Every year, the Academy of Ophthalmology holds an annual meeting that most ophthalmologists attend. Those that are usually left behind are junior surgeons who end up covering the on-call pager.

I was unfortunate to be covering the primary pager for the hospital this weekend, which is Academy weekend. Generally speaking, this is the worst weekend to have an eye problem, because your primary ophthalmologist is probably out of town in a meeting (or getting drunk). My pager rang early yesterday morning with a long distance callback number. Bad news. When the emergency room or floor resident pages me, I usually receive the hospital extension. A long distance number always means that you’re getting shit that you don’t want to (and should not have to) deal with.

The call turned out to be from one of my attending’s wife. She woke up with an itchy eye and foreign body sensation. Her husband was at the AAO meeting in San Francisco, and she did not wish to bother him with a call. Her son-in-law, daughter, nephews, and nieces were all ophthalmologists at the meeting as well. Her primary ophthalmologist was in town, but she did not wish to bother him either because it was Saturday (Jewish sabbath).

WTF?

I suppose that leaves me, the on-call resident. I offered advice to the best of my abilities over the phone and offered to see her in the emergency room (the one where patients wait 4 hours to be triaged). She politely declined.

Lesson to be learned: if everyone in your family is an ophthalmologist except you, you should go with them to the Academy meeting.

medicine ophthalmology, rant, work

I remember when Instant Messaging flooded the workplace computers back in the tech-boom days. My colleagues working at IBM would get company-wide emails stating that IM decreased productivity and was prohibited. When company threats weren’t heeded, port 5190 was blocked on the company firewall.

Now that instant messaging has been superseded by text messaging and MMS, I see my colleagues “texting” away during conferences and lectures. It’s become a nuisance. If you’re simply notifying your spouse that you’ll be late for dinner, that’s one reason to be texting during fluorescein conference. However, checking the stock ticker? Chatting with your medical school classmate? What are you thinking? That is simply abusing technology. Perhaps I say this only because I don’t have a data plan on my phone, but there is a point in which your attention should be directed toward the lecturer and not your iPhone.

Our eye clinic is in the basement, where our cellphones unreachable by the outside world. You’d think that there wouldn’t be any contact with the outside. Wrong. Last week one of the technicians (who are supposed to be obtaining visual acuity for our patients) was logged onto her MySpace page. Another computer was logged onto Facebook.

I wonder how much social networking affects workplace productivity. A quick search online shows that this actually increases productivity. USAToday also states that we work better with social networking… The caveat? None of these companies are involved with healthcare.

computing, medicine rant, tech, work

An obvious facet of owning a business is knowing your competitor’s prices. If you don’t, then you’ll likely be out of business soon. We see this with taxi drivers. In NYC, there are city-governed yellowcabs and unmarked private cabbies. Most private cabbies command a higher rate, not because they provide better service but because they lurk around areas where yellow cabs are not as readily available. As a customer, the key is to negotiate a price prior to getting into the cab. However, even with informed preparation, you can still run into trouble.

I hailed a grey taxi to help me move an air conditioner 5 blocks away from my apartment.  I offered $10 for his assistance in carrying the unit to and from the cab in addition to driving me. He agreed. Afterward, he didn’t help me move the A/C, AND he charged me $15 because my A/C was “big”. Asshole. A $15 cab fare would normally get you at least 20 blocks.

My friend Bob had a more harrowing experience. After agreeing to a standard $8 fare to travel between hospital campuses, the cab driver demanded $14 when they arrived at the destination. Bob refused, and the driver locked the doors to the cab and refused to allow him to exit. He spent over 30 minutes in the cab until the driver gave in and let him out.

I understand that any business is difficult to run these days, but knowingly ripping off your regular customers is no way to remain profitable.

medicine rant, travel

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