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 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

We have several days of outpatient electives during our rotation blocks for the year. This week I’ve been bouncing around various private ophthalmology offices in the area basically shadowing the attending. For the most part, it’s like being a medical student, because the private offices are usually swamped, and there is little time to discuss cases with the attending while the patient is in the room.

Today I was at a busy retinal office pretty much observing intravitreal injections for diabetic retinopathy and wet AMD. By noontime, we had fallen about 8 patients behind schedule (that’s about 1-1.5hrs). Both the attending and I had realized that I was not getting much education out of this. Thankfully, she dismissed me to go back to the hospital, knowing that keeping me around would delay her schedule even further.

I thanked the attending and walked around the corner (marked on the diagram above).  As I was blowing my nose (I have a lingering cold), the following dialogue took place:

[I blew my nose on a tissue]

Nurse: Ha. You must be picking up at cold going around the office!

Me: Yea, I guess so. (I had never been to this office before)

[Office coordinator, with BMI around 35, storms in]

Coordinator: (Yells at me) No chatting at the nursing station! You are supposed to be with Dr. [attending's name] at all times!

Me: Is there a problem? I am blowing my nose, and I’m about to head out.

Coordinator: Where is Dr. [attending's name]?

Me: She is next door with a patient.

Coordinator: Residents are assigned to be with the doctors at all times!

At that point, I walked out and left.

I have no idea why the office worker was so furious. Firstly, residents are also “doctors”. Secondly, even if she is responsible for arranging resident schedules, she has no right to enforce arbitrary rules upon the residents. How does she benefit from making me sit through another Lucentis injection? Does she get a salary bonus if she’s able to make me follow the attending like a puppy? If I sneezed in the patient exam room, how would that reflect upon the office hygiene practices? Maybe it’s some stupid office wager they have going on…

Otherwise, the only other reason I have for her domineering attitude is that she just got high off this power trip at my expense. L-O-S-E-R.

medicine rant

Even if you haven’t travelled by air recently, you probably have heard about airlines cutting operation costs by reducing services. Obviously, domestic travel has been hit the hardest. On United Economy Class, beverage service no longer includes any 0.05oz bag of pretzels to accompany the drinks (for flights < 2hrs). United has also opened up a dozen or so “Economy Plus” seats on their 737′s that offer an extra 5 inches of legroom. Their website states that these seats are available for one-time upgrades starting at $14. No bad right? Bad indeed. The $14 only gets you the seat on ultra-short haul flights only (Chicago <-> Detroit). On my flight from Chicago -> Philadelphia the other day, the upgrade was available for $40. Indeed, it was such a hot item that it seemed like the only takers were those willing to shove through the flight attendants barracading the division between economy and “economy plus” class. Read more…

misc rant, travel