attractive, don't have as compelling a story, or just aren't as Internet savvy or lucky enough for their story to have gone viral. And those families get nothing.

It's sort of like the lottery, in a way. One family gets rewarded with more than they actually need, while everyone else gets nothing.

I think it's great that there are people out there kind enough to donate their money to help others. We make donations every year, but I let my husband handle it because I think he is smarter about choosing charities that are worthy (I know he gives a lot to Doctors without Borders). I just think it makes more sense to donate to a large charity that will help a large number of people, instead of just rewarding one lucky family.

What charities do you think are worthwhile to donate to?

Thursday, March 19, 2015

psychogenic polydipsia

Recently, I overheard a nephrologist, a resident, and a med student discussing a psych/med patient with hyponatremia from psychogenic polydipsia. The nephrologist was arguing that a patient couldn't maintain that significant degree of hyponatremia just from drinking lots of water.

Nephrologist: "Hey, we have a third year med student... we can experiment on her."

Med student: "Huh?"

Nephrologist: "So she would have to drink about a liter and a half of water every single hour, right? Actually, she's small, so maybe only a liter. She'd have to drink a liter an hour every hour, 24/7."

Med student: "I think I'd get tired..."

Nephrologist: "What do you think? Could she keep it up?"

Resident: "I don't know. Is she a psych patient?"

Nephrologist: "Well, she seems like a pretty nice girl. Also I don't think they let psych patients into medical school. So is it possible?"

Resident: "I think it's possible."

Nephrologist: "She'd have to keep drinking while she was peeing."

Resident: "You mean you don't do that?"

Nephrologist: "Yes, but I thought I was the exception."

Tuesday, March 17, 2015

Dr. Orthochick: ROM

Physical therapist: I'm a little confused about the activity restrictions for [your patient who just had a hip revision.] Can you please clarify?
Me: Yeah. Dr. J wanted her on anterior and posterior hip precautions. And no hip abduction.
PT: So...no active motion? Because with those precautions she can't internally rotate, she can't externally rotate, she can't flex, she can't extend, she can't abduct, and she can't adduct.
Me: Yeah, and she needs to wear a knee immobilizer brace at all times as well.

Sometimes the cure is worse than the disease.

Monday, March 16, 2015

The LP

When I was a medical student on my neurology rotation, I was sent down to radiology because the radiology attending who was doing an LP didn't want to take more than 6 cc out of the patient's spine, because he was worried the patient would get a headache. So in order to absolve himself of responsibility, he said that if neuro wanted more than 6 cc, we physically had to go down and take out the rest of the fluid ourselves. Specifically, I had to go down there and hold a test tube to catch the fluid (over 6 cc) dripping out of the patient's spine.

As soon as I got down there, the rad attending was acting like an asshole. After much ado and my having to page my attending, he agreed to let us take out 25 cc total, as long as I was the one taking it out.

So the radiology resident got the tube in his spine and got out the first 6 cc. He hands me the test tube and the attending said to me, "OK, we're all leaving now."

I looked at him with sheer panic and I was like, "Wait!" I didn't know what could possibly go wrong with the patient during this procedure, but considering I knew very little, and the attending felt it was dangerous enough that he didn't want to be there, I didn't want to be alone.

The resident was sympathetic and asked the attending if he could stay with me. But the attending was insistent that nobody be in the room with me. I said, "What if something goes wrong? How do I get it out?" The answer to that question was that they would be a few doors down and the patient's son could go get them. Finally, the resident told me quietly that he'd come back before I was done and remove the tube from the spine.

It baffles me that an attending could act that way. I was shocked and I felt awful for the patient who had to hear this exchange.

Saturday, March 14, 2015

Weekly Whine: Build a Bear

If you've never heard of the store build a bear, it's sort of the bear equivalent of an American girl doll store. I try to avoid them when possible, but last weekend, we were passing the store with my mother, and somehow we ended up inside. (I blame grandma.)

The premise is sort of cool. They have all these unstuffed bears that are only slightly creepy, and your kid gets to pick out one. You do a little ritual which involves naming the bear and picking out a heart to place inside it, then you press the pedal and the bear fills with stuffing. The bears aren't cheap, but not ridiculous. Least expensive one was $12, which is not entirely out of control for a pretty large teddy bear.

It's the rest of the store that's out of control.

