The Official Anti-Clinical Medicine Thread

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B

b&ierstiefel

Hi folks,

This represents the birth of the new anti-clinical medicine thread in the pathology forum.

Lemme kick off the rant-fest. So yep, it happened! Andy capped today on call today. Andy is upset cuz Andy wanted an easy time on his LAST week of clinical medicine*. We stop admitting at 9 pm today (it's 8 pm now) but it's already been a hellish morning/afternoon/early evening. The team caps at 12, last time I heard we had gotten 10 admits today (all in a span of 6 hours).


* This is truly the last week of clinical medicine for Andy. Andy does pathology next month and originally was registered for a consult month during the month after (his last month in med school). However, in a stroke of clarity and lucidity, Andy called the scheduling office and replaced the consult month with a non-clinical medicine elective. In a few days, Andy will truly be able to say "FIVE MORE DAYS" as yaah so eloquently and poignantly indicated in a post a year ago. Andy will be celebrating next weekend...if anyone is in Ann Arbor, drinks are on me!
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Of course, the day that the Official Anti-Clinical Medicine Thread is started, deschutes doesn't have anything to spew.

1 admit so far that for whatever reason got turfed to another clerk.
2-hour nap in the afternoon.
3 stable patients.
4 treats at the nursing station (an apple, a banana, and 2 hunks of cheese)
And only 5 call-nights left in the next 3 weeks!

#4 is possibly the only item that I will miss about clinical medicine. Don't give me thank-you cards, give me Bernard Callebaut!

I'm still trying to figure out the underlying principle behind #1 and put it into action. Out of sight out of mind perhaps? I should hide more often.
 
AAAUUURGHHH!!!

Spent 1 hour with a junior rez trying to come up with an approach to a neutropenic, newly-febrile CLL/NHL patient.
Spent another hour with him as he went in to talk to the patient+husband and find out no more than I did.
Spent half the THIRD hour waiting for him to review the case with the other junior rez and senior rez, and the other half listening to the 3 of them talk about experiences with staff on Teams while planning my Friday afternoon in my head and fixing an enthusiastic wildly-entertained expression on my face.

Hate waiting. Hate.

Just lemme go off and do my volume assessments and get to bed, dammit!
 
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Y'know, the more I do this clinical medicine thing, the less I feel like a fraud.

That doesn't necessarily mean that I know any more than I used to.

I just feel more confident LOOKING confident while not really knowing anything.

Which makes me a fraud, through and through.

I suppose even path requires this look-confident thing.
 
Yeah I think confidence comes with experience. Once you start figuring out just what the heck you are supposed to do during the day a lot of the other stuff starts to fall into place. It's all about confidence. If you give a solid answer, even if it's wrong, it sounds better than giving the right answer but prefacing it with "well, I think," or "I'm not sure but..."

This is what I am working on currently. I say too much phrases like, "Possibly" or "Could represent." I don't like that. That's radiology for Pete's sakes!
 
yaah said:
It's all about confidence. If you give a solid answer, even if it's wrong, it sounds better than giving the right answer but prefacing it with "well, I think," or "I'm not sure but..."
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That's what I knew in theory and have been working to put into practice. But really, if everyone builds this house of cards pretending they know what they're talking about when they actually don't, how does this NOT compromise patient care?

~
Thirty fuggin hours awake. Fuggin madness.

Nobody, and I mean nobody, should have to do this. And I know it isn't even close to what some others have recorded.

"We have two call rooms. When two juniors are on, you'll have to sleep elsewhere." WTF!

The only way I will survive another 3 weeks of Teams is by associating with non-Team-members.

I suppose it must seem anti-social, if I get in, do my job and get the heck out of there as soon as I can.

The residents are going off service, and are celebrating by having an End-Of-Teams BBQ this weekend.

Go? I'd rather pull hair off my back.
 
OK deschutes,

Here's an idea.

Now all you need to do is take this anger, bitterness, and frustration...put it in an empty 2L bottle of your choosing (Coke, Diet Coke, or whatever)...take it to work...and open this bottle of whoopass the next time somebody on teams gives you any crap!

And Yaah,

I'm totally with ya on the confidence bit. I talk out of my ass everyday on rounds but I do it with confidence (especially when it has to do something related to pathology). And the attending smiles and nods. I never realized how bull****ting on rounds actually works!
 
