Am I really this cold hearted?

We get prepped in med school for dealing with the patient who for religious reasons refuses blood products. It's a scenario we discuss with each other and practice dealing with the anger we may potentially feel. Anger to what though? To a religion? To parents? To spouses? To Jehovah? Or even, heaven forbid, to our patient?
I'm not sure how this happened, but as a rule, as long as it is what my patient truly wants, I'm ok with it. You want to avoid pain meds because you want the chance to say good bye to your kids? No problem. You don't think going for a chest X-ray is worth your time? Your choice.
You don't want any blood products whatsoever, even if it means you may die within the week? Got it. Let me help you with some meds that will reduce your inevitable air hunger.
Speaking with some nurses today, I had the impression I'm not as affected as I should be by patients' choices. It seemed to me though, that they may be projecting their own belief systems and choices they would make for their own lives onto their patients'.
These nurses clearly care and give their patients compassionate, intuitive care. Because they care so much though, they are frustrated when the care plan they would have for a family member is not the one chosen by a patient.
I still cry with patients over beautiful moments and sad news. I touch them and try to make them laugh when appropriate. I respect their choices.




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How to annoy Dr. Impostor

I was asked to scrub in for a c section being done by two obstetricians. There is nothing for me to do in a case like this except keep sterile, which is what I did. It's frustrating.

During the surgery, Dr. Vulva asked Dr. Uterus what they should be teaching family medicine residents.

Dr. Uterus didn't understand.

"He means, what are the things that family doctors screw up all the time and annoy you."

"Exactly!" said Dr. Vulva.

He then went on to list everything that a family doc has ever done that annoyed him.

Why consultants feel a need to dump all they see wrong with other specialties onto the residents is honestly beyond me. I had the same experience in pediatrics and in the ED.

Implicit is that the complainer has never made a mistake that the other specialist has had to deal with, such as a consultation note that was illegible or so brief that it was useless.

They also tend to assume that the patient they are sharing with a colleague was in the same state as what they see in front of them. Illness is a changeable thing that presents differently during its course. The patient I saw in the ED last night may look quite different the next morning or even 2 hours later. We need to trust each other when we share our clinical opinions with one another.

It's time to stop the propagation of the gap between specialties. They make me too cranky.


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Oh. Boy.

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