Every so often I overhear unruly commentary from various hospital staff about the doctors. The ones from environmental services are particularly colorful, even more so now that I’m in NYC.

“F-cking docs,” I heard one custodian mutter as he was cleaning up some coffee cups strewn about in the emergency room.

Other times I hear commentary among the cleaning crews about how good we [residents/doctors] “have it”, with our fancy clothes and expensive tastes.

There is a food stand in the lobby of our hospital. As residents, we receive $10 worth of food while on call. I believe that the cashier has gotten wind that we don’t pay for anything up to $10 from the way we stock up on beverages.

There is a cashier working on weekends who appears to be passively aggressive towards our “luxuries”. For the last three weekends I’ve been on call, I’ve always gotten 4 sodas ($1.50 ea) and 4 bags of chips ($1.00 ea). This should naturally ring up as $10, but the register magically rings up as $10.05 every time she is working the register. On weeknights that I’ve gotten the exact same items, I have never been asked to supplement my purchase with an additional 5 cents.

I haven’t attempted to rationalize with her on the absurdity of the purchases. There’s not even a $0.05 tag to any of the items I purchase.

misc

One of the most painful aspects of clinic, at least where I work, is that nine out of ten patients I see daily do not speak English. While I feel that I’m reaching my limit at broadening my linguistic abilities, it is disheartening not to be able to communicate fully with your patients. I occasionally use the interpreter lines only when necessary, because it adds an insurmountable delay to the schedule that cannot possibly be regained. At times, even the interpreters have difficulty understanding a patient’s native tongue.

Today a patient came into emergency triage stating that she had lost vision suddenly in one eye a month ago, but only decided to come to the clinic today. She also denied ever being here in the clinic. To no surprise, we did not have any records of their encounters in the clinic either.

I spent the next hour toiling around to find an egregious cause for her vision loss, only to find non-specific drusen in her fundus. When my attending, who was fluent in Spanish, questioned the patient again, the story was relayed in a different manner than I gathered. She had GRADUAL vision loss over a month, and she also “lost” her glasses 20 days ago. Her chart also magically appeared underneath my progress note–I suppose one of the techs found it 4 hours later–and a workup of AMD  was suggested in her plan.

Lesson learned: you can’t win.

medicine life

Interesting logo on our box of pig eyes for practicing sutures…

medicine medicine

I slept about 4 hours over the course of 3 days I was on weekend call. The call day started off after a full day of clinic (about 10 hours).

Why?

Ophthalmology receives too many consults that aren’t legitimate. Despite what the emergency physicians or floor team thinks, there are many reasons why ophthalmology should NOT be consulted. For instance, a patient with diminishing vision while having a stroke in the occipital lobe probably doesn’t need at STAT (get your ass over here in 5 minutes or I’m reporting you to your program director) consult, especially if the patient’s not even on the floor.

If we were twiddling our thumbs waiting around for consults, we’d be glad to see your floor patient by the time you round in the morning, but that is not the case. Moreover, ophthalmology consults take a LONG time. Dilation drops require a good 30 minutes of wait time. A non-bullshit consult could take more than an hour for an average resident. Ten consults spaced out thirty minutes apart could potentially run over the course of an entire day.

When you do decide that your patient actually would benefit from an ophthalmology consult, tell your medical student to make sure he/she knows some basic information about the patient before calling:

1. Vision. Use a Neer card. The one on the back cover of Maxwell‘s is adequate. Know if the patient can see LIGHT.
2. Know if there’s redness in the eyes or purulent DISCHARGE. If you don’t know what that is, search for a picture online.
3. Know the patient’s name and where to find them.
4. Don’t call for a STAT consult over the phone when the ophthalmology consult is sitting next to you, and you just spoke to him less than 2 minutes ago regarding another patient–and have your STAT patient not even be on the floor for the next 2 hours.

It’s unfortunate that we never learned certain key vitals to make interactions with other services prompt, but we train for a minimum of 3 years. Hopefully we can all learn the system in that span of time.

medicine ophthalmology, rant

I received a copy of my annual residency contract, which I signed before reading. The first line reads:

This Agreement between [hospital] and [resident] is entered into for the 2009-2010 academic year, which is generally July 1, 2009 through June 30, 2010 but may begin earlier and end later if deemed necessary by the Hospital..

Aside from the grammatical inconsistencies of that statement, which includes the double period at the end, I could potentially work until December 31, 2010 under the contract on my fixed stipend!

That would be extremely uncool if it were enforced…

medicine ophthalmology, rant