I just finished a week of night float at what is probably considered one of the “outside hospitals”.  The nursing pages are painful. I’d typically receive a page every evening notifying me that a patient had not moved his bowels in 3-10 days, and that the constipation protocol was just initiated. Other times, nursing would demand that I order Seroquel to knock out patients who were simply irritating. While I don’t mind constructive advice on patient management, I don’t appreciate illogical verbal pressure from unqualified people to medically subdue a non-hostile, non-psychotic patient who asks for ice chips.  These select ancillary staff workers leave a foul air that mars the reputation of nurses and techs, and I have to remind myself that not all nurses are lazy assholes. On weekends where I’m in the hospital for 30-36hrs, my pager goes berserk every 10 hrs with 10-15 pages within 2 minutes for inconsequential order clarifications–this corresponds to the nursing shift changes. They tend to forget that my shift spans four of theirs.

On Tuesday, my co-resident and I caught a rotund technician lurking around the resident’s lounge. He stated that he left a “paper” somewhere in the lounge and promptly dashed off. Later, we noticed that half of my co-resident’s iced tea was missing, and his sandwich was gone. We should have confronted the tech in the lounge, since all other staff is forbidden from hanging out in our lounge.

While hospital staff that outright harm patient care are terminated, the majority of the subpar group continue to maintain their duties without penalty even though the hospital administration is aware of them. It is unfortunate, but there is a shortage of qualified nurses in American hospitals. I believe that the shortage is expected to worsen in the next decade; it does not look good for inpatient medicine from this aspect. Hopefully, I will be out of the inpatient business by then…

medicine medicine, rant

I’ve been experimenting with some Google Labs Gmail options, and came across the mail goggles feature. When enabled, a simple Ajax menu with basic math appears whenever you attempt to send an email. You must answer five basic arithmetic problems correctly in order for the mail to send. It’s intended to prevent you from sending unintended emails that you’d regret afterward–likely ones that you send late-night or while inebriated.

Initially I was surprised that such an add-on even existed; how often do we send unintended emails? I don’t think I ever do. But hey, accidents do happen. I get emails every week from hospital administration notifying us of an upcoming conference, only to see them retracted (via Outlook). Surely misdirected emails could possibly only come from misdirected souls, right? How could an electronic sobriety meter ever save me from email embarassment?

In any case, I fired up the mail goggle feature last night, and enabled it for the hours from 10pm until 6am. Since I’m working night float this week, it was a great way to test out its efficacy. Early on, I had little problem sending mail. Around 3:45am, however, the problems surfaced. 343-88? 403-159? Damn subtraction. As I was fumbling to send an email I wrote to Joe about how much I hated my rotation, the 60 second timer expired, and I was presented with five new arithmetic operations. Damnit! As I cursed at myself for being stupid, I glanced at the header field and realized that I had erroneously addressed the email to Janine.

While I’m sure Janine, Jacob, or Jim would probably not have known that my email was intended for Joe anyway, Mail goggles had validated its existence. Mistakes happen to even the best of us, especially with sleep deprivation.  If there were only a similar invention that worked for vocalizing thoughts…

computing tech

I have been cycling through paperwork for my new residency over the past few days. The packet contains a mix of poorly photocopied forms, some of which is either illegible or completely cut off. The hospital also graciously included a photocopied Chase Bank flyer dated 2004, which offered $200 for opening a checking account. I called the graduate admissions office (GME) later to clarify some issues:

Me: Hi, I’m starting residency at XXX next month, and I’ve got some questions about some of the forms I received from your office.

GME guy: You need to call YYY.

Me: The forms came from your office, one of them is a verification of medical school training. I’m not…

GME guy: (cuts me off) And?

Me: I’m not in town, and I was going to fax in the form to the Registrar’s office to be stamped. Do you accept faxed signatures?

GME guy: It depends if you sign it. Up to you.

Me: It goes to your office! Ok, I’ll fax it over. I’ve another question: what time and where do I show up for the orientation in June? The forms don’t say.

GME guy: We don’t do orientation.

Me: The form says “Please show up to Occupational Health on time”, but it doesn’t say when and where.

GME guy: This is OHS. You said orientation, confusing me.

Me: (I was getting really pissed off at this point) Yea, OHS. Where do I show up?

GME guy: <paused for 10 secs> You got the green sheet? Read the top.

Me: <looking at the green sheet> It says ..ving Pavilion, and no address.

GME guy: Yup, call the number at the top for info. Irving Pavilion.

<click>

Apparently the address for Irving Pavilion was completely cut off the top of the page. If I didn’t already know where the buildings on campus were, I’d have no idea where to find it.

Ah yes. And now I am reminded why I left NYC…

medicine humor, rant

Paperwork is the bane of the U.S. health system. Hospitals hire trolls to ensure that physicians and nurses document every last detail of a patient’s bowel movement in case of legal dispute. Social workers hound us to document minutiae so that the hospitals will receive their cut of the bill. I was recently told to draw a down arrow along with “K+” to document hypokalemia so that the hospital will be able to bill for the medical condition.

I am in the process of registering to work in a new hospital system in another state. The other day, I received a huge packet of poorly photocopied paperwork to be completed before I get hired. One of them is a statement that I will not sue my employer under any circumstances. Another form states that if I choose to work at this hospital, I am forbidden to moonlight in my free time. Other forms include various tax withholding forms (W-4′s, IT-2104′s), applications for employment, background check forms, and a variety of nondescript forms with a blank to sign and date.

To think, these forms are only for residency training! How much worse is the paperwork for a real job? I would have thought that the blood and sweat ended after I matched, but I’ve come to realize it’s a lifelong journey.

Do doctors in other countries have to go through the same harrowing process simply to practice medicine? What if I moved to France or China? Would there be as much paperwork? The thought of practicing medicine outside the U.S. is intriguing….

Readers! Please share your thoughts!

medicine humor, medicine, rant

In the research arena, there is always a “conflict of interest” declaration to enumerate any reasons why the researcher may benefit from favorable results of a study. Many times, the researcher’s lab is sponsored by the very same company whose drug  is being studied. Other times, the primary investigator holds stock in the pharmaceutical. Regardless, any conflict of interest is often viewed with critical skepticism, based on the notion that research should be purely scientific.

I’ve never had any financial disclosures in research. Is that good? I’ve begun to reconsider. Would it not be a privilege to be able to state that you are a primary shareholder in a pharmaceutical company? After all, don’t you have to be an important person to be in that situation? Don’t we all want to be important?

My next goal: strive to generate as many conflicts of interest as possible. More to follow…

medicine humor, medicine