Grief

People try so hard to be helpful with those dealing with the loss of a loved one. They hate to someone they care about in pain.

My advice to anyone in this situation - "should" is a bad word. You mean well, I know, but telling someone they should take dance lessons or should get out more or should lay down and cry is only adding to any guilty feelings they already have.

Instead, if you know of someone who found dance lessons helpful, "I know my friend Sally found dance lessons got her out of the house and gave her a chance to talk with people who didn't know Stanley. I don't know if that's the sort of thing you like, but I know it made Sally happy." Now your friend Sue doesn't feel she's letting you down if she doesn't want to tango.


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Overwhelmed

At least once a week, I look at what I don't know but feel I should know to be a "good doctor" and am completely paralyzed by the volume. I "read around" my cases and try to get ahead but feel like its an uphill battle.
I know uncertainty is something family docs need to be comfortable with. I wish there was a way for that to be taught in residency. Seeing older docs who have all the answers is not very good for this fragile ego.



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An open letter to clinical clerks

I've recently been thinking a lot about medical education again. There are some clerks who really seem to get it - why they are in the hospital rather than sitting at home learning from books. This post isn't for them.

I don't expect much from a clerk, but I make my expectations clear on the first day. Please read it. You know what, if your resident sends you any email, read it.

Don't argue with your resident about these expectations, especially to suggest that the staff physician should have already done the tasks that belong to you. Yes, some of these tasks are time consuming, but by fulfilling your obligations to the service you are practicing your clinical skills, solidifying knowledge and finding things you don't already know. What's Celestone? You can leave the obstetrical service without ever knowing if you don't recognize the medication in the patient's history.

Pretend to have fun. Even if you hate the rotation you are on, it's a big deal to the patients, nurses, staff and your residents that you at least appear interested. You'll be surprised at how much more you will learn when you feign interest. Residents will be more likely to drag you to the cool case they saw last night. Nurses will include you in their patients' care. You will see more and learn more as you dig in and pay attention to the facets of various illnesses and how they present. Pregnant women get cholecystitis. Pediatric patients fracture limbs. Geriatric patients are like petri dishes for all aspects of medicine. Pay attention. Something you find interesting will show up every day when you pay attention.

If you think your resident is over reacting, you may not be paying enough attention. Ask his or her thoughts.

Respect the hierarchy. If you respect your junior residents, they will protect you and keep you in the loop when fun things are happening. Basically, you are at the bottom of the totem pole. The guy cleaning floors is above you. Show respect to everyone you work with. They all have something to teach you - even the guy cleaning the floor.

Respect your fellow clerks. Backstabbing is not cool.

Be available. Don't turn off your pager or cell phone. Don't hide.

Get to know your patients. Very often, only the clerk knows the full story about a patient.

Unless you have the evidence to back your statement don't contradict your resident. Really.

You don't know enough to start looking for short cuts through your clinical and interviewing skills. Follow the guidelines you have.


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Car

I had my first car accident this week. After it happened my initial thought was to make sure the other driver was ok. He was.

I am very surprised at how my mind and body responded to the accident so I want to have a record to remind myself later.

Once it was established we were both walking and talking, I looked at the damage to my car.


My initial thoughts were about how late I'd be for class. Then how much money it was going to cost to fix my precious LuLu. Then - wow, my chest is sore. I realized I'd slammed into the steering wheel with the right side of my chest. The air bag hadn't deployed.

Day of the accident, I was overwhelmed by how kind everyone was. Things with insurance, towing, police and repair went much more smoothly than I could have anticipated. I was sore. It was reachable by Tylenol and Advil but really sore. Adrenaline was definitely the hormone du jour.

The next day, was much worse. As predicted by my clever, concerned little brother. I was stiff, sore, had a crazy headache when i woke up that wouldn't go away and now nausea added to the whole thing. I actually considered seeking medical advice. I hate going to the doctor. Doctors freak me out.

I had to take quite a bit of the second day off because I was very much afraid of vomiting, the room was spinning, I was sore and honestly, I just wanted gravol and my bed.

The third day was the most surprising to me.

My headache was gone, the nausea remained. My entire body was stiff. My heart was racing. I had a feeling of impending doom. No matter how much I stretched or drank water and ate bananas, my entire body felt like it had run a marathon. I think this is from lactic acid release post collision but I'm just guessing.

Because my body was in a state of disrepair and the imbalances were affecting my heart rate, I spent most of the day rehydrating and attempting to convince myself that I wasn't going to die. The panic was really overwhelming. I'm grateful that my preceptor gave me the day to take care of myself.

While not my favorite way to spend a week, I'm glad for the experience and hope it will help give me insight into the reactions that my patients have to trauma in their lives. Mine was tiny compared to most. I am, as ever, impressed with what we can put up with.

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Facebook and medicine

(814): Wow, im gonna be a great doctor..."hi let me save your life but first check out this pic of me deep throating a handle of grey goose"
From TFLN

To avoid that awkward moment when a pt says "right! I saw you tagged in my cousin's sister-in-law's bachelorette party photos on Facebook!", I'm tempted to delete my account. The truth is though that it's how I'm able to contact family and friends.

Maybe I'll jump on the band wagon and change my name into something less recognisable.

Or just continue to keep my Facebook Mom and child safe.

These are definitely the kinds of decisions my preceptor didn't have to make before he set up practice.


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Last day on L&D

I'm a little sad. The team here has been so much fun to work with.


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Triage nursing

I was chatting with some of my nurses about patients who push to get to the front of the line at the emerg triage. There are many with unreasonable expectations, either based on what telehealth has told them, a misunderstanding of their own illness, and, or an inflated sense of self worth.

One nurse told a story about when she was working triage in Detroit. A patient stood up and started yelling that he needed to be seen and he was being discriminated against. The nurse also stood up, looked at the patient, and said "that bullet wound is in your leg, no where near your heart. You can wait."

Wow.


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Freudian autocorrect?

Today while updating my patient's chart I typed bariatric. It autocorrected to barbaric.

That's exactly how the patient feels about the bariatric clinic.


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You can't take the nurse out of the patient

Without fail, every nurse I treat (whether they be retired or active) will change the paper on the exam table before they leave.

Ding dongs.



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