Sorry for the lack of posts. I am on a difficult rotation right now! Very thankful for the Thanksgiving holiday coming up. I will be spending it with family and hope you all get to do the same.
Will try to post more starting Monday.
Happy Thanksgiving to you and yours!!!
Wednesday, November 27, 2013
Thursday, November 14, 2013
Mr. Sleepy
I know it is a necessary part of medicine but I do feel bad for patients that pre-rounds and rounds tend to be early in the morning. This particular patient was being treated for hepatic encephalopathy and not getting quality sleep due to seizures. Come 8am rounds we have to wake him up, and part of the exam is to document how oriented he was given his diagnosis.
Attending: Mr. Sleepy, how are you?
Mr. Sleepy: (snore)
Attending: Mr. Sleepy. Wake up. (gently shakes patient)
Mr. Sleepy: Huh, yes. Hi.
Attending: How are you?
Mr. Sleepy: Tired.
Attending: Yes, do you know where you are?
Mr. Sleepy: The hospital.
Attending: Good, and the month?
Mr. Sleepy: Huh, oh, September.
Attending: Well, today is October 1st so I guess that was a trick question.
Mr. Sleepy: (snore)
Attending: (gently shaking him) Mr. Sleepy, who is the president of the United States?
Mr. Sleepy: ..... (sigh, grunt).... Osama ..... (snore)
(The various residents and students is the room start laughing. Luckily Mr. Sleepy is undisturbed by this and continues to snore lightly.)
Attending: Ok, Mr. Sleepy, just don't say that to anyone else.
Mr. Sleepy: (snore)
(The Attending does a quick exam and we move on to disturb the rest of the next patient.)
Attending: Mr. Sleepy, how are you?
Mr. Sleepy: (snore)
Attending: Mr. Sleepy. Wake up. (gently shakes patient)
Mr. Sleepy: Huh, yes. Hi.
Attending: How are you?
Mr. Sleepy: Tired.
Attending: Yes, do you know where you are?
Mr. Sleepy: The hospital.
Attending: Good, and the month?
Mr. Sleepy: Huh, oh, September.
Attending: Well, today is October 1st so I guess that was a trick question.
Mr. Sleepy: (snore)
Attending: (gently shaking him) Mr. Sleepy, who is the president of the United States?
Mr. Sleepy: ..... (sigh, grunt).... Osama ..... (snore)
(The various residents and students is the room start laughing. Luckily Mr. Sleepy is undisturbed by this and continues to snore lightly.)
Attending: Ok, Mr. Sleepy, just don't say that to anyone else.
Mr. Sleepy: (snore)
(The Attending does a quick exam and we move on to disturb the rest of the next patient.)
Wednesday, November 13, 2013
Just get used to it
Interacting with patients as a 3rd year student is a great experience but you soon realize that many don't tell you the whole story so when the doctor comes in the room you kind of look like an idiot.
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Me: So besides the refills on your hypertension medications is there anything else you are here for?
Patient 1: No.
Me: Great. So we already talked about diet, exercise and medication side effects. Any questions you want me to ask the doctor?
Patient 1: No, I don't think so.
Me: Ok. The doctor and I will be back in together in just a minute.
Doctor: Hi Patient 1, so my student says you are doing pretty good. Nice to hear!
Patient 1: Doctor, I hate that medicine you have me on. It makes me pee at night and I can't sleep!!
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Me: How does that abdominal pain feel?
Patient 2: Like an achy pain.
Me: Can you rate it on a scale of 1 to 10 for me and tell me if it radiates anywhere?
Patient 2: It is about a 5 and it just stays right here by my belly button.
(Later)
Doctor: How is your pain?
Patient 2: Oh, it is this sharp pain in my belly that goes all the way to my back and it gets so bad I can barely breath!!
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Me: So besides the refills on your hypertension medications is there anything else you are here for?
Patient 1: No.
Me: Great. So we already talked about diet, exercise and medication side effects. Any questions you want me to ask the doctor?
Patient 1: No, I don't think so.
