Our team was on short call today. The intern and senior resident were raving about ZDoggMD and his videos. This is his parody of Rebecca Black’s song “Friday.”

We watched it during lunch in the cafeteria. I think this version is better.

Internists are hilarious!

*****

Doctor: Go see this patient, she’s going into active labour. I want you to check if she’s dilated or not.
Med Student: Um, okay. I will go check.

Medical student sees patient, checks the patient’s eyes, then reports back.

Med Student: Um…I think they both look pretty dilated.
Doctor: …What do you mean…both?

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.

Image by Fizzy at DocCartoon

This made me laugh so I had to share.

I found the above image at the blog of Doc Cartoon. Seems like it has some interesting posts. You should check it out. The address of the blog is: http://doccartoon.blogspot.com/. If you click on the image above, it will take you to the specific post where I got the image.

As a bird flew overhead, the family practitioner started to shoot but decided not to because he wasn’t absolutely sure it was a duck.

The gynecologist also started to shoot, but lowered his gun when he realized he didn’t know whether it was a male or a female duck.

The surgeon, meanwhile, blew the bird away, turned to the pathologist and said, “Go see if that was a duck.”

- Brought to you by the Internet
Source: Link

I love patients with a sense of humor. Well, I hope my patient was just joking…

He asked me for my thoughts regarding the differential², but I didn’t really have a good answer. My first thought was that the symptoms were due to an infection. However, I was already told that this was not the most likely etiology for her symptoms for a couple of reasons: 1) symptoms started about a month ago, 2) blood pressure, temperature, respiratory rate were all within normal range 3) the chest x-ray came back normal, and 4) Gloria’s file showed that she had come in annually around the same time of the year with similar complaints.

At this point, the attending told me that the most likely cause of the symptoms was allergies. And, looking into Gloria’s file I saw that she had a history of allergic rhinitis³. Mentally, I chastised myself for not thinking of allergies. The attending, though, just moved on and ignored my ignorance.

The good thing about being a lowly 2nd year medical student attending clinic is the low expectations — expectations that you probably won’t even be held to. The doctors know that you are still just going through your basic sciences and know that your clinical knowledge/skills still have a ton of room for improvement.

I went to the waiting room, called Gloria inside, and walked her to the exam room. She explained that she had been congested for a month and also had a cough. Her symptoms had a seasonal pattern, occurring around the same time each year. They had also worsened in the days leading up to her clinic visit. This had coincided with the increased winds.

I proceeded to ask for specific symptoms. I asked Gloria about her eyes. I asked if she had any pain. I asked if there was a change in vision. I asked if she had any problems with her eyes. Each time I asked she said, “no.” And so I moved on to other organ systems.

When I finished the interview I listen to Gloria’s lungs. The lung fields were clear with normal breath sounds. Feeling pretty sure it was allergies (and not something more serious like a pneumonia), I left the patient in the exam room and waited for my attending so that we could discuss Gloria’s case.

After reporting my findings to the doctor, he asked if I had done a HEENT exam⁴. Sheepishly, I told him I hadn’t. Another thing had slipped my mind. He then asked if the patient had any problems with dry, itchy, red, and/or watery eyes since those are common with allergies.

I hadn’t thought about asking specifically, but I told him that I had asked the patient about eye problems in general, and more specifically, about pain and visual acuity changes. She told me she had no complaints about her eye.

Well a few minutes later when the attending pulled Gloria in to see her for himself, he asked her if she had experienced and itching or redness in her eyes. Her eyes lit up. “Why, yes,” she exclaimed.

And I, standing in the corner, shook my head — mentally. Physically, I just kind of looked straight ahead.

Sometimes patients just won’t give you the answers.

1. An attending physician is a doctor who as completed his or her residency. See here for more details.
2. I like to compare a differential diagnosis to a lineup of suspects that may be causing the patient’s complaint(s). Click here for Wikipedia entry.
3. Medline Plus: Allergic rhinitis is a collection of symptoms, mostly in the nose and eyes, which occur when you breathe in something you are allergic to, such as dust, dander, or pollen.
4. Head, eyes, ears, nose & throat exam

The patient nodded but then let out with this statement:

I refuse to go with you. I usually have some pretty girl take me.

 
So there’s that… At least I found out that I don’t look like a pretty girl…

Enjoy.