Another open letter to clinical clerks

If your preceptor asks if you want to stay and see patients, the answer is always yes. Especially if it's not even noon yet.

When ER docs chat

"ya, my brother and I are both boys"

Thanks for clearing that up Tom.


- Posted using BlogPress from my iPhone

Just decoration

Nurse: patient has a fixed dilated pupil
Me: oh no!
Patient's wife: is that the glass or eye his own eye?

Laughter.


- Posted using BlogPress from my iPhone

My concentration is poor when I am observed

Ichibod Crane in Tim Burton's Sleepy Hollow pushes everyone out of the OR so he can perform his autopsy alone.

I wish I'd thought of that.

Instead, I bumble through my procedures with my preceptor looking over my shoulder, making me ill at ease, waiting for them to take over whatever I'm working at.

It's happened so many times now that all I do now is ensure that the patient isn't harmed when the scalpel or other implement is snatched away.

For someone who thinks she is strong at self critique and awareness, it's ridiculous that I didn't notice. Fortunately though, my new preceptor is much more in tune with learning. He pointed out that he makes me nervous and will, from now on, stay outside the room until and if I need him.

I'm so very lucky. And most importantly, about to get much better at my procedures!

- Posted using BlogPress from my iPhone

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.




- Posted using BlogPress from my iPad

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.


- Posted using BlogPress from my iPad

Oh. Boy.

- Posted using BlogPress from my iPad