Me: Ok. The doctor and I will be back in together in just a minute.
Doctor: Hi Patient 1, so my student says you are doing pretty good. Nice to hear!
Patient 1: Doctor, I hate that medicine you have me on. It makes me pee at night and I can't sleep!!
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Me: How does that abdominal pain feel?
Patient 2: Like an achy pain.
Me: Can you rate it on a scale of 1 to 10 for me and tell me if it radiates anywhere?
Patient 2: It is about a 5 and it just stays right here by my belly button.
(Later)
Doctor: How is your pain?
Patient 2: Oh, it is this sharp pain in my belly that goes all the way to my back and it gets so bad I can barely breath!!
Sunday, November 10, 2013
Mrs. Patch
Me: So I see you are in for your physical today. Any health concerns for the doctor?
Mrs. Patch: None except my weight! I would like to lose.
Me: Okay. I see the nurse gave you some diet information.
Mrs. Patch: Yes.
Me: Some other things you can do are...
Mrs. Patch: Let me stop you right there. I don't want no exercise or diet advise. Just stick a patch right here (slaps thigh). A patch that will suck the fat right out!
Me: I don't think they have that yet but if it comes out how about I let you know?
Mrs. Patch: (laughs) Sounds good. Now how about you tell me those other things you were going to say. Even though I know I don't want to here it honey.
Mrs. Patch: None except my weight! I would like to lose.
Me: Okay. I see the nurse gave you some diet information.
Mrs. Patch: Yes.
Me: Some other things you can do are...
Mrs. Patch: Let me stop you right there. I don't want no exercise or diet advise. Just stick a patch right here (slaps thigh). A patch that will suck the fat right out!
Me: I don't think they have that yet but if it comes out how about I let you know?
Mrs. Patch: (laughs) Sounds good. Now how about you tell me those other things you were going to say. Even though I know I don't want to here it honey.
Saturday, November 2, 2013
Rough and Tumble
Dr. Boss: I want you to see this patient first. The mother thinks her son has ADHD but he is only 5 years old so it is a little early for diagnosis and I wouldn't treat him with stimulants anyway.
Me: Ok.
Dr. Boss: Ask them about family history and such, have her fill out this questionnaire and do a quick physical.
Me: No problem.
(Entering room.)
Me: Hi, I am a medical student. I am going to see you before Dr. Boss if that is ok?
Mother: Yes.
Me: So I hear you are concerned that little Tommy might have ADHD, can you tell me why?
(Before the patient can open her mouth Tommy peaks his head out from under the chair where he was hiding and screams at me.)
Tommy: Hi!! Watch what I can do!
(Tommy proceeds to dance around the exam room and "spin" like a helicopter.)
Mother: Um, well. He acts like this constantly and doesn't listen. He won't sit still. Tommy sit down!
(Tommy ignores her and begins to pull on my stethoscope, asking if he can play with it.)
Me: Not right now buddy, let me talk to your mom.
Mother: I just get so frustrated.
(Tommy is back under the chair now and is pretending to swim on the floor.)
Me: I can imagine. Does any behavior like this run in the family?
(Mom goes on to explain how she has three older boys, and none have ever been this wild. We talk about some other things such as aggression and other authority figures in the household.)
Me: Ok, great, now if Tommy doesn't mind I would just like to examine him really quick.
(I help him up on the exam table and just as I am explaining about listening to his heart....)
Tommy: SMELL MY FEET!! (He lifts his feet in the air and nearly kicks me in the head.)
Mother: I am so sorry!
Me: It's alright, he missed!
(I manage to listen to his heart and lungs but that is about it as he is squirming and won't let me do much else.)
Me: Alright, I am going to talk to the doctor but if you could just fill out this questionnaire.
Mother: I already did one! Please, show the doctor!
(She has indeed filled out three pages of questions about Tommy's behavior. I show Dr. Boss and report what I observed. He says Tommy might be showing some signs of ADHD but also might improve his behavior once he starts school and is in contact with more authority figures. I wish that mother the best of luck!)
Me: Ok.
