48 peripheral smear reviews...

[DarksideAllstar]

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, 6 body fluid/CSF reviews, 9 coagulation test approvals, 13 clinician call backs, 6 heme-onc requests to look at smears, 8 minutes for lunch, and 12 hours later, I'm finally at home. If there was a "gun to the head" smiley, now is when I'd use it.

 

[DarksideAllstar]

oh yeah, almost forgot the stat malaria review that I got at 5pm...

 

[LADoc00]

, 6 body fluid/CSF reviews, 9 coagulation test approvals, 13 clinician call backs, 6 heme-onc requests to look at smears, 8 minutes for lunch, and 12 hours later, I'm finally at home. If there was a "gun to the head" smiley, now is when I'd use it.

all that and 12 hours? Im confused, what did you do for the other 11 hours 20minutes?

 

[DarksideAllstar]

all that and 12 hours? Im confused, what did you do for the other 11 hours 20minutes?

Hmmm....good question. I'd say that the rest of was spent reviewing all those smears and fluids with the attending and handling "issues" that the lab personnel would encumber me with. It was 12 hours from the time I left home til the time I got home. It just wouldn't have sounded as good if I had said 11 hours.

BTW-- keep in mind I'm a noob at looking for the infamous "rare" blast. I have to look up every coag patient history, look up the test, indications, and try to get ahold of the clinicians. Its a pain in the @ss when you don't know what the hell you are doing.

 

[yaah]

I think we get about an average of 30-40 peripheral smears per day, those are usually signed out during the morning hemepath signout (afternoons is for lymph nodes and bone marrows). A lot of people don't preview them, they just sit there at signout while the attending looks and look up pertinent histories, and while the hemepath fellow is doing research somewhere.

 

[djmd]

We didn't S/O PBlood smears with attendings unless we had a question.

Hell is all those Pbloods, a dozen body fluids, a couple flows, and 8-10 Bone Marrows. (with a few MDS 500 cells diffs)

Heme is a acid bath. If you ever needed to know what you personal break points are, and what you body starts to do under massive stress..

Personally, I get a eye twitch thing that is very annoying...

 

[dermpathlover]

, 6 body fluid/CSF reviews, 9 coagulation test approvals, 13 clinician call backs, 6 heme-onc requests to look at smears, 8 minutes for lunch, and 12 hours later, I'm finally at home. If there was a "gun to the head" smiley, now is when I'd use it.

aren;t you on elective? WTF did you elect to do?

 

[DarksideAllstar]

aren;t you on elective? WTF did you elect to do?

I'm on hemepath this month (marrows and smears). I am helping a resident out right now, so I am only covering the hematology service (smears, fluids, coag) this week.

 

[LADoc00]

and while the hemepath fellow is doing research somewhere.

I wandered into a Starbucks once and saw a guy reading the WHO Heme book and asked what he was doing, responded his Hemepath fellowship on a reading rotation. I couldnt stop laughing, spit some grande latte out my nose even. Quite a scene.

Heme is EASY. Come back when you have some crazy non-neoplastic medical kidney, liver or lung....

 

[beary]

Hell is all those Pbloods, a dozen body fluids, a couple flows, and 8-10 Bone Marrows. (with a few MDS 500 cells diffs)

Heme is a acid bath. If you ever needed to know what you personal break points are, and what you body starts to do under massive stress..

Personally, I get a eye twitch thing that is very annoying...

This is where I am right now. I really wanted to like heme but I really feel in some ways that I am going to have a nervous breakdown. I'm sort of twitching too.

 

[DarksideAllstar]

I wandered into a Starbucks once and saw a guy reading the WHO Heme book and asked what he was doing, responded his Hemepath fellowship on a reading rotation. I couldnt stop laughing, spit some grande latte out my nose even. Quite a scene.

Heme is EASY. Come back when you have some crazy non-neoplastic medical kidney, liver or lung....

Sure, heme might be easy, but I haven't been exposed to it enough to find it easy. The thing that is so difficult about this service isn't the friggin heme-- its the endless assault of pages and interruptions from wandering hem/onc fellows that keeps me from getting anything previewed or signed out.THAT's what is so difficult.

 

[LADoc00]

Sure, heme might be easy, but I haven't been exposed to it enough to find it easy. The thing that is so difficult about this service isn't the friggin heme-- its the endless assault of pages and interruptions from wandering hem/onc fellows that keeps me from getting anything previewed or signed out.THAT's what is so difficult.

Yeah its funny, big academic institutions are so over staffed with docs they have people sitting around with a thumb up their butt with nothing better to do than pester pathology. You never realize how bad it really is until you get into private prac and no one calls you for like a month. The best way to deal with them is to immediately lower their expectations, then stay ahead of the curve by churning the cases out so fast they never have a reason to call you.

UCSF path is actually pretty good at this. Stanford path, not so much so.

 

[pathstudent]

Sure, heme might be easy, but I haven't been exposed to it enough to find it easy. The thing that is so difficult about this service isn't the friggin heme-- its the endless assault of pages and interruptions from wandering hem/onc fellows that keeps me from getting anything previewed or signed out.THAT's what is so difficult.

That's path. We are nothing without the clincians. If they don't exist then we don't exist. Our mission is to serve them in order to help them with the managment of their patients. Once you forget that, you are worthless.

