My newest diversion from studying

Learning to spin my own yarn. I'm not brilliant at it but I guess that's what practice is for right?



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Nursery wackiness.

Why is it that once one baby in the nursery starts crying, they all start crying?

We were desperate for a soother. Couldn't find them. Disaster.


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Unprofessional behaviour

Like every other job I've had, I have good and bad days at work. Most days are good. I can help my patients and coworkers have a better day and, cheesy as it may seem, that makes me happy.

Bad days can include patients having bad days, me screwing up, the usual type stuff.

Really bad days often occur because other physicians have neglected to complete what I consider their duties.

My worst day to date ended in me crying for over an hour and hiding in the dictation room until my face was no longer red and streaky. There is nothing sadder than hearing a stoic man with a paralyzed larynx cry because he had no idea that his illness is terminal. This despite seeing a specialist for the illness for the past two years. He had been told the diagnosis but did not understand what it meant.

The medical profession has acronyms that the public doesn't always understand. It's not fair to use these acronyms to protect us from having to deal with the squishy, sad and emotional delivery of bad news.

Our whole team had been avoiding mentioning the diagnosis to the patient because no one knew if this man actually knew how sick he was. I tend to be much more straightforward.

Telling this man that he had a terminal illness in a way that he would understand made both of us break down in tears. It shouldn't have been a complete stranger telling this patient he would die within the next few years. It shouldn't have been in the hospital when he was already feeling vulnerable and unwell. It should have been the specialist who made the diagnosis who could answer his difficult questions and had been with him on the journey to make the unusual diagnosis in the first place, or the family doctor who knew him well.

We learn about transference and countertransference in medical school. Essentially, I shouldn't get so involved with a patient that I take bad news this poorly. It was unprofessional of me to cry with this man who I just met over his death sentence. To be honest, I think this is the first time I've actually cried while giving bad news and I'm sure at least part of that was because he was alone and reminded me so much of the small town men I grew up around.

I think that I was also crying from frustration. There were other doctors who, in my opinion, were also behaving unprofessionally. Not communicating a diagnosis in a language that a patient understands undermines the doctor - patient contract. Not only are these docs unprofessional, they are also cowards and I think that if I ever meet them at a party I will snub them for fear of getting into an argument that will end violently with me in jail.

Unfortunately, as a resident, I am in no position to tell docs who have been in practice for years how to behave in such a way that they might be recognized as human. Instead, I'm forced to sit on my hands, shut my mouth and take the garbage they shove out, just like their patients are doing.

Questions to ask residents at your family medicine interviews

There is increased traffic to my site looking for information about CaRMS. Welcome. This post's for you.

Coming up with questions to ask in your interview can be mortifying as you stumble over your words wanting to just leave the interview room now that your questioning is over. These are some questions I wish I'd asked.

How well organized do you think your program is?
Do you like the order of your rotations?
What is the formal teaching portion of the program like?
When you talk to people at other sites, how does yours compare to theirs?
Do your docs like to teach?
Do you get the impression that your teachers are well supported?
What sort of support do the residents receive?
How often do you get to see other residents and learners?
Do you see a wide variety of patients?
Do you get opportunities to teach?
Do you have time for a life outside of medicine?
How much time do you spend driving?
Are you happy here?

These are things that aren't covered on the website so you won't look like a goof by asking something obvious. Like I did.

Gah.

Good luck!!

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So a car accident walks into a bar....

It was like a weird joke.

Driving to work, I saw that a van had flipped and there were no flashing lights yet. I pulled over to help because it looked like a bad situation.

When I got to the van, there was someone perched on top working on pulling the driver out. He said "don't worry, I'm a paramedic", guy beside me said "and I'm trained in first aid" then, of course I had to say it, "and I'm a doc".

I've always known that the paramedics do so much for the patients at crashes but I didn't really get it until I saw this guy on his way to other gig standing on top of a van helping an injured stranger out through the passenger window. I felt useless aside from acting as cushioning in case either fell off the overturned vehicle.

When the driver was safely at the barrier, he looked at us incredulous "you ALL stopped to help me?". He hadn't seen the cars on either shoulder of the highway making sure we didn't need the extra help. We didn't. This driver had a small cut from broken glass and was otherwise perfect. Lucky guy!

The first aid responder said it best "that's just what you do - someone looks like they might need help, you help them."

Words to live by to make this a happier place don't you think?

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Suddenly without warning,

I found myself comfortable introducing myself as Dr. Impostor.

Not entirely sure when it started or why. It may the docs I work with calling me Dr. Or seeing it on all my CMAJ mailing labels.

It's definitely not because I'm suddenly smarter and feel competent enough to deserve the title.

Gratuitous lap shot.


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Irony?

Getting sick on my paediatric rotation because my preceptor keeps coughing in my face.

In other news, I've avoided all wee ones coughing in my face so far.

Gah.

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The CHEP Guidelines

This app was being promoted at FMF this year. It's one stop shopping for all your hypertension management needs based on the latest guidelines. No one wants to hear another lecture on treating hypertension. This app gives us the update without the watered down coffee.


It includes what your targets are for different co-morbities.


And helpful tables based on evidence.


It's a logical, fairly easy to use app.

And it's free. Download it. Now.

For iPhone, iTouch and iPad.