Dr. Boss: Ask them about family history and such, have her fill out this questionnaire and do a quick physical.
Me: No problem.
(Entering room.)
Me: Hi, I am a medical student. I am going to see you before Dr. Boss if that is ok?
Mother: Yes.
Me: So I hear you are concerned that little Tommy might have ADHD, can you tell me why?
(Before the patient can open her mouth Tommy peaks his head out from under the chair where he was hiding and screams at me.)
Tommy: Hi!! Watch what I can do!
(Tommy proceeds to dance around the exam room and "spin" like a helicopter.)
Mother: Um, well. He acts like this constantly and doesn't listen. He won't sit still. Tommy sit down!
(Tommy ignores her and begins to pull on my stethoscope, asking if he can play with it.)
Me: Not right now buddy, let me talk to your mom.
Mother: I just get so frustrated.
(Tommy is back under the chair now and is pretending to swim on the floor.)
Me: I can imagine. Does any behavior like this run in the family?
(Mom goes on to explain how she has three older boys, and none have ever been this wild. We talk about some other things such as aggression and other authority figures in the household.)
Me: Ok, great, now if Tommy doesn't mind I would just like to examine him really quick.
(I help him up on the exam table and just as I am explaining about listening to his heart....)
Tommy: SMELL MY FEET!! (He lifts his feet in the air and nearly kicks me in the head.)
Mother: I am so sorry!
Me: It's alright, he missed!
(I manage to listen to his heart and lungs but that is about it as he is squirming and won't let me do much else.)
Me: Alright, I am going to talk to the doctor but if you could just fill out this questionnaire.
Mother: I already did one! Please, show the doctor!
(She has indeed filled out three pages of questions about Tommy's behavior. I show Dr. Boss and report what I observed. He says Tommy might be showing some signs of ADHD but also might improve his behavior once he starts school and is in contact with more authority figures. I wish that mother the best of luck!)
Thursday, October 31, 2013
Mr. Ham
Me: What brings you in today Mr. Ham?
Mr. Ham: I need refills on my blood pressure medications.
Me: Alright, I see you are on two medications X and Y. Does that sound correct?
Mr. Ham: Yes.
Me: Great. Any trouble with your medications?
Mr. Ham: No.
Me: In a given week how many doses would you say you miss?
Mr. Ham: None.
Me: Ok, well I see your bottles are empty, so when did you take your last pill?
Mr. Ham: This morning.
Me: Ok, well, when I took your blood pressure just a minute ago it was a little high can you tell me why that might be if you never miss your medications?
Mr. Ham: Well, I had some bacon for breakfast. Yes, a lot of bacon and I never do that. You know bacon has a lot of salt so that must be it!
Me: Well yes, salt can increase blood pressure in some patients but usually not that fast.
Mr. Ham: I promise it was the bacon!!
(Cue standard talk about medication compliance and salt reduction. Yes, I still want to do Family Medicine where I will see patients like this everyday, and I plan on loving every minute of it!)
Mr. Ham: I need refills on my blood pressure medications.
Me: Alright, I see you are on two medications X and Y. Does that sound correct?
Mr. Ham: Yes.
Me: Great. Any trouble with your medications?
Mr. Ham: No.
Me: In a given week how many doses would you say you miss?
Mr. Ham: None.
Me: Ok, well I see your bottles are empty, so when did you take your last pill?
Mr. Ham: This morning.
Me: Ok, well, when I took your blood pressure just a minute ago it was a little high can you tell me why that might be if you never miss your medications?
Mr. Ham: Well, I had some bacon for breakfast. Yes, a lot of bacon and I never do that. You know bacon has a lot of salt so that must be it!
Me: Well yes, salt can increase blood pressure in some patients but usually not that fast.
Mr. Ham: I promise it was the bacon!!
(Cue standard talk about medication compliance and salt reduction. Yes, I still want to do Family Medicine where I will see patients like this everyday, and I plan on loving every minute of it!)
Sunday, October 20, 2013
This happens a lot
Me: What medications are you on?
Mr. Smith: Something for blood pressure.
