May 2013
35 posts
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“Agree with above medical student’s assessment.”
– The satisfying addendum by attendings to a well written assessment and plan.
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Baby's Life Saved with Groundbreaking 3-D Printed... →
A bioresorbable splint has been created and used for first time at the University of Michigan, where doctors implanted the device in an infant and stopped a life-threatening condition called tracheobronchomalacia.
This volumetric printing business is really starting to make some medical advances possible. Last time it was 3-D printed liver lobule, this time it is a tracheal splint to help a baby...
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The Burning Flush of Confrontation
I stood there and did my best to explain what we felt was going on, our impression of the possible causes, and our investigations around them, some of which simply could not be done tonight.
The family was not satisfied. “We want answers. Now.” From there came the questions. “Why must it happen later? Why is this test being done? Why will you not take our complaints seriously?”
I reassured...
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Why Physicians Need to Write →
I would argue that one cannot be a good doctor without being able to communicate one’s thoughts, knowledge, opinions, and analyses in writing.
I write for many reasons. One of them is to reflect on my day, to debrief on the moments that my colleagues and seniors impart on me. Another reason I continue to write is to keep the passion of medicine alive.
It is no secret that most of us lose our...
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“Invest in building your network. It will pay dividends in the future.”
– A specialist’s advice on building relationships with other doctors, community resources and services in a future practice.
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Five Doctors Go Hunting
Five doctors - a general practitioner, a paediatrician, an internist, a surgeon, and a pathologist - decided to take a weekend trip and go duck hunting.
Soon after they were in their duck blind, a bird flew over and the general practitioner said, “I think that is a duck,” and so he took aim and slowly squeezed the trigger…but then he lowered his rifle and said, “I better...
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The Biopsy: Medical School Essay Edits →
I was recently contacted by Roheet from the Biopsy. A prospective medical student who has been maintaining a beautiful blog that reflects on the process of medicine in the digital age, he is offering to help anyone who is applying to medicine with reviewing their personal essays.
The deadline for submissions is May 20th, 2013. Submit here.
Many thanks to Roheet for his kindness and generosity in...
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Tailored Presentations: Replies
Thumri: I like this post and think it is true, but from my experience, all of medical education is designed to help us avoid what you describe as the pain and shame of not knowing. I would be interested to know what you think would be a better way to summarize quickly and communicate about complicated patients.
ShrinkRants: ...I do wish standard medical practice were different. These tips, and the condensed presentations given as examples, are shot through and through with impersonal “objective” language. Such language hides the subjective nature of its collection. It works directly against any reflection on the discourses that shape what is included and excluded. It is all about knowing. The tips are offered in service of helping presenters look and feel knowledgable and avoid the shame of not knowing. The people the presentations describe are not present as people, as living breathing, hoping, fearing persons. They are reduced to a collection of facts, signs, and symptoms. This is not, cannot in this form be, “patient-centered medicine.” Until we as a profession change our everyday language, we will not be able to practice patient-centered medicine... (Read the rest at http://bit.ly/18M0bDz)
The shame of not knowing is pervasive but I would agree that it does not mean that it must remain an engrained part of this culture. There are positive ways of delivering feedback. It really depends on the doctor I work with. While subjectivity is generally excluded from these presentations, it helps bring the pertinent information to the forefront, the pieces that are most easily examined, investigated and followed. I always try my best to paint a picture of the person behind the presentation, to tell a story and not just a list of facts. From more descriptors to using a FIFE model to better understand this patient's subjective state, I try to keep them all intact, even if my audience is not completely interested. But the purpose is always to deliver concise presentation that informs enough for another doctor to draw his own conclusions and to do his job effectively. Having said that, some specialties simply do not lend well to subjective language at all in a presentation.
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Sick Leave
I showed up to the ward, hoping to be productive or at least to lend a helping hand for the day. I managed to round on all of my patients.
But I despite my best efforts, I could not quite hack. Having barely a voice is not conducive to this line of work.
After just two hours of work, I am taking the rest of the day off to sleep and rest. I shall see you guys on the other side.
Sincerely, Tom...
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“Please keep penis elevated and upright.”
– A physician’s order for a patient with balanitis.
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In the Dark
On call. 3 AM.
Resident: Resident on call.
Nurse: Hi. I have a 35 year old lady who came in with a cellulitis and a really soft blood pressure of 95/60. I would like to bolus her with some fluid.
Resident: Um...can you tell me more? What is her blood pressure usually like?
Nurse: Her usual blood pressure is in this range too.
Resident: And is she feverish or tachycardic? What is the rest of her vitals looking like? Is she stable?
Nurse: I don't know. I was going to do the rest of them after this phone call.
Resident: ...
Nurse: ...So can you bolus her with some fluids?
Resident: Does she look dry?
Nurse: Maybe? I'm not sur...