OK ... best case scenario for me during my waning days on the wards...

Census = 3
Discharge processing in progress
Day off tomorrow
Hopefully they will be gone by Sunday and I will have no prerounding to do.
Monday is my last call
Team has a no-hitter
Andy rides into the sunset with census of zero.

Worst case scenario

Census = 3
Discharge snafu x 3 ... no even worse, all 3 patients code and go to the CCU/ICU
Andy gets drunk on day off
Andy comes into work on Sunday hungover
Andy realized what happened on his day off
Andy gets really super pissed
Andy flips out (www.realultimatepower.net)
Monday call comes
Andy caps on Monday call and admits 3 drug-seeking malingerers
Andy's census = 6 until last day of internal medicine EVER.

Andy will pray to the discharge and no-hitter gods this weekend.
 
AndyMilonakis said:
I never realized how bull****ting on rounds actually works!
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Oh absolutely. The best times I've ever had on Teams were those that I bullshat.

But don't you ever sit in wonder of everyone BS-ing everyone else?
 
The other amazing thing about BS is that you really don't have to know very much to sound really impressive, i.e. I got out of extra work and staying late by excellent BS-ing skills.

Some days I watch myself in wonder.

So where in all this is the problem, you ask?
I'll tell you where the problem is. The problem is I don't like doing it.
 
deschutes said:
The other amazing thing about BS is that you really don't have to know very much to sound really impressive, i.e. I got out of extra work and staying late by excellent BS-ing skills.

Some days I watch myself in wonder.

So where in all this is the problem, you ask?
I'll tell you where the problem is. The problem is I don't like doing it.
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I hate to jump in this but i think from experience i can tell that people KNOW....They just KNOW when students bull****....But they just tend to overlook it cause it is an appreciation of things that they themselves did once....It is really not a big deal to spot a bull****ter....what they are looking for though is effort....if you make an effort,even if it is bull****....it is good for most of them(The reason why your attending is smiling andy.....) Most of them are polite and wouldnt make a fuss about it, but you can expect the odd honest crank who d say.."Hey stfu, you re bull****ting me..."....

I know....someone said that to me once.... :laugh: :laugh:

Hey Deschutes...."I hate waiting, hate waiting" thing?....that is the reason i quit clinical medicine....i HATEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE waiting for things to happen ....cause you can't do much in the meanwhile and you have to wait and wait till something happens....i totally empathise with you girl...i honestly do!!!!!..... :laugh: :laugh:

Dont worry....... this is time you pay for the joy of having to do research...or pathology...

Regards
Quant
 
quant said:
I hate to jump in this but i think from experience i can tell that people KNOW....They just KNOW when students bull****....But they just tend to overlook it cause it is an appreciation of things that they themselves did once....It is really not a big deal to spot a bull****ter....what they are looking for though is effort....if you make an effort,even if it is bull****....it is good for most of them(The reason why your attending is smiling andy.....) Most of them are polite and wouldnt make a fuss about it, but you can expect the odd honest crank who d say.."Hey stfu, you re bull****ting me..."....
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OK Dr. Negativity. Thanks for giving me a dose of reality :)
 
AndyMilonakis said:
OK Dr. Negativity. Thanks for giving me a dose of reality :)
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Hey Andy,offended?....i was jus encouraging you to bull**** your attending.....with an awareness of what goes on the other side too.... :laugh:

Bull****ting is the birthright of medical students after all the world over....

Regards
Quant
 
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In my stoned-ness, I neglected to comment - nonono, no anger bitterness or frustration - just objective contribution to the OACM thread.

Internal Teams is still proving to be a more positive overall experience than Peds Teams.

Privately I think BS-ing works most of the time because because a lot of the questions I get asked are really not issues that will majorly change management of the patient. Which is why if you look the resident in the eye and say "He (the patient) does not remember" in response to their "Did you ask....?" questions, they will get off your back.

I'm still trying to ignore the constant "Know your patient" exhortations. I know and I'm trying, so stfu already.

Okay, enough swearing for one day. :cool:
Dinner and a movie and more sleep! Yay!
 
deschutes said:
Dinner and a movie and more sleep! Yay!
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Speaking of movies...I highly recommend seeing Collateral. I also liked Harold and Kumar go to White Castle very much too.
 
deschutes said:
In my stoned-ness, I neglected to comment - nonono, no anger bitterness or frustration - just objective contribution to the OACM thread.

