Laws of House of God - Mimelim's commentary
1. Gomers don't die - Only the good people die. The cockroaches live forever. Obvious selection bias, but the worst things seem to always happen to the good people.
2. Gomers go to ground - Attention to small details saves people. After doing a central line, gotta drop the bed back down to the lowest level and put the railings up. E = mgh. Sure as hell can't change my patient's mass or the size of the Earth, but patients fall no matter what you do and hospital causes subdurals or broken femurs suck++.
3. At a cardiac arrest, the first procedure is to take your own pulse. - Has a different meaning in Vascular Surgery, but panicking doesn't help anyone. I've seen codes 'taken away' from residents because they were clearly unable to provide the best care because of their inability to compartmentalize and focus.
4. The patient is the one with the disease. - You see so much pathology around you. Yes, it could all happen to you, but you can't worry about it because you will go insane. Move on, take care of your patient and worry about it another day.
5. Placement comes first. - ER docs don't even bother trying to admit to me. If they have more than one medical problem, they go to a medical service and with a Vascular Surgery patient population, that means they always go to a medical service. I have 50+ patients on my list, patients will suffer if I need to titrate their DM or HTN meds. Yes, I can do it and yes, I can do it well, but a medicine team has more time and will actually do it. As soon as someone arrives, you have to think dispo. Paperwork in modern medicine sucks LTAC, SNF, rehab, and home health all take time and coordination. I have two PMR docs on the front page of my phone. If one doesn't respond to my text message about a patient, the other gets the consult. Last week we actually consulted them before we did the AKA. Worked out great.
6. There is no body cavity that cannot be reached with a #14 needle and a good strong arm. - Although I enjoy getting my trauma numbers thanks to the interventional cardiologists that think they know how to do procedures, for the sake of the patients... LEARN TO USE THE GOD DAMN ULTRASOUND (and a micropuncture kit).
7. Age + BUN = Lasix dose - Never really thought about this one.
8. They can always hurt you more. - They always hurt you more.
9. The only good admission is a dead admission. - I'm the happiest and most optimistic person I know. This was relatively repulsive to me initially. Then I did trauma call for 10 straight weeks as a junior resident at the busiest trauma hospital in the US. On those nights with 15+ level 1/2 traumas, the page that says, "Level 1 GSW to head, G-3 S-0 BP-0 R-0, CPR in progress" was a breath of fresh air because it would require minimal work and minimal paperwork. Also presenting at morning report wasn't stressful. "Patient arrived dead and remained dead. The next patient...."
10. If you don't take a temperature, you can't find a fever. - Your job is take care of patients. Not to cure them of all their ailments, the vast majority of which are not medical.
11. Show me a student from the "best medical school" who only triples my work and I will kiss his feet. - Invest in students. If you don't have the attitude, "I need to make these students better than I was at their level", you aren't working hard enough or are at the wrong hospital. Doctors (residents) are good students, but we do not select for good managers and administrators. Yes, the advent of EMRs decrease the scut that can be turfed to students, but there are things, both physical and cognitive that medical students can help a lot with.
12. If the radiology resident and the "best medical student" both see a lesion on the chest X-ray, there can be no lesion there. - "Trust, but verify." - my chief my first week of residency. If you depend on radiological studies in your practice, you should be able to read them for what you use them for. There is no excuse for not being able to do basic interpretation of films.
13. The delivery of medical care is to do as much nothing as possible. - Yes, modern medicine is amazing. Yes, we can improve the health and lives of many patients. But, we are limited, by resources and our own abilities. Nothing HAS to be done. It is always possible for a patient to say, "No, just stop and let me be". It is always a possibility that the "right" thing to do is to tell a patient, "We can do XYZ, but for you, it would be better to do nothing." You might get paid less, but it is still the right thing to do.
