I used to toss sensitive documents in the hospital shredder bin. The bin is usually a locked cabinet that is emptied occasionally by a professional shredding company.

Several weeks ago, I noticed that a few of the hospital maintenance workers were digging around the “locked” bin. Since then, I’ve acquired a cheap-o-shredder for shredding purposes.

What I’ve discovered is that the standard 6-8 page vertical shredders are junk. You can’t aggressively shred anything thicker than 5 pages without jamming the grinder. In addition, the papers shreds could actually be reconstructed without too much difficulty if all the pieces were available.

I guess I have two alternatives:

1. Buy a nicer, cross cutting shredder with larger blade.
2. Burn my documents.

Or shred AND burn them. That would be entertaining and most effective.

misc humor, work

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

In medicine, patients who have been admitted to the hospital have an option to leave despite being deemed too ill to be discharged. We refer to these patients as leaving “against medical advice”, or AMA.  Many times patients sign out AMA whenever they feel a desire to leave the hospital when work-up is still pending. I once had a patient who presented with symptoms suspicious for myocardial infarction, but had a flight to India several days later. He felt symptomatically better a day after presentation, and decided to leave to pack his bags even though we had not completed all of this cardiac tests.  I had another patient who was admitted for a gastrointestinal bleed from ruptured esophageal varices. No sooner had I finished transfusing him 6 units of red cells did he demand to leave. This guy was a cocaine addict who needed another fix. These are the cases which disobeying medical advice could result in death.

Other cases are not as obvious. I had a young diabetic teenage patient who was admitted for drainage and antibiotic treatment of an infection neck abscess. He left AMA before bacterial cultures could be speciated. While he was unlikely to die from premature cessation of his antibiotics, he did not complete his treatment and risked developing a superinfection or worse, a superbug.

Interestingly enough, the one universal bond that I have noticed about AMA patients is that they were all cared for by a medical team. Not a surgical team. Not a gynecological team. You can argue that fewer surgical patients leave AMA simply because there are fewer surgical patients in the hospital, but I believe the explanation is simpler: surgery has more tangible results.

The argument that surgeons “do more” for their patients is not only stated by surgeons, but also perceived by patients. When I was a medical student, the surgical attendings considered themselves the “Physician +” because they are expected to manage their patients medically and surgically. Those students choosing to specialize in surgery crave the satisfaction of intervening in order to make the patient better. Patients admitted to the surgical service expect a tangible intervention, like removal of an organ or excision of a tumor. They are not likely to leave against the advice of the doctor. Even those surgical patients who are managed medically, such as the small bowel obstructions, almost never leave the hospital without a doctor’s blessing. They are in pain, they cannot eat, and they also know that there is still a possibility that they may be cut open.

Sadly, the same cannot be said about patients managed by internists. The diabetic in ketoacidosis will start feeling better when their anion gap is near closure, but we cannot send them home if their white count is sky high from an unidentified infection. The patient doesn’t see this. He feels better, and wants to go home. The HIV patient with cryptococcal meningitis feels great after I hit him with some narcotics and a dose of amphotericin. He thinks that all he needs are some painkillers. Think again. If he goes home after this, he will be as good as dead–the amphotericin will have just enough time to frag up some fungi in his system to trigger whatever is left of his immune system to go berserk and maybe put him into sepsis.

It is unfortunate that medicine is perceived in this manner, by doctors, patients, and even insurance companies. It is at times frustrating to practice medicine in the context of this disconnect; it feels as if doctors are broadcasting on a different frequency as everyone else. Policy needs to be revised. Policy is being revised. But in the meantime, we will have to wait it out.

medicine medicine, work

As a rotating intern, I spent time on the general surgical service. Traditionally, off-service interns are granted minimal responsibilities on the surgical service; they are akin to glorified medical students with M.D’s. Most of the rotators intend to become radiologists, dermatologists, or ophthalmologists. The administration is aware of the circumstances, and usually schedules accordingly. When I reflect back to my stint, however, this was certainly not the case. Somehow I was promoted to a level I was probably underqualified for, at least part of the time. Perhaps it was because I had mentioned to the team that Mehmet Oz once lectured to us about incorporating flaxseed into our daily meals.  Or maybe there was simply a shortage of bodies on service. Mind you, while some ophthalmologists spend a year in surgical internship, the only experience I had to draw from was one rotation as a third year medical student. Most of my time as a student was spent changing wound dressings. Here are a few notable instances that I was subjected to:

10. Consulted on 12 surgical cases while covering a service of 58 patients while on call. (A new pager battery died in a matter of 10hrs)

9. Incised, drained, and packed thigh abscesses on the floor. (I read a blog on how to perform the procedure beforehand)

8. Closed up subcuticulars in several inguinal hernias and lumpectomies.

7. Ate 10 chocolate chip cookies and drank 3 20-oz Powerades for dinner.

6. Served as first-assist in a laparoscopic J-tube placement on a woman with peritoneal mets–the case started at 8pm and ran 3hrs. I read a website how-to guide on the general progression of the operation. My responsibilities were minimal–just holding the camera at awkward positions, keeping the field clear, and working the 2nd alligator and dolphins.

5. Diagnosed an acute appy in the ED (cool!), but had to assist in the case at 4am. (I watched a video from some website in India beforehand to figure out where to put the trocars)

4. Replaced a G-tube that had fallen out of a floor patient (with guidance from a nurse and the instruction manual).

3. Placed a G-tube via endoscopy (with supervision from attending)

2. Hand wrote 16 progress notes in one morning.

1. Performed 50% of a lumpectomy including sentinel node biopsy and tagging. (Attending thought I was a surgical resident and did not listen when I explained that I was a non-surgical intern; I did however prepare for the case extensively beforehand)

The experience, while harrowing at the time, was actually extremely gratifying afterwards. Now that it’s over, I suppose that I’ve added to my adventures of residency.

* Note: In no way should the aforementioned anecdotes be construed as a reflection of those parties involved. Ophthosurgery and its authors hold no responsibilities to any parties mentioned on this website. Ophthosurgery is not liable for the use or interpretation of any content found on this website. See disclaimer for more details.

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