Internal Teams is still proving to be a more positive overall experience than Peds Teams.
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You truly are stoned deschutes. Lay off the pipe :)
In all seriousness though, I'm glad medicine teams is working out OK for you. Think about it, it could be a lot worse.

deschutes said:
Privately I think BS-ing works most of the time because because a lot of the questions I get asked are really not issues that will majorly change management of the patient. Which is why if you look the resident in the eye and say "He (the patient) does not remember" in response to their "Did you ask....?" questions, they will get off your back.
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The best responses to any pimp question:
(1) It was difficult to tell as the patient was a poor historian and not very reliable when I went to see him.
(2) That's a really good question. I believe the verdict isn't out on this issue yet and this is still pretty controversial.
(3) Sarcoid
(4) Lupus
(5) You asked me that yesterday (this only works if the attending backs off after this answer...this is risky though because if the attending says, "so what was the answer yesterday", you're screwed).

---

oh btw quant...not offended at all :) i need a vacation
 
Often when I was pimped about something stupid, I wanted to throw it back in their face. If the attending asked me if I looked for asterixis, I wanted to ask why he cared since the patient is jaundiced and his coags are off and he just came in after a drinking binge. And why do you care if he has an upgoing toe if he has slurred speech and severe new onset unilateral weakness?

Either that, or I wanted to ask them a question. Do you know that testicular tumors are a difficult microscopic diagnosis and they can show lots of mixed patterns?

Deschutes that can backfire because then you all go in and the attending asks the patient the question (Like a patient with left sided weakness and the attending wants to know if he ever had a stroke before or similar symptoms) and he says, "of course, I remember that well, I had a stroke on July 14th 1982, I remember because my daughter had gotten married the day before. My symptoms now are slightly different and here's how..."

Internal medicine was a lot more educational, in my opinion, than pediatrics. Maybe pediatrics used to be educational, but now all the kids with anything interesting see specialists as outpatients and you don't see that unless you do an elective. Inpatient pediatrics is weeks of trying to figure out how to let a kid feel their belly because the staff wants you to assess the patient even though the clinical impression from trying to press on a 4 year old's belly is going to be sufficiently vague that they will order the tests anyway. Damn kids! Don't they know that I'm trying to figure out what's wrong with them and I'm not trying to hurt them? Go ahead, run away! Run off and hide! Then that appendix will burst and you'll end up septic, on 5 IVs and possibly dialysis and be intubated. But at least it won't hurt as much! And sure, we don't have to check that important lab test because you don't like needles. Instead, we'll just guess. :rolleyes: I do like kids actually, I just don't like kowtowing to their wimpy behavior and letting them decide how things should proceed. When I was a kid, dammit I might have cried but they drew my blood and I let them and no one had to hold me down. And when it was over I realized it wasn't that bad and had my lollipop.
 
yaah said:
And sure, we don't have to check that important lab test because you don't like needles. Instead, we'll just guess. :rolleyes: I do like kids actually, I just don't like kowtowing to their wimpy behavior and letting them decide how things should proceed.
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you didn't go to a very good peds program if this were the case.

i would argue that kids are more complicated than adults. not only do you have a more limited arsenal of meds/treatments (which change dosages according to weight), but you have different pathogens, different "normals" depending on their age, strange presentations of illnesses, and an annoying tendency of patients to look fine one minute and crump the next. (as well as the feature you talk about above-- having a patient that can't always communicate what is wrong with them). i enjoy it because i can see the difference i make with a patient population that (99% of the time) is not responsible for their disease.

one thing that annoyed me with pathology was that after the diagnosis was made, the clinician really couldn't care less about the details the pathologist threw in. all they care about is 1) is it malignant or 2) did we get it all? after that, no one cares how many mitotic figures per hpf were found, or the subtype of cancer this happens to be. treatment is paramount, the diagnosis, once made, secondary.

--your friendly neighborhood clinical caveman
 
Homonculus, your points are well taken. And my post is not an attempt to start any kind of an argument...but rather to articulate my personal view.

I'll start by saying that it's all a matter of preferences. We can argue about what we think is important and what is less important; what is paramount or what is secondary.