 

[DarksideAllstar]

That's path. We are nothing without the clincians. If they don't exist then we don't exist. Our mission is to serve them in order to help them with the managment of their patients. Once you forget that, you are worthless.

Yeah, I know. I actually like showing cases and talking with clinicians. I enjoy heme as well, which makes this even more trying for me because I'd like to spend more time looking at cases and reading about them, but I can't until I get home--I'd rather read about something I see while I am previewing but its impossible. The main problem is that I've started a new service that I'm still figuring out how runs, trying to give info on tests that I know nothing about, and trying to preview/sign out/show cases. It is really difficult to make progress throughout the day with so much going on and a huge volume.

Yeah its funny, big academic institutions are so over staffed with docs they have people sitting around with a thumb up their butt with nothing better to do than pester pathology.

I'm not sure that this is entirely the case. The issue, at least here, is that there are numerous sub-specialty and sub-sub specialty services all with residents and fellows. For instance, there are 6 adult hem/onc fellows split between the VA, SFGH, Mt Zion, and Moffitt. I doubt that they are overstaffed considering their is an abundance of onc patients here, but in addition they do see a lot of consults from other services (hypercoag/bleeding issues, thrombocytopenias, etc) that usually involves lots of tests for me to approve and communicate with them about. But yeah, I agree-- get the cases out ASAP. I had a pericardial fluid come in last night at 5:30 and there were lymphoma cells swimming in it in a pt with out a history, so I ran it over to the attending and had it signed out and called in to the CV service within 45 minutes of getting the specimen. Needless to say they were surprised by the turnaround time when I paged them with the results.

 

[Logos']

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[LADoc00]

I'll give you my take on calling results back: Its great if you know the people and understand them well enough to know how they will react when you tell them the results. It can backfire if you have a complete idiot of a resident/intern as a communication intermediary. Ive had incidents where "suspicious for malignancy" or "inflammatory atypia cannot rule out low grade dysplasia" are completely misinterpeted and miscommunicated to the attending. If you have the option of directly paging the attending, I would do that rather than a resident.

My policy is simple now: I will NEVER EVER communicate results via telephone to anyone but the treating attending physician and that includes frozen sections. There just is far too much liability in doing anything else. The only malpractice case I have seen roll on a path resident was over this very issue.

PS- UCSF is CRAZY overstaffed, in fact all of SF is by the far the most over-MD'd area on the West Coast given its paltry population and massive penetration of managed care. Maybe only NYC and Boston are worse. At UCSF, Linda Ferrell would staff 3+ pathologists to do my current workload and probably flop 2-3 more admin types to help. That is the nature of the beast with places like Zion and the General.

 

[b&ierstiefel]

, 6 body fluid/CSF reviews, 9 coagulation test approvals, 13 clinician call backs, 6 heme-onc requests to look at smears, 8 minutes for lunch, and 12 hours later, I'm finally at home. If there was a "gun to the head" smiley, now is when I'd use it.

Awww...poor baby! Baby want his bottle?

 

[b&ierstiefel]

I'll give you my take on calling results back: Its great if you know the people and understand them well enough to know how they will react when you tell them the results. It can backfire if you have a complete idiot of a resident/intern as a communication intermediary. Ive had incidents where "suspicious for malignancy" or "inflammatory atypia cannot rule out low grade dysplasia" are completely misinterpeted and miscommunicated to the attending. If you have the option of directly paging the attending, I would do that rather than a resident.

My policy is simple now: I will NEVER EVER communicate results via telephone to anyone but the treating attending physician and that includes frozen sections. There just is far too much liability in doing anything else. The only malpractice case I have seen roll on a path resident was over this very issue.

PS- UCSF is CRAZY overstaffed, in fact all of SF is by the far the most over-MD'd area on the West Coast given its paltry population and massive penetration of managed care. Maybe only NYC and Boston are worse. At UCSF, Linda Ferrell would staff 3+ pathologists to do my current workload and probably flop 2-3 more admin types to help. That is the nature of the beast with places like Zion and the General.

I agree with LADoc00. When communicating critical results or requesting more clinical information, I will ALWAYS page the attending. Yes, I am not an attending yet but I really don't care. I'm not going to page some intern...and god forbid, I will NEVER page a med student covering the patient. Yeah, I've actually had requests to page medical students with critical results. Sorry...I never honor that request since JCAHO mandates me to communicate results to a clinician. My job is not to make med students look like superstars (unless I know them personally or they're really hot) and help them get brownie points and Honors.

So for the med students, don't go calling up the path department to get results paged to you. We will look up your pager number, see that you're a med student, laugh out loud, and go right over your head and talk to your attending.

As for your PS statement...I think you could extend your claim to many academic institutions.

 

[yaah]

What bothers me is when you have to communicated results to 3 different teams. It's often the general medicine + the heme-onc + the surgery teams. God forbid they ever communicate with each other. And what is annoying is that the medicine team only wants to know the result so that they can tell the surgery team anyway.

Can we get a prelim? Can we get a prelim? Can we get a prelim? I often get called before the biopsy is even done, let alone even in the processor, asking when the results will be in and if they can get a prelim. Yeah, *******, your prelim is that we received two ****ty cores that are probably just collagen and fat. How's that for a prelim?