Me: Ok, do you remember the name?
Mr. Smith: No. It's the blue one.
Me: I don't know what the pills look like, each pharmacy can be different.
Mr. Smith: Well I don't remember. Wait.... it starts with an "L" I think... Liso....
Me: Lisinopril?
Mr. Smith: Yes!!
Me: OK, great. Do you know what dose you take?
Mr. Smith: One of the blue pill every day.
Me: Maybe it will say the dose in your chart. Let's move on and you tell me about your family history....
Wednesday, October 16, 2013
An accident
*This happened to Dr. Drinks, one of the residents I worked with on a rotation. Maybe it was part of the reason for his comments here.*
Dr. Drinks: (Enters patient's room, notices strange smell but continues over to the bed.) Good morning Mr. Jones, how are you today?
Mr. Jones: Not so good. I had an accident.
Dr. Drinks: An accident sir?
Mr. Jones: Yes, I needed to pee but couldn't get up.
Dr. Drinks: Did you call the nurse?
Mr. Jones: No, I just went here. Then threw my pants there.
Dr. Drinks: (Looks to where the patient is pointing, realizes there is a large wet spot on the wall and a pair of pants crumpled on the floor. His gaze continues across the floor until he realizes he is standing in a puddle of urine by the patient's bed.)
Mr. Jones: I feel better now but it smells in here.
Dr. Drinks: (Leaves quickly to regain composure and dissipate any thoughts of strangling Mr. Jones.)
Dr. Drinks: (Enters patient's room, notices strange smell but continues over to the bed.) Good morning Mr. Jones, how are you today?
Mr. Jones: Not so good. I had an accident.
Dr. Drinks: An accident sir?
Mr. Jones: Yes, I needed to pee but couldn't get up.
Dr. Drinks: Did you call the nurse?
Mr. Jones: No, I just went here. Then threw my pants there.
Dr. Drinks: (Looks to where the patient is pointing, realizes there is a large wet spot on the wall and a pair of pants crumpled on the floor. His gaze continues across the floor until he realizes he is standing in a puddle of urine by the patient's bed.)
Mr. Jones: I feel better now but it smells in here.
Dr. Drinks: (Leaves quickly to regain composure and dissipate any thoughts of strangling Mr. Jones.)
Tuesday, October 15, 2013
Dr. Compliance
Setting: A primary care office I was assigned to shadow at by my medical school during first year. Patient is a recent immigrant from India. Here for a follow up appointment for diabetes.
Dr. Compliance: Hello Mrs. Patel. How are you? Have you been taking your medications?
Mrs. Patel: Hi Doctor. I try to but sometimes I forget and I don't like to inject the insulin.
Dr. Compliance: Yes. I knew that because your labs were bad! Your hemoglobin A1c was 8.5! That tells me about the sugar in your blood.
Mrs. Patel: (Looks at her feet.)
Dr. Compliance: You have to take these medicines. If you don't you can get numbness in your feet. Or worse! You can go blind! Then your husband will find another wife to raise your child. Is that what you want?
Me: (Looking in horror.)
Mrs. Patel: No, I will try harder to take the medicine.
Dr. Compliance: Good. Now let me examine you.
He is friendlier to the patient for the rest of her visit. Later in his when it is just him and I.....
Dr. Compliance: So you remember what I said to that Indian lady?
Me: Yes?
Dr. Compliance: You see you have to do that sometimes. You have to scare patients to make them listen. Especially immigrant patients. The culture is different. I know this.
Me: (Some sort of shrug because I have no clue what to say)
He quickly changes the subject and we go on with the rest of my day. What was so weird was this doctor was an immigrant from somewhere in the Middle East so the line about "understanding the culture" didn't even make sense with the patient being from India. He was just really mean to his patient and I wasn't really sure what to say about it. I just chalked it up as a "what not to do" learning experience!
Dr. Compliance: Hello Mrs. Patel. How are you? Have you been taking your medications?
Mrs. Patel: Hi Doctor. I try to but sometimes I forget and I don't like to inject the insulin.