Ultimately, we must do work that we enjoy. Conversely, we must avoid work that we do not enjoy. That ensures that we are happy with the respective paths we have chosen. In that vein, from my point of view, I do not feel anyone should feel morally obligated to choose a profession just based on the perceived notion of service.

I choose pathology because I like the science of medicine, I like working in a laboratory environment, and I like making diagnoses through science. I would also like to do research to better understand pathophysiology at the basic science level. Being able to treat is nice too; however, treatment encompasses many dimensions. From my limited exposure to various clinical fields in medicine during my short (and soon to end) time on the wards is that addressing the social and family issues is just as important to treatment as changes or institution of medications.

Personally, I really do not care for the social stuff such as: Where is this old guy gonna go after we discharge him? Does the kid's parents smoke? Could stress be contributing to the person's ailment? Is this patient coming to the hospital for secondary gain? Why is that? Is it because the patient is poor and can't afford painkillers? All this social stuff...no thanks for me. Why? Because it's not my cup of tea. Somebody else can deal with all that stuff.

On the other hand, I like diseases. I like diagnosing diseases. Then I want to be able to go home with the thought in mind that some other guy is gonna treat the patient accordingly. Does that afford me a better lifestyle with less work to do around the clock? Maybe. If so, awesome! I don't feel morally obligated to work long or hard hours just because some people find that work ethic of doctors to be honorable.

Diagnosis is just as important as the treatment. It is the yin and yang of medicine. Without diagnosis, the proper treatment cannot be instituted. Without treatment, the diagnosis surely is secondary. Sure, there are quite a few diagnoses that need not the expertise of a pathologist. For those, treatment truly is paramount. But for some diseases (especially cancers), the expertise of the pathologist and radiologist are paramount because their conclusions ultimately shape the mode of therapy, side effects, and how it will affect their ADLs and IADLs (and I will gladly let someone else deal with all of that).
 
AndyMilonakis said:
Homonculus, your points are well taken. And my post is not an attempt to start any kind of an argument...but rather to articulate my personal view.

I'll start by saying that it's all a matter of preferences. We can argue about what we think is important and what is less important; what is paramount or what is secondary.

Ultimately, we must do work that we enjoy. Conversely, we must avoid work that we do not enjoy. That ensures that we are happy with the respective paths we have chosen. In that vein, from my point of view, I do not feel anyone should feel morally obligated to choose a profession just based on the perceived notion of service.

I choose pathology because I like the science of medicine, I like working in a laboratory environment, and I like making diagnoses through science. I would also like to do research to better understand pathophysiology at the basic science level. Being able to treat is nice too; however, treatment encompasses many dimensions. From my limited exposure to various clinical fields in medicine during my short (and soon to end) time on the wards is that addressing the social and family issues is just as important to treatment as changes or institution of medications.

Personally, I really do not care for the social stuff such as: Where is this old guy gonna go after we discharge him? Does the kid's parents smoke? Could stress be contributing to the person's ailment? Is this patient coming to the hospital for secondary gain? Why is that? Is it because the patient is poor and can't afford painkillers? All this social stuff...no thanks for me. Why? Because it's not my cup of tea. Somebody else can deal with all that stuff.

On the other hand, I like diseases. I like diagnosing diseases. Then I want to be able to go home with the thought in mind that some other guy is gonna treat the patient accordingly. Does that afford me a better lifestyle with less work to do around the clock? Maybe. If so, awesome! I don't feel morally obligated to work long or hard hours just because some people find that work ethic of doctors to be honorable.

Diagnosis is just as important as the treatment. It is the yin and yang of medicine. Without diagnosis, the proper treatment cannot be instituted. Without treatment, the diagnosis surely is secondary. Sure, there are quite a few diagnoses that need not the expertise of a pathologist. For those, treatment truly is paramount. But for some diseases (especially cancers), the expertise of the pathologist and radiologist are paramount because their conclusions ultimately shape the mode of therapy, side effects, and how it will affect their ADLs and IADLs (and I will gladly let someone else deal with all of that).
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:thumbup:

no argument from me. remember, i almost turned to the Dark Side myself :smuggrin:

--your friendly neighborhood skywalker caveman
 
Homunculus said:
:thumbup:

no argument from me. remember, i almost turned to the Dark Side myself :smuggrin:

--your friendly neighborhood skywalker caveman
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cool man...the dark side? LOL I like it!
 