For starters, my daughter wanted her bear to have a headband, which was not unreasonable. Just a headband cost four dollars. Four dollars for a headband for a toy bear. I could buy 10 headbands for my daughter to wear herself for less than that.

Then of course, you have to buy your bear some clothing, because in this state, there are nudity laws against build a Bears. The cheapest outfit for a bear is $12. My daughter picked out an Elsa dress for her bear, which was $20. I kid you not. That bear is better dressed than me right now.

The accessories progress in ridiculousness from there. You can buy your bear shoes for another $10, a hat for another five dollars, and there was even bear underwear. There even appeared to be some mildly sexy bear lingerie.

For $20, you could get your bear a motorcycle, and for $10, he could wear a leather jacket to look cool on his motorcycle. And if something went wrong when he was driving the motorcycle, you could get him a wheelchair for $25.

If I ever find myself buying my child a wheelchair for her bear, you'll know that I have done something seriously wrong as a parent.

Thursday, March 12, 2015

Work it out

When I was in medical school, I ran into a friend of mine in the bookstore one day. He told me he was about to start his OB/GYN rotation another month and he wanted my advice on something. I had already taken the rotation so I assumed he was going to ask me some sort of academic question.

Instead, he said, "do you think I should start working out?"

"What?" I said.

"Well," he said. "All the residents on OB/GYN or women, right? So maybe they'd appreciate it if I started working out and were in shape."

I didn't know what to say. "Um, you can start working out for yourself…"

Tuesday, March 10, 2015

Dr. Orthochick: PM&R Consults

There's a remarkably dumb rule here that if you want to discharge a patient to an inpatient rehab facility (IPR), you have to order a Physical Medicine and Rehabilitation (PM&R) consult. I have no idea why that is because i know for a fact it is not a national rule.

Me: Ortho res returning a page
Case Manager: Hi, I'm calling about your patient in room 987, Ms. Jones. Physical therapy is recommending she go to IPR, so you need to call a PM&R consult.
Me: She had a hemipelvectomy. She can't get out of bed without two people helping her. I don't think she's going to be able to do inpatient rehab since usually you have to be able to do about 4 hours of therapy or so.
Case Manager: Physical therapy thinks she can do it
Me: But she doesn't want to go to rehab. She wants to go to a nursing home. She has about 6 months left to live.
Case Manager: You need to call a PM&R consult so I can get started with discharge planning to get her to a rehab facility
Me: I don't understand why I need to do that.

So I did and the PM&R doc said that not only would the patient not qualify for IPR, but, uh, she didn't want to go.

I figured the issue was put to rest, but I got paged again today:

Me: Ortho res returning a page
Case Manager: I'm calling about your patient in room 999, Ms. Smith. Physical therapy said she needs to go to a rehab facility, so you need to put in a consult for PM&R so I can get started on that.
Me: She's supposed to go home later today.
Case Manager: No, physical therapy said she needs rehab. So put in the consult.
Me: I spoke to her this morning and she feels very comfortable going home
Case Manager: I just spoke to her and she agrees she needs rehab. You need to put in a consult.

So I went to talk to the patient and she said that no, she didn't need rehab. She wanted physical therapy (fair enough), but she felt safe going home and didn't want to go to a rehab facility. Which I agree with. Except then I had the case manager and the physical therapist breathing down my neck until I finally ordered the stupid PM&R consult in the hopes that the PM&R doc would be more successful than me in convincing everyone that she didn't need it.

I really hate calling stupid consults. Mostly because I hate when people call me for stupid consults so I can sympathize with that one and I try not to do it. I'm not saying I've never called a stupid consult, but usually when I do it it's because my attending is making me. And it is really a waste of another doctor's time if I have to call a consult to get the case manager to stop telling me what to do.

Also, physical therapy and I do not always get along. They usually make discharge recommendations and that's fine, they see the patient mobilize more than I do, but sometimes I feel like they overstep their boundaries. Which is fine because sometimes I feel like everyone oversteps their boundaries, including me. And when I do it, I justify that i"m doing it in the best interest of the patient, which is probably how everyone justifies doing it, so whoever uses that argument generally wins the war. (just like the first person to say he/she is not comfortable doing something wins that war) Also, the physical therapists kind of hate me over at one of the hospitals because we got into, shall we say, a disagreement over a patient. They didn't think he was safe to go home, I personally walked him around the second floor with a walker and made him demonstrate foot-over-foot, pivot, stand to sit, sit to stand, off and on a toilet, and stairs...and then I decided he was safe to discharge and discharged him. They didn't like that one too much. And it was a case of me totally overstepping my boundaries. Which was, of course, in the patient's best interest (long story), but OK, I can see why they wouldn't be too impressed with that one.