Dr. Compliance: Yes. I knew that because your labs were bad! Your hemoglobin A1c was 8.5! That tells me about the sugar in your blood.
Mrs. Patel: (Looks at her feet.)
Dr. Compliance: You have to take these medicines. If you don't you can get numbness in your feet. Or worse! You can go blind! Then your husband will find another wife to raise your child. Is that what you want?
Me: (Looking in horror.)
Mrs. Patel: No, I will try harder to take the medicine.
Dr. Compliance: Good. Now let me examine you.
He is friendlier to the patient for the rest of her visit. Later in his when it is just him and I.....
Dr. Compliance: So you remember what I said to that Indian lady?
Me: Yes?
Dr. Compliance: You see you have to do that sometimes. You have to scare patients to make them listen. Especially immigrant patients. The culture is different. I know this.
Me: (Some sort of shrug because I have no clue what to say)
He quickly changes the subject and we go on with the rest of my day. What was so weird was this doctor was an immigrant from somewhere in the Middle East so the line about "understanding the culture" didn't even make sense with the patient being from India. He was just really mean to his patient and I wasn't really sure what to say about it. I just chalked it up as a "what not to do" learning experience!
Ms. Brown
Many Saturdays during second year I worked at a free clinic that caters to under-insured patients. The vast majority of our patients are there for hypertension and diabetes follow up. Great experience for first and second year students. First year students often shadow the second years to get some tips on interviewing patients. I would like to think I helped show the first timer following me this day how to keep your cool when a patient says something very unexpected...
Me: Hello Ms. Brown what brings you in today?
Ms. Brown: Well, I heard you all can help me with my meds. I never been here before.
Me: Ok, I see you brought your bottles with you. Is that all the medication you take?
Ms. Brown: Yes.
Me: Great. I know we carry some of these but it looks like these two are psych meds which we don't have. Do you have somewhere you can get these ones?
Ms. Brown: Yes, I go to (other clinic) and they help me there but only with these two medications.
Me: Yes, they are a mental health clinic while we are a medical clinic. I just want to be sure you can get them. Can you tell me what health problems you have?
Ms. Brown: High blood pressure, back pain and schizophrenia.
Me: Do you know what type of schizophrenia?
Ms. Brown: The type where I hear voices. I hear them all the time. I hear them now.
(At this point the first year medical student is looking at me with some panic. Mind you, they have not had psychology as it is a second year class and this is their first time at our clinic.)
Me: (Without missing a beat) You say you hear the voices now. Are they telling you anything? To hurt yourself or others?
Ms. Brown: Oh no, nothing like that. They just talking like normal people. Mostly about the weather!
We continue the rest of the interview normally. Ms. Brown gets her hypertension medications filled and the first year student says they plan on returning to work at the clinic again. They also admit to me that they thought all schizophrenics had violent hallucinations so it was nice to learn that is not always the case. Breaking down the stigma of mental disease is something I am defiantly passionate about and I like to think this one little moment in time helped for that student. (And maybe people more now that I am sharing the story).
Thanks for reading!! ~#102~
Me: Hello Ms. Brown what brings you in today?
Ms. Brown: Well, I heard you all can help me with my meds. I never been here before.
Me: Ok, I see you brought your bottles with you. Is that all the medication you take?
Ms. Brown: Yes.
Me: Great. I know we carry some of these but it looks like these two are psych meds which we don't have. Do you have somewhere you can get these ones?
Ms. Brown: Yes, I go to (other clinic) and they help me there but only with these two medications.
Me: Yes, they are a mental health clinic while we are a medical clinic. I just want to be sure you can get them. Can you tell me what health problems you have?
Ms. Brown: High blood pressure, back pain and schizophrenia.
Me: Do you know what type of schizophrenia?
Ms. Brown: The type where I hear voices. I hear them all the time. I hear them now.
(At this point the first year medical student is looking at me with some panic. Mind you, they have not had psychology as it is a second year class and this is their first time at our clinic.)