AndyMilonakis said:
cool man...the dark side? LOL I like it!
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the only thing worse than resisting the Dark Side was trying to explain to people how in the hell i narrowed down my specialty choices to peds and path. talk about some confused looks :laugh:

--your friendly neighborhood split personality caveman
 
well i mainly get angry looks when i tell people that my options are pathology vs. post-doc.
 
Homunculus said:
the only thing worse than resisting the Dark Side was trying to explain to people how in the hell i narrowed down my specialty choices to peds and path. talk about some confused looks :laugh:
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Peds and Psych baby :D

Psych fell off the list when I realized I wouldn't get to go sailing every day.
 
deschutes said:
Geez all these P words. I meant PATH and Psych :)

And of course you knew that already.
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are you high? and can i have some?
 
Did you know that pathology is NOT the study of walkways, covered or otherwise?

And did you know that being stoned is to carry a lump of rock around in your skull?
 
I am high au naturel.

Right now though, I am still feeling a bit blunted - whether from lack of food or sleep at the appropriate times, I cannot tell.

The combination of high + blunted = a little weird.

I prescribe a walk.
 
yaah said:
If the attending asked me if I looked for asterixis, I wanted to ask why he cared since the patient is jaundiced and his coags are off and he just came in after a drinking binge. And why do you care if he has an upgoing toe if he has slurred speech and severe new onset unilateral weakness?
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That is exactly what I mean. The PFTs come back and me and the junior rez look over it and see that the FEV1/FVC is <75% and the curve demonstrates characteristic scooping and what do you know, is even reported as being a mild obstructive picture with air trapping.

So I go back to the senior who asks if I have seen the PFTs and I tell him all this and he goes, "Well, what were the numbers?"

:mad:

Goshdarnit, if one week of Teams is getting this much whinging out of me, I wonder what a whole month will do. :wow:

And I have always wanted to use that smiley.
 
Homunculus said:
you didn't go to a very good peds program if this were the case.

i would argue that kids are more complicated than adults. not only do you have a more limited arsenal of meds/treatments (which change dosages according to weight), but you have different pathogens, different "normals" depending on their age, strange presentations of illnesses, and an annoying tendency of patients to look fine one minute and crump the next. (as well as the feature you talk about above-- having a patient that can't always communicate what is wrong with them). i enjoy it because i can see the difference i make with a patient population that (99% of the time) is not responsible for their disease.
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Well, I was being half serious. The needed tests obviously got done, but still so much time was spent trying to pacify the child when it seemed to me the trauma would be lessened if things were just done.

I think kids can be more complicated than adults, a lot because of the huge range of possibilities. Everything presents differently in kids.
 
deschutes said:
That is exactly what I mean. The PFTs come back and me and the junior rez look over it and see that the FEV1/FVC is <75% and the curve demonstrates characteristic scooping and what do you know, is even reported as being a mild obstructive picture with air trapping.

So I go back to the senior who asks if I have seen the PFTs and I tell him all this and he goes, "Well, what were the numbers?"

:mad:

Goshdarnit, if one week of Teams is getting this much whinging out of me, I wonder what a whole month will do. :wow:

And I have always wanted to use that smiley.
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Is this your last month of inpatient internal medicine? If so, be thankful that you'll be done with all this lame stuff in 3 weeks.

I'm doing medicine now and I did CCU last month...two consecutive medicine months is brutal. I've already gone crazy. I need some Vitamin H.

I hope you don't end up going crazy during this month.
 
AndyMilonakis said:
Is this your last month of inpatient internal medicine? If so, be thankful that you'll be done with all this lame stuff in 3 weeks.
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I still have that month of Nephro to follow. Not sure what it's going to be like (hopefully lots of time spent in the library) but anything, just anything, has to be better than Tough-Love Teams.

One friend who wants to go into Psych called Internal "the longest 3 months of (her) life" (gee thanks). This girl never swears, and she did so THRICE on the phone yesterday, just at the memory of it all. She also has Peds looming on the horizon (sorry Caveman) and I am completely unable to offer her any comforting words.