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Editions for iPad

Ok, not a med app, but still med relevant.


This is a "magazine" put together by AOL from the parameters you give them. Each article has a heading that allows you to choose more or less of the content.


It's only available on iPad, not the phone or touch, and takes a few minutes to load your magazine. It's supposed to archive the information for you to look at later off line but I've yet to have that work well.It does include a lot of the stuff that my patients come in to ask me a out. E.g. "is the TLC diet any good?". Without my Editions, I wouldn't have even known it existed. And it's a great way to catch up on celebrity gossip - Katy and Russell are splitting? Not surprising, but still upsetting.


And, best of all, it's free.- Posted using BlogPress from my iPad

Reach MD

It's time I started reviewing some apps again. Before Christmas I bought an iPad and went a bit nuts increasing my library of medical app library to justify having it for work.


Reach MD requires you to be connected to the Internet. It's an archive of radio shows broadcast on satellite that is aimed at physicians. Most of the shows are about 13 minutes long but some are longer. There are many specialties featured in the archive - paediatrics to geriatrics.


Checking out what everyone else is listening to is a good start. The shows feature experts talking about how they approach clinical problems. You get expert opinion as well as reviews of literature.

Because the shows are nice and short they keep my tiny attention. Some problems with the archive though - updates are infrequent. The last new shows I saw were a month ago. The shows are sponsored by pharma so you have to take what is being said with a grain of salt.

Check it out though, it's free.

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That's a silly name

A while ago I had a patient recovering from stroke. She was a sweet, tiny, very old nun.

The stroke had affected her memory significantly. I called her by the name in her chart - Sister Timothy.

Her response: that's a silly name!!

Me: well you chose it!!

Her: call me Susy.

Because that's not a silly name for someone who is almost 100.

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Quilt in progress

It's strippy.


Today was my first day on paediatrics, so I feel overwhelmed and stupid. That seems to be the purpose of every first day on rotation.

To gain a tiny bit of control, I am sewing together hundreds of strips of pretty fabric.

Kitty approves.



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Doctors make the worst patients

I know I've said it before, but I'm a terrible patient. I hate being unwell and I hate admitting weakness in any way.

Right now I'm in the waiting room of my doc's office trying to look inconspicuous. Maybe if it's not obvious I'm here she'll miss me and I won't need to have an appointment.

My friend has been pushing me to go to my doc for a while. I thought I was doing well just finding a doc, but apparently she wants me to actually visit the doc too. Jerk.

I've been trying to diagnose myself. Every time something happens, I have a reason for it. I don't need someone else to tell me what's going on, I went to med school. What I don't have is perspective or the ability to differentiate between what needs to be included in a differential and what can be discarded. I have been throwing out almost all choices my friends suggest. I judge myself on a different ruler than I would my friends, family or patients. I feel ashamed for being sick. Goofy, but true.

Flipping into the mind set that I'm here as a patient and need to act that way is going to be difficult. I've always felt like I'm a bother at the docs office and since my own family doc retired, I've never really liked doctors. Like most in the health care field, my mom ensured that we were bleeding from the head or unconscious before taking us to the doctor. She sent me to school with a broken wrist, sure I was exaggerating. Even at 4 years old, I was ashamed of my broken wrist and the art work I made as a kindergartner with only one functional hand.

There's no reason for it and I don't know where this message of "thou shalt not be sick" came from but it really gets in the way of me taking care of my preventative health activities as well as getting to the doc when I am actually sick.

In general, I'm well. I get viruses like crazy because kids love sneezing in my face. While I'm this healthy and well, I should be fostering a relationship with my doc so that she will notice changes as I age that I don't notice because I'm too pig headed.

So, to my annoyingly bossy friend, I say, thanks for making me make this appointment.

Even if the doc is running over an hour behind schedule.

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Blanket in progress

New Year's Resolutions

Happy New Year!

I have a very ambitious new year's resolution this year. I want to follow the advice I give my patients.

Sure, there's the usual exercise, eat smaller meals, make sure to have at least a serving of fruits and/or veggies at every meal, etc. Those are obvious and frankly very similar to the resolutions I make (and break) every year.

Sometimes though, I give my patients pretty good advice that has nothing to do with calories in and out.

Give yourself a break. We all can be our own worst critics. It can be difficult to step back and have a bit of perspective. I often ask my patients if their best friend would let anyone talk about them like the way they are describing themselves (I'm too stupid/lazy/fat etc. to do this). We all need to act like our own best friends and support ourselves when we are thinking goofy, awful thoughts about ourselves.

Do what you love. "I hate my job", "I never have time for .... any more". Screw that. Make time. There are 7 days in a week, each with 24 hours, there has to be time to do the things we love to do.

Get the hell out of the house. It's so easy to get bogged down in the mundane triviality of our lives when we are stuck in the middle of it. Forcing ourselves to get out of the house and go to the theatre, lectures, painting classes, the lake front can make life worth living. And can add new categories of things to do that we love.

Dance. It's hard to take things too seriously while dancing. This can be done in the morning while getting dressed, at night at a bar, in the kitchen with the one you love while making a dinner full of veggies.

Let's see how this goes. I may need reminders that it's time to get out of my head and my house and that what I really need is a good dance, but this could make for a very happy new year.