Monday, March 9, 2015


At the beginning of my third year of medical school, a guy in my class named David, who was an Orthodox Jew, had a son. He sent an email out to our class, announcing the birth and informing us of the babies upcoming Bris (ritual circumcision).

For the record, David was one of the nicest people in the class. He was one of those guys who was always making study spreadsheets and then emailing them out to everyone to help them study. He was always trying to obtain Study aids to help everyone. He was only 24, but married to a really nice woman, and had been really excited about the baby.

Anyway, a few congratulations went out, then an email went out from an anonymous address, but that had to be from a member of our class because it quoted the original email that just went out to our class.

The email was a page long rant about circumcision. The email called David a "dumb Jew" and said that if he "believed in God so much, then he wouldn't take something away that God gave the child." The person then asked if he liked the taste of the foreskin in his mouth, and concluded by saying that David and his people were the cause of most turmoil in the world, and now he is added another Jew to the world.

I think we were all completely shocked that someone would send an email like that. Somebody in our class, who we knew and worked with and studied with. Somebody who was going to be a doctor soon.

And the disturbing thing is, we never found out who it was.

Sunday, March 8, 2015

Leave a review pleeeaaaase!!

I'm doing a large promotion of The Devil Wears Scrubs on Wednesday. So if you read the book, and you enjoyed it, now would be a great time to leave a really positive review on Amazon. Especially since I just got a really bad review for explaining medical things too much.

Thank you guys so much in advance! Have I mentioned that I really love my blog readers?

Saturday, March 7, 2015

Weekly Whine: Play doh

For a long time, I did not allow Play doh into my house. It's too messy and I was worried about it getting into the carpet and getting everywhere.

Recently, one of my daughters brought home a handful of play doh. The two girls fought over that little piece of play doh and played with it like it was the best toy that ever gotten. Finally, I gave in and bought them one play doh kit.

That was the beginning of the end.

About 24 hours after buying that play doh kit, I had play doh ground into large portions of my carpet. Despite restricting them to only playing in one area, it was everywhere. All the play doh I had bought them had vanished, and the tiny bit that was left they were fighting over again.

Where did all that play doh go? How do you get play doh out of the carpet? And why did I break my rule and let them have play doh in the first place?

Thursday, March 5, 2015

Pediatricians and vaccination

I recently read that about 25% of pediatricians are refusing to see patients in their practices who are not vaccinated.

I can see both sides of this issue. Obviously, we are concerned about the health and well-being of these children, and just because their parents have made a decision that we don't agree with, that doesn't mean the child shouldn't have access to healthcare.  If they stay in the practice, there might be a better chance that the pediatrician can educate them and eventually get the child vaccinated.  I feel like the child should not suffer in all this.

There are a lot of arguments on the flipside though. These are a few that I've heard:

-- when you have an unvaccinated child in the practice, it puts the other patients in the practice at risk

-- A parent who refuses to follow the most basic recommendations of the pediatrician obviously does not respect their opinions and it is frustrating and often pointless to work with a patient who refuses to listen to you

-- if enough practices refuse to see unvaccinated children, parents might feel pressured into getting the vaccines just so they can see the doctor of their choice

Truthfully, I sympathize with pediatricians who do this, but I wonder if a stiff hike in insurance rates for unvaccinated children might influence parents without sacrificing the child's health.  

Tuesday, March 3, 2015

Dr. Orthochick: Professionalism

I was briefly at the "Young Practitioners' Forum," which is supposed to be how to get a fellowship, how to get your first trauma job, how to keep your first trauma job, etc etc etc. Anyway, I kept on having to leave for stuff, but while I was there I heard one of the traumatologists giving a talk on 'things that you don't think matter but actually do.' I've heard this particular traumatologist speak before and he's really funny and his talks are always entertaining, even if they're about nonunions or something. (I've seen him on webinars and I've heard him speak at courses. I have no idea what he's like in real life, but as a speaker, he freaking rocks.)