I'm sitting here trying to study for Friday's (non-certifying) OSCE/Mid-term, and keep wandering off.
This is SO not inspiring. I mean, I know I can probably pass this rotation without stressing out about how much (or how little) I am studying, but I figure I really should learn this stuff. Not that it's going to stop being a blur anytime soon. :oops:

It's gonna be a week of rain here in wet wet wet Cowtown... thank GOD I ride for free starting Monday! Woo hoo!! *does happy dance*
 
I heard Nephro is pretty painful. Even nephro consults. Basically anything involving long-ass-hell rounds automatically qualifies as a sucky rotation. Hopefully you get somebody that rounds nice and quick.

deschutes said:
This girl never swears, and she did so THRICE on the phone yesterday, just at the memory of it all.
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Yeah, what's with internal medicine and swearing. There's something about internal that really gets my angry-juices going. Do I really hate it that much? It must be the case as I didn't swear nearly as much when I was doing other rotations. I mean seriously, I come into work everyday saying to myself, "Damn I hate this." And I rush to do signouts to the on-call intern so I can get out of the hospital as early as possible. Then during my drive home, I get paged and I almost crap my pants.

Anyways, I feel unfortunate that internal medicine really brings out the worst person in me. I'm sure this is not good for my health. The good thing is that it'll all be over this Friday and I'll be a very thankful and much happier person (and very drunk too).

Best of luck on your OSCE. I'm sure you'll kick ass!
 
Nephro is painful. They used to descend on the path lab with their team of 20 people so that they could use the 12 head microscope to look at someone's piss they had spun down. This is why nephro was not interesting to me. The highlight of their day was coming down to look at piss under a microscope. Hey, I can look at slides all day and everything is more exciting than trying to find the occasional muddy brown cast.

Plus, all this dialysis, acid base balance. You do learn electrolytes and acid base very well though. Smart people. BUt all those diabetics.
 
I think part of hating Infernal, is that it lasts so damned Eternal.

The one good thing about Teams (aside from the food) is that we don't have to stand to round. Count my puny blessings.

AndyMilonakis said:
I mean seriously, I come into work every day saying to myself, "Damn I hate this."
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OK, good to know. Because I was talking to a gen surg resident about more or less the same thing, and she asked me if it didn't seem like I was burning out too quickly.

I'm not burnt-out - I'm just a lot perkier in the evenings.

I got switched over to the other teaching team late today. Just so all the juniors could do q5 call. (Of course, we clerks are still stuck doing q4.) I sincerely hope that this move is in a positive direction... especially since I had this scheme in place whereby I would acquire a 3rd stable patient on my original team.

Thanks for the well-wishes. I'm actively bribing myself into studying for IM by channelling the prospect of Step 2. Ugh!

I'm told that half the class traditionally fails the mid-term non-certifying OSCEs anyway and have to review it with any attending they can grab in the hallway.
If I do fail, it will be a small price to pay for the opportunity to go hang out with that very kewl rheumatologist... :love:
 
deschutes said:
If I do fail, it will be a small price to pay for the opportunity to go hang out with that very kewl rheumatologist... :love:
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Isn't it fun to have a crush on one of the attendings? Pure unrequited love. We had one pediatrics attending I was always trying to follow around. Other than that it was mostly the ancillary staff, like the Nuclear Medicine girl and a smokin' hot brunette nurse on the oncology floor...
 
yaah said:
Isn't it fun to have a crush on one of the attendings? Pure unrequited love.
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It is deadly!

yaah said:
Other than that it was mostly the ancillary staff, like the Nuclear Medicine girl and a smokin' hot brunette nurse on the oncology floor...
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Yes, there tends to be more female ancillary staff. Sure, they're "part of the team" - but so is the electrician. Crushing on an electrician isn't half as romantic as getting the squishes for a Nuc Med gal studying for the MCAT.
 
Last call completed.

Truly clinical medicine sucks. 3 admits...all bull****.

We capped today (again). I heard a story a while back that the assbag who is the internal medicine chair at this hospital goes down to the ER and requests that they admit more patients to the teaching services. Who is that sadistic to do such a thing? What a total douchebag.

My first two weeks on teams...life was beautiful. No patients first week and 4 the second week. Luck? Perhaps. However, I am told that douchebag is out of town. But then he would call the senior residents on the 4 teaching teams always asking what the census was.

