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

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

OMT, manipulation, counterstrain, and circulatory stasis are a few terms that were never incorporated into my medical school curriculum. They are all associated with osteopathic medicine, or D.O.’s. I never considered osteopathic medicine when I was applying for medical school, partly due to my ignorance of the specialty, and mostly due to the stigmata that D.O.’s aren’t real doctors. To clarify, the M.D. and D.O. educational curriculum are theoretially identical except that D.O. curriculum includes more training in musculoskeletal systems.

I’ve gotten the occasion to discuss medical cases with some osteopathic folks, and the experience was eye opening. The following is an excerpt from one of my first presentations. I was presenting a gentleman who had a hemidiaphragm weakness later found to due to demyelination disease:

Me: “Mr J is a 64 guy with Class III heart failure and emphysema who presented with SOB over the last week after experiencing some viral URI-like symptoms. He also has a-fib, liver di…”

OMT attending: “Yeah, yeah, what did the ribs look like?”

Me: <confused> “Well, he did had some asymmetrical inspirations. The right side was more sluggish. Lungs were crackly…”

OMT attending: “Which ribs were preferred? Inspiration? You think it’s pump, bucket, or caliper?”

At that point, one of the other residents, an osteopath, bailed me out by saying, “He’ll benefit from some treatment”.

Over the next hour, we performed some rib raising, muscle energy techniques, and diaphragm release/facilitations. The patient told us he felt symptomatically improved afterward. Several days later after I switched services, I believe the next team transferred him to UPenn.

Nuts. I guess OMT didn’t work in this case.

medicine medicine

Several entries ago, I wrote about my experiences with Google Voice.  It is by far one of the best forwarding services available today; one of its features include transcription of voicemail to text.  The transription has been shockingly accurate for me…that is, until I started using my number to discuss medical-related issues. Take the follow excerpt a urogynecologist left for me:

Hi...I last changed her catheter on Feburary eighteenth. Uh, I placed a sixteen
French foley catheter over her suprapubic site...if you think it looks cruddy
you can exchange it out...

Here is the transcription from Google voice:

Hi...if I west change her catherine said you were eighteen i placed a sixteen
french pollack after for super P B X site...if you think it works cruddy
always replace it out...

The message was actually enunciated clearly in the voicemail, and the doctor did not have any weird accents (Egyptian or Bostonian).  Overall, the transcription was accurate, and I assume that these shortcomings will be promptly corrected after the Google bots scour this entry and flag the development team. (Yeah, I know you Google spider bots are lurking around.)

Hilariously, I initially thought the transcription was a spam solicitation. I was about to file a complaint to Google that they were selling my number to spammers, but then listened to the actual voicemail. An admirable first attempt, it was. But then again, how often do you use words like, “suprapubic”, “catheter”, and “foley” anyway?

computing medicine, tech