The great aspect of having a small residency group is that we could all potentially get along and have a good time. I’m fortunate that this is the case. Everyone is willing to pitch in and help each other out.

One of my friends at a large ophthalmology residency program recently disproved the aforementioned statement, however; his relatively large class of 7 residents per year get along nicely as well.

What is true about a small residency is that no gossip goes unturned. For some reason everyone knows everything about the patients that roll into our clinic or ED. That’s the disturbing fact. How does this happen? Is everyone nosy?

In fact, I wouldn’t be surprised that the chairman of my program has visited my website…that would be very interesting. I’d better only post constructive criticism from now on… ;=)

medicine ophthalmology

We get many calls from the ED regarding eye trauma by various objects and substances. Some of them are absurd–how did you get nail glue into your eye again?

I always considered these people who roam into the ED as inferior beings, until I experienced a similar episode days ago.

Somehow grapefruit juice managed to circumvent my glasses and splash into my eye. It was painful. I flushed my eye for about 30 seconds with sterile saline, and felt better afterward. Ideally, I should have flushed even longer, but I had 2 consults to see in the ER.

The next time I triage someone who sprays antiperspirant into their eyes, I’ll think twice before ridiculing them…

medicine ophthalmology

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

The community of patients that our ophthalmology clinic serves is notorious for providing bogus contact information. This includes phone numbers, addresses, and sometimes even ages. This is likely not intentional–they travel back and forth from their home country frequently. Many of them do not have a permanent U.S. address and provide a relative’s, friend’s, or neighbor’s when asked. This is problematic when we have to contact them.

For missed clinic appointments that is usually not a problem. They can reschedule at their own leisure, and there are usually enough patients to be seen in clinic already. Our surgical numbers, however, are dependent on our ability to reach our patients.

I had 2 patients that I’ve been trying to schedule for pterygium surgery, and none of their provided telephone numbers work. How can I reach them? I have a listed address on the demographic sheet, but should I go to their house to ask them to return to clinic for surgery?

Imagine that your doctor shows up at your doorstep to get you to have surgery. How would that feel? I wonder if he’d be treated like any other annoying traveling salesman hocking his wares.

I guess I’ll find out soon enough…

medicine ophthalmology, rant