OK so the douchebag is back in town starting last week and this week. Our team is significantly busier now. Apparently assface has been at it again going down to the ER every evening asking them to admit more cases. Now, if we got some decent admits that weren't crap, I wouldn't mind. But when you get two patients who just slipped and fell on their faces and they're calling it syncope...this is getting utterly ridiculous.

Post call...time to preround, say "good morning", walk out, and write the same half-ass progress notes I write each day. 4 patients...should take about 20 minutes.
 
AndyMilonakis said:
Last call completed.
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You sound pretty good for 5:30am. I'm usually a blithering idiot by that time, able to focus on one thing and one thing only - going home.

AndyMilonakis said:
My first two weeks on teams...life was beautiful. No patients first week and 4 the second week.
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O Lord Andy, please instruct thy faithful servant in the art of acquiring NO patients...
 
I think we need to clarify whether his real name is douchbag or assface. One cannot be both.

According to google:

This is a douchebag:
college2.jpg


And this is an assface:
joey-assface.jpg
(at least, that's the suitable for public consumption picture).
 
deschutes said:
You sound pretty good for 5:30am. I'm usually a blithering idiot by that time, able to focus on one thing and one thing only - going home.

O Lord Andy, please instruct thy faithful servant in the art of acquiring NO patients...
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Yeah this was 5:30 in the am after 7 hours sleep. We capped and stopped admitting patients as of 8:37 pm last night. I got ****ed cuz I got to admit the last patient. I finished up writing up orders and finished my admit note by about 10:00 pm. Slept after that...not bad ey?

Best ways to acquire no patients on call:
(1) Volunteer to put together a presentation for morning report. And say that you'll have to do a lot of literature searches and read lots of papers (i.e., a 5 second search on UpToDate) and make the best presentation possible.
(2) Go hide.
(3) Pray.
(4) Ritual sacrifices (usually 3 and 4 get lumped together).
(5) Never volunteer to take that first patient, or second, or third. If you're fourth in line and there are only 3 admits...you're scott free.
 
deschutes said:
I'm sitting here trying to study for Friday's (non-certifying) OSCE/Mid-term, and keep wandering off.
Click to expand...

Holy crap...I just got my CCA scores back in the mail and just opened them. Apparently I passed all the stations. God damn I'm a lucky SOB. However, I was close to failing two of them. The passing score for the 2 sections in question were 68...my score was 68 and 69.

So...if I can pass an exam like this, I'm sure you won't have any problems. Cuz I totally suck at these kind of things.

Kick ass on Friday and go celebrate once it's over.

Friday is my last day of clinical medicine. I'm going out on a pub crawl on Friday and I'm gonna get totally tanked and wasted. First stop, Dominicks...next stop, that German place whose name I can't remember now, then the brew pub, and then whichever place that won't get me killed.
 
AndyMilonakis said:
...say that you'll have to do a lot of literature searches and read lots of papers (i.e., a 5 second search on UpToDate)
Click to expand...
You're going into Path and you have UpToDate. Keener.

Y'know, now that you mention it I really haven't seen clerks doing presentations on morning report. And I've never known even the internist-wannabes to volunteer for such. I wonder if it's the local hospital culture. Not that I'm complaining :D

Given these circumstances, I'd really rather lie low than volunteer. It'd be almost worth it to see the pressure-effects on the other clerks, but I'm quite happy to coast along for the next 2 1/2 weeks. "Above Expected Level" on my Teams evaluation would be great, but SO not worth the white hairs.

Hiding therefore is the only really viable alternative.
And seeing as I'm still drumming my fingers waiting for a transfer to turn up so that I can write a note, I think I'll just go ..... sleep? study? sleep? study?

Ahh, eternal questions.
No, I'm not apneic.
 
deschutes said:
You're going into Path and you have UpToDate. Keener.

Y'know, now that you mention it I really haven't seen clerks doing presentations on morning report. And I've never known even the internist-wannabes to volunteer for such. I wonder if it's the local hospital culture. Not that I'm complaining :D

Given these circumstances, I'd really rather lie low than volunteer. It'd be almost worth it to see the pressure-effects on the other clerks, but I'm quite happy to coast along for the next 2 1/2 weeks. "Above Expected Level" on my Teams evaluation would be great, but SO not worth the white hairs.

Hiding therefore is the only really viable alternative.
And seeing as I'm still drumming my fingers waiting for a transfer to turn up so that I can write a note, I think I'll just go ..... sleep? study? sleep? study?

