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The Details Matter

In clinic today I saw one of Dr. B’s patients. I grabbed the chart, went to see the patient, and came back to present to Dr. B.

After 3 weeks at my site I have managed to avoid seeing any of Dr. B’s patients. Let’s just say that Dr. B is rough around the edges and his vocal chords have a propensity to produce very loud noise when speaking to people. He is also over 60 years old and looks like he could be your grandfather.

Anyways, while presenting my patient to him, I mentioned that my patient had experienced dark red blood in her stool for “months.” The conversation then continued like this:

Dr B: Months? What do you mean months?!? Is it 2 months or 200 months? It matters!

Me: Right (while nodding my head. He is right, after all. I have nothing about which to argue.)

Dr. B: In medicine, the details matter. Are you married?

Me: No

Dr. B: Do you have a girlfriend?

Me: Not at the moment.

Dr. B: Well when you get a girlfriend you ask, “Do you have a lot of money?” She says yes, and then your next question is, “How much?” See? The details matter!

Me: (Nodding my head)

Point taken. The details matter. Got it, coach!

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I get a shadow tomorrow!

The first years have completed their first year. Now it’s time for their 4-week clinical ward experience. They were given the option of ranking the different specialties and the dean’s office did their best match up the students to their requested specialties.

Tomorrow will be the first day of their ward experience. I have already been notified of which students have been assigned to me. The first years were also told and instructed to contact their third years about where to meet up. I haven’t been contacted yet. It’s not like I blame the guy, though. For some reason, they gave the first years our pager number. Which is kind of ridiculous since they don’t have pagers yet. So they have to figure how to use the hospital paging system, page us, and wait for us to return the call. I suppose it’s because they can’t just give out our contact information without our permission.

On my surgery team, there are already 3 third year medical students — two of which are from my school. I have one 1st year. She has 2. So rounding will become a large group experience.

Should be fun. I remember when I had my clinical ward experience after my first year. Hopefully they will find the experience useful.

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Words With Patients

Let me set up the scene. I had just met my patient and examined her in her room. She was an older woman. She was an inpatient (meaning she was staying at the hospital). We were discussing a possible trip to the OR that day. I wasn’t sure if she would go that day or if the surgery would have to wait.

Nevertheless, our conversation was pleasant and I felt that we had fairly good rapport. We laughed and smiled throughout the conversation even though she was obviously anxious about surgery. And then this conversation happened:

Me: Well, it was good meeting you. I’ll probably see you later today. If you’re here tomorrow, then I’ll see you then too.
Her: If I’m here? Where would I go?

I sensed the panic in her voice. She sounded like I had just casually mentioned that her future existence was in question.

My only thought was that she could have gone home after surgery since I didn’t think the procedure was too serious. But poor, lady. She was thinking more negatively than I anticipated.

And once again, I was reminded how important communication really is. And seemingly innocent remarks can be understood in a completely different light that it was originally intended.

Oh, and I did clarify what I meant as soon as I heard her reaction. And we laughed again.

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Medical Humor – Hiding $100

How do you hide a $100 dollar bill from a general surgeon?

Put it in the patients notes.

How do you hide a $100 dollar bill from an orthopedic surgeon?

Put it in a textbook.

How do you hide a $100 bill from a radiologist?

Tape it to a patient.

How do you hide a $100 bill from an internist?

Hide it under a dressing.

How do yo hide a $100 bill from a psychiatrist?

Anywhere — just call a code and they’ll be headed away from it.

How do you hide a $100 dollar bill from a plastic surgeon?

It’s a trick question. You can’t.

How do you hide a $100 bill from a neurosurgeon?

Tape it to his kid.

– Brought to you by the Internet
Source: Mainly here but also from people who have told me.

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Book Review: Doctor Confidential — Secrets Behind the Veil

Doctor Confidential
Last month I received an advanced copy of this book. This book, Doctor Confidential: Secrets Behind the Veil by Dr. Richard Sheff, was released this past Sunday (May 1).

Dr. Sheff is a family physician with over 30 years of experience in practice. In this book, Sheff eloquently and openly shares stories that have stayed with him through the his time as a student, then as an intern, then a junior resident, and finally as a senior resident. Readers who are unfamiliar with the world of medicine will be happy to know that this book should be understood by the lay person. When the story being recounted requires the use of medical jargon, footnotes offer a clear explanation.

As a medical student, I couldn’t help but smile when reading through portions of the book recounting Sheff’s medical school experiences. At times, I had to remind myself that Dr. Sheff attended medical school a couple decades ago. Yet some things never change — and other things change very little.

One piece of advice that a senior medical student shared with Sheff, and that Sheff subsequently shares with his readers, is to remember that “Medicine is a bottomless pit. You can pour all of yourself into it, seven days a week, 24 hours a day, and still not fill it up — still not do enough for your teachers or for your patients. Only you can decide when you’ve done enough.” It is short. It is brief. But it is profound. And those who have gone through medical school will likely agree with this statement. It is a pity that many hear this later than necessary. As I began reading the book, it was nuggets of wisdom like these that kept be going.

As the book continues, Sheff describes the slow, gradual change from student to doctor through many memorable stories. They are poignant stories that question the system of healthcare and healthcare education we have in place in America, and ultimately accomplishes what the book set out to do — to reveal the “secrets behind the veil.”

If you are interested in getting a look behind the scenes, I’d recommend this book. And if you are a medical student like me, I think you will enjoy reading someone eloquently express many of the feelings we experience during our clerkship years.

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Placed A Laryngeal Mask Airway Today!

Today was my second day on Anesthesia. Unfortunately, none of the cases required an endotracheal tube placement. So I could not get that procedure signed off today.

However, the attending did let me place a Laryngeal Mask Airway (aka LMA) on one of the older patients. And by older, I mean teen-aged.

You can click the link above to see a description about what it is and what it does. But below is a picture of how an LMA might look.

Silicon & PVC LMA

I placed one that looks like the second, clear one. Once the patient is sedated with the anesthesia, you open their mouth and push that mask into their mouth and down into the pharynx.

 
This figure illustrates where the LMA sits within the patient.

Anyways… I was just excited about this. Not like it is a huge procedure or anything. It’s simple, really. But a first, nonetheless.