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

Loaded shopping cart at Trader Joe's

Sure, today is Superbowl Sunday and people have a right to load up on groceries for the big game…but shopping rage? That’s excessive.

This weekend was my only free weekend in 7 weeks, and I decided to drop by Trader Joe’s to pick up some tasty snax. Business is always booming at the local TJ’s–they actually expanded twofold despite the recent economic slump. The store was so crowded, that I decided to just pick up a container of calimyrna figs for the week; while their prices are generally reasonable, my budget is more suited for shopping at the local Hispanic supermercado, where I get most of my groceries.

As I approached the checkout counter, a middle-aged woman (dressed to downplay her age) with a loaded shopping cart shoved in front of me. I glared at her, and prominently displayed my sole container of $3.69 figs as a means to politely hint that she should let me check out first. Naturally, she glanced at me and my figs, and turned to unload her groceries on the counter. B-I-T-C-H.

The further add insult, she decided to switch out a packaged of fresh chicken legs for a frozen bag–the employee had to return to the refrigerator section to bring her a new one. When her final bill rang up $131.XX, she fumbled through her wallet while stating, “Oh, I think I have a giftcard somewhere. I know it doesn’t have much on it, but might as well use it…”

Sadly enough, she’s not the only jerk out there.

Uncategorized rant

I hate writing progress notes. Sure, they’re essential to document to a patient’s hospital course, but most of the note is repetitive. Even worse, my hospital uses a hybrid medical record system.  The computerized portion stores all laboratory values and initial consults. The daily progress notes by the primary team and consults are all handwritten.  The nursing pods usually have only one or two computers, one of which is always used by nursing to view people.com and perez hilton.  Thus, every morning I vie for that lone open computer while fumbling through illegible chickenscratch.  Do we regress that quickly from grade school? And clearly I’ve discovered that penmanship doesn’t correlate with hand dexterity- surgeon scribble is no better than internist scribble. I’m no calligrapher, but at least I make an active effort to be legible.

This cycle repeats for each of the 8-12 patients every morning for 4 week blocks at a time. That’s enough to push anyone into insanity, or any cynical housestaff to reinforce his jaded outlook on the medical system.  And if slovenly human behavior doesn’t do it, the computers like to seize and go into endless reboots daily around 6am – 8am.  That’s hospital IT (information technology) for ya.

medicine inpt medicine, rant