He said some stuff that i agree with, like never walk through your own waiting room late because then it looks like you don't care. Don't park your porsche in your patient parking lot. Don't tell patients you're going on vacation, say you're going to a conference. Stuff like that. He also said a lot of stuff that I try to do, like do your own dressing changes, which is something I always try to do myself. First off because otherwise I might never see the incision, and also because I think patients appreciate it. A guy who graduated a few years ago used to take the bandage off and write an order for the nurses to replace it and that drove me crazy. I mean, some attendings like Dr. Smile and Dr. Chatterbox take the dressing on postop day #2 and leave the incision open to air, but it seems really half-assed to me to take off a bandage and make someone else put another one on. Anyway.

He then showed a picture of a med student texting in the OR while the patient was being moved on to the operating table. If you've never done that, usually it takes a few people to move the patient, you need the anesthesiologist at the head (although I've done it once or twice) and then you need someone on either side of the patient and someone to get the feet. If the patient's really heavy, you need more people. So if you're in the OR when the patient is getting moved (and you should be), then you should be helping. PD once got bitched out for not helping to move the patient (he was doing orders at the time) and it even showed up in his mid-cycle evals that he wasn't helping move enough. So really, this is a little thing that has potential to be A. Big. Deal. My personal ritual is to do orders while the patient is waking up, help move the patient, and then thank everyone in the room and walk out.

Back to the story, the traumatologist said it was inappropriate and unprofessional for the med student to be texting when people around him were doing work. He then said that the med student had gone to him for a letter of rec and he showed the student the photo and said he wouldn't write a letter for him. The med student didn't apply to ortho.

There was a lot of murmuring around me after that story, the guy in front of me seemed to think that was excessively harsh and the guy behind me seemed to think it was appropriate, but I wasn't totally sure how I felt. Part of me kind of agrees. I don't think you should have your phone out in the OR. And unless everyone else's med school is very different from mine, it's almost impossible that he was texting anything important about a patient. (this would also imply everyone else is a different resident from me because I wouldn't trust a med student to do something important for me. I mean yes, I'd trust them to do dressing changes and stuff like that, but for the most part if it's important, then it needs to be done by someone who has the ability to write orders. Feel free to disagree with me) So then yeah, it looks like he didn't care about being helpful in the OR, which is a red flag. We had a med student last year who I thought was lazy and yes, I did say something when his application was being discussed because if you're lazy as a med student on an audition rotation, I don't want to be your coworker when you become a resident. But if it was a one time thing and he was texting then I don't think he deserves to lose the ability to be an orthopod over that. If it's a pattern, sure, but if he just happened to have his phone out, then OK, it doesn't seem like that big of a deal. Also, if you're a med student, it's not like you're doing all that much to begin with. The guy was probably bored after a long day of watching people do stuff. So yeah, he had his phone out, but if texting had been invented when I did my third year rotations (it was. I just didn't do it because it was back in the days when typing the letter C involved hitting 1 three times and really, that was a lot more trouble than it was worth for any message longer than "hi") I probably would have texted more.

So I have mixed feelings on the subject. I don't know what else the student was like. I guess he really screwed up in front of the wrong person though.

In the interest of full disclosure, I was once seeing a patient and she was looking away from me and talking with her eyes shut so I took out my phone to read a text and reply to it. She opened her eyes and looked at me and said "Oh. I'm sorry. I see you're busy." I still feel guilty about that because it was really inappropriate and unprofessional and actually just plain rude to text in front of her like that. I have never done that again, I do not answer my phone in front of patients unless it is that patient's attending calling, I do not read or answer texts in front of patients and for the most part, I do not pull out my phone in front of patients. I don't answer pages in front of patients either. Someone once told me that the most important patient is the one in front of you so really, I think everything else can wait. Otherwise it's pretty freaking rude. And apparently can cost you your dream. And i got really lucky that my patient never told anyone because i definitely deserved to get in trouble for that and I didn't.

Monday, March 2, 2015

Worst thing about Medicine

I was just thinking the other day about how there are a lot of good things about being in the field of medicine. Namely, not to be sappy, but it's a field where you can actually help people. Sometimes you don't even realize how much you're helping them until later.

But there are also things about the field that many of us don't like. One of my least favorite things about being a doctor is the pressure to work through having any sort of illness myself. I am just praying I don't get the flu, because I know I'm going to feel pressured to work through it, and I don't know if I can. I've seen other doctors who were literally throwing up between patients, but just kept going. It's hard, because if you work in an inpatient setting, somebody has to be there. You can't just throw up your hands, and say you will deal with Mr. Smith's chest pain tomorrow.

What is your least favorite thing about being in medicine?