Ahh, eternal questions.
No, I'm not apneic.
Click to expand...

Gawd...notes are stupid. It seems like on internal medicine your whole day revolves around writing one stupid note. It takes me about a minute to write a progress note. Heck I even write 95% of it before seeing the patient. Then I fill in a few holes after talking to and "examining" the patient for a few minutes.

A surgery resident once taught me the concept of the "triple point." Put your stethoscope in the xiphoid area (or subxiphoid depending on body habitus). You can listen to breath sounds, heart sounds, and bowel sounds all in the matter of seconds. Of course the only conclusion one can truly reach from listening to the triple point for about 3 seconds is this: the patient is breathing, his heart's beating, and he's gonna poo someday. Of course, what ends up going into his note?

RRR S1 S2 no m/r/g
LCTAB no w/c/r
Abd S/NT/ND/+BS

The physical exam is such a wash. Management rarely changes due to a physical exam finding. All you're gonna do is order another stupid test.
 
AndyMilonakis said:
Gawd...notes are stupid. It seems like on internal medicine your whole day revolves around writing one stupid note. It takes me about a minute to write a progress note. Heck I even write 95% of it before seeing the patient. Then I fill in a few holes after talking to and "examining" the patient for a few minutes.

A surgery resident once taught me the concept of the "triple point." Put your stethoscope in the xiphoid area (or subxiphoid depending on body habitus). You can listen to breath sounds, heart sounds, and bowel sounds all in the matter of seconds. Of course the only conclusion one can truly reach from listening to the triple point for about 3 seconds is this: the patient is breathing, his heart's beating, and he's gonna poo someday. Of course, what ends up going into his note?

RRR S1 S2 no m/r/g
LCTAB no w/c/r
Abd S/NT/ND/+BS

The physical exam is such a wash. Management rarely changes due to a physical exam finding. All you're gonna do is order another stupid test.
Click to expand...


BRAVO ANDY BRAVO!!!!!!!!!!!!

You echo exactly my thoughts i had once upon a time...
" management rarely changes due to a physical exam finding..."

SOOOOO very true....all we end up doing is order another test...

TRIPLE POINT is hilarious....

Keep em coming andy

Regards
Quant
 
AndyMilonakis said:
It takes me about a minute to write a progress note. Heck I even write 95% of it before seeing the patient.
Click to expand...
I mentally shake hands with you on that one. It's not as if the patient is going to tell me what his potassium level is.

I actually went 3 days on Peds Teams without seeing a single one of the 3 patients that I was carrying, and writing perfectly adequate progress notes throughout.

AndyMilonakis said:
Of course the only conclusion one can truly reach from listening to the triple point for about 3 seconds is this: the patient is breathing, his heart's beating, and he's gonna poo someday.
Click to expand...
You can also tell that Dr. Johnson is being paged on the overhead and the patient is watching The Shopping Channel and you've gone and dislodged the bloody ECG monitor lead.

CV N S1,S2 no S3,S4 no m JVP ~3cm ASA PPPx4
(sometimes just for kicks I throw in an SEM II/VI LUSB non-radiating - not that anyone ever notices)
RS BS+ A/E L=R to bases no c/w

What's RRR? resp rate regular...? (can't be because that's obviously the CVS field)
and LCTAB = lungs clear to ausculation.....B?

I had a good call night. By my standards.
Zero admissions, no calls from 10 to 8 - although I got woken up 4 times because the resident in the next room was getting all the excitement.

6 meals in the hospital without once venturing to the cafeteria!

Outside it is grey, the same temp as when I went in yesterday... and the leaves are turning. Goodbye summer - you were never really here anyway.
 
RRR stands for regular rate and rhythm...it's kind of a misnomer because "regular rate" doesn't make much sense whereas "regular rhythm" does make sense. How can a rate be regular. A rate is a rate. One of the interns I worked with several months ago commented on this and requested that I write NRRR for normal rate (as opposed to bradycardic or tachycardic) regular rhythm. Semantics semantics...it's all BS anyways.

LCTAB = lungs clear to auscultation bilaterally

Nice job on the zero admissions....(lucky bastard) j/k j/k

Anyways, I discharged my one and only patient today. I get the day off tomorrow. ONE DAY OF CLINICAL MEDICINE LEFT BABY!
 
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