Resident: I will just come up...
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A Rookie Cut
Over the past year, I have noticed a young man attending the barbershop I frequent. A tall and well-dressed adolescent who bared some resemblance to my barber, he initially started off with the scut work: sweeping the floor, greeting the customers, and watching. Always watching intently as my barber trimmed my hair.
Slowly, over time, he had begun to learn the tools of the trade - the different...
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Breaking Even
Patient: I swore to myself, "You better live to be 150!"
Me: That's a ripe old age! Why 150?
Patient: It's because of all of my pension, medical benefits and coverages. I figured, for all the years I paid my taxes, I cannot die before the government pays their due diligence and covers me for all of my future medical problems.
Me: I see.
Patient: I did all of the math already, you see?
Me: To break even? At 150?
Patient: *Serious tone* That's right. If I die before that, the government wins.
We share a laugh.
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100 Days Left in Third Year
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Burn Out
I can feel it around the bend. It is creeping in from all sides: I am not sleeping well; I am not eating well. When I sit down to study, I cannot maintain my concentration and the information seems to evaporate before it has a moment to settle in my mind. While I hate to admit it, it is become more and more evident.
The first step to fixing any problem is acknowledging that there is a problem.
...
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Watch3D Printer Makes World’s Smallest Human ‘Livers.’
3D printing technology just keeps getting better and better. This time, scientists at Organovo in San Diego were able to create a 3D printer that prints using liver cells. Layering these cells into a histologically correct lattice, the team plans to model disease processes and medication effects more accurately.
The plan is to...
April 2013
33 posts
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A Stressed Resident: Replies
Melodym: Did you calm her down? And remind her that she has been preparing for it for a long time?
Wayfaringmd said: Whoa, calm that mess down.
I tried to reassure her. We all eventually went out for drinks after the practice OSCE and she seemed better once she got to unwind a bit. She is a great resident. Really smart and kind. I cannot imagine her doing poorly. But stress is a funny thing and can get the best of us too.
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“I have a board exam in five days and I am freaking out. This is the culmination...”
– A R2 stresses over her upcoming OSCE and board exam.
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You know you are drinking too much coffee when...
…the baristas at the hospital Starbucks know your name and your order.
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A practice OSCE experience: Reply
Cranquis: I always wanted to be an OSCE patient! Hope they didn’t have to practice any focused physical exams for that complaint on you… :)
No, thank goodness. Although, I think one of the residents did not read the instructions carefully and wanted to do a physical as well. "Take off your pants." I will not forget that.
Thuc: I love participating in and proctoring the osce exam. its a great experience to practice and evolve your clinical skills as well as learn how others communicate or perform.
I felt the same way. Really good learning experience to see different approaches to the same problem. I think it was also beneficial from a practical standpoint to know what the exams will be like.
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“I see it in all of you. You will all make great doctors because you care about...”
– An inspiring attending gives us a pep talk.
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Bad Form: Replies
WayfaringMD: Word. That will backfire soon enough.
CompoundFractur: Pretty sure that’s illegal and could lead to jail time.
I had never met them before and only saw them briefly while working up a few new consults on the ward. I have no idea who the attending is and it really is none of my business. However, I probably should have given the person a heads up but never saw them again.
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Bad Form
If you happen to be a visiting junior medical student who is accidentally issued an ID tag with “Doctor” in front of your name, in order to avoid confusion for the staff and the patients, please go get that corrected.
Or at the very least, correct anyone who calls you a doctor and assumes you are actually a doctor.
And at the very least, do not join sensitive or emergent situations...
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Harpoon Pierces Man's Skull in Cleaning Accident,... →
Despite accidentally shooting himself in the face with a speargun last week, Bruno Barcellos de Souza Coutinho of Brazil will somehow manage to leave the hospital with his brain intact.
This man lost the vision in his left eye when the harpoon penetrated the eyeball but beyond that and a bit of “negligible brain trauma,” he is set to make a full recovery. And hopefully he has learned...
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Pew pew pew! Insert Coin to Play
In the designated urology operating room hangs a scoreboard for the urologists' greenlight laser TURP procedure. The laser machine records both the amount of laser energy used for the procedure and the elapsed time as you blast away prostate tissue with the green laser. There could be no better setup for a bunch of avid gamers. Level clear!
#1: AAA - 1,214,687 joules
#2: AAA - 623,692 joules
#3: AAA - 463,921 joules
#4: RAS - 452,480 joules
#5: SCM - 398,723 joules
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The Impossible Workload for Doctors in Training →
I remember reading about these new regulations when I was in first year. It was all that everyone could talk about: the days will be better.
Being exposed to clinical teaching this year, I can tell you that this restriction often times exists as a formality on paper only. By mandate of the university, we are only supposed to work up sixteen hours excluding call shifts. At that point, we are...