Me: (Without missing a beat) You say you hear the voices now. Are they telling you anything? To hurt yourself or others?
Ms. Brown: Oh no, nothing like that. They just talking like normal people. Mostly about the weather!
We continue the rest of the interview normally. Ms. Brown gets her hypertension medications filled and the first year student says they plan on returning to work at the clinic again. They also admit to me that they thought all schizophrenics had violent hallucinations so it was nice to learn that is not always the case. Breaking down the stigma of mental disease is something I am defiantly passionate about and I like to think this one little moment in time helped for that student. (And maybe people more now that I am sharing the story).
Thanks for reading!! ~#102~
Saturday, October 12, 2013
Mr. High
Student A: Mr. High, have you ever smoked?
Mr. High: Yes, 2-3 packs every day! For many years. But I stopped that now.
Student A: Ok, do you drink?
Mr. High: No, never. I can't stand that stuff.
Student A: Any other drug use?
Mr. High: Yes, cocaine. And other stuff. I tried lots of things when I was young. I used to be high every day. Have you ever been high?
Student A: No, I have not.
Mr. High: I feel sorry for you. You are really missing out!!
Mr. High: Yes, 2-3 packs every day! For many years. But I stopped that now.
Student A: Ok, do you drink?
Mr. High: No, never. I can't stand that stuff.
Student A: Any other drug use?
Mr. High: Yes, cocaine. And other stuff. I tried lots of things when I was young. I used to be high every day. Have you ever been high?
Student A: No, I have not.
Mr. High: I feel sorry for you. You are really missing out!!
Dr. Drinks
Me: Sitting studying while the residents complete their notes.
Dr. Drinks: (enters room) I have so much to do today! Now I know why Dr. Amazing always looks forward to going home and having a beer at the end of the day.
Dr. Smiley: I think all doctors are secretly alcoholics. When I have the time I plan on drinking every night. (laughs)
Dr. Drinks: Me too! In fact, I think I might start tonight. (leaves room)
Me: (thinking to myself) I wish that was the first time I had heard some random doctors have that conversation.....
Ah, the joys of medicine. A very rewarding yet stressful field. I had heard that alcohol was a part of doctor "society" but didn't realize how true it was until I entered medical school. I personally don't have any problem with a drink now and then. I like wine and rum and diet. However, I can't see myself drinking every night, and I really hope I never get to the point where I feel like I NEED a drink to deal with my day. The unfortunate truth is that alcohol dependency is this professions little dark secret. We even had a couple lectures about it in school. How to spot someone with a problem, how to get them help. Kind of scary if you think about it. But it also proves what many people forget: doctors are humans too. The only difference between doctors and everyone else is some specialized education. Doctors are still susceptible to stress and need to be aware of this. From medical students to residents to attendings, taking care of yourself should come first! You can't take good care of your patients if you don't take care of you. :)
~#102~
Dr. Drinks: (enters room) I have so much to do today! Now I know why Dr. Amazing always looks forward to going home and having a beer at the end of the day.
Dr. Smiley: I think all doctors are secretly alcoholics. When I have the time I plan on drinking every night. (laughs)
Dr. Drinks: Me too! In fact, I think I might start tonight. (leaves room)
Me: (thinking to myself) I wish that was the first time I had heard some random doctors have that conversation.....
Ah, the joys of medicine. A very rewarding yet stressful field. I had heard that alcohol was a part of doctor "society" but didn't realize how true it was until I entered medical school. I personally don't have any problem with a drink now and then. I like wine and rum and diet. However, I can't see myself drinking every night, and I really hope I never get to the point where I feel like I NEED a drink to deal with my day. The unfortunate truth is that alcohol dependency is this professions little dark secret. We even had a couple lectures about it in school. How to spot someone with a problem, how to get them help. Kind of scary if you think about it. But it also proves what many people forget: doctors are humans too. The only difference between doctors and everyone else is some specialized education. Doctors are still susceptible to stress and need to be aware of this. From medical students to residents to attendings, taking care of yourself should come first! You can't take good care of your patients if you don't take care of you. :)
~#102~
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