Things NOT to do as a doctor

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Do not say the following:

M3: Are you currently sexually active?
Male Patient: No, haven't gotten any for a while.
M3: Yeah man, I know how you feel.

For the record, that wasn't me.
 
Do not say the following:

M3: Are you currently sexually active?
Male Patient: No, haven't gotten any for a while.
M3: Yeah man, I know how you feel.

For the record, that wasn't me.

LOL... that is something I would be stupid enough to say :meanie:
 
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from when XKCD was funny...
 
I don't think it would be a good idea to look at the patient smiling, and without hesitation sociably saying, "This is my first surgery! I'm excited...So are you ready to go under?"

It's just hypothetical but I got a kick out of reading the rest 😉
 
36-year old woman asks doctor (me 😳): why do you suppose I got gall bladder stones?

Doctor: There's a saying.. Fat females in their forties.. have you heard it?

I wasn't too popular after that.:laugh:
 
they warned us when practicing our breast exam skills to not say things like "everything looks really good!" or "that feels good!"

The only thing worse than doing this would be having sex with your girl and saying "yep, everything appears to be normal".
 
I Stole these from CollegeHumor:
"
It's sort of a boy.

Let's just hope when you die it dies with you

I don't think anything is wrong, you can go… Whoa! I don't think shaking hands is necessary right now.

Now when you look in the mirror at your new nose keep in mind yesterday was St. Paddy's day and my last name is O'Connor.


You have what my Uncle Frank had…He was a good man.


I'll take some money off your surgery if you can score me some clean urine.
"
 
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Love this! It's so true. One of the most important things we can take away from clinical years is what TO DO and NOT TO DO in clinical situations. I'm talking interpersonally here - not medically. Don't call you're patients lovey and don't dismiss their concerns. Oh, and medical speak should be avoided at ALL COSTS.

I once heard a resident telling a patient about breast reconstruction and using the actual names of the muscles - describing the procedure as his medical text does. The patient looked much more confused when he was done. Finally, when the attending said, "We're going to basically make a hammock from your own tissue" the patient said "OH, I get it!" Moral of the story: read your patient's face and simplify it so they undrestand it. Some want muscle names and procedure details, others just want the basics and some reassurance.
 
If you come in and find your patient asleep, whatever you do don't give put a lit match betwen his toes giving him a hotfoot and then when it burns him awake laugh and point to his face and shout, "Gotcha Turkey!"

don t date a trichomonas vag patient or date a drug addict

dont do surgery on your mother in law
 
dont tell your patients they have a ticking time bomb inside their chest no matter how truthful or urgent you believe that statement to be. crushing their spirits will crush their immune system.
 
Do NOT place your hand on a lady's precordium during a cardiac exam and tell them you are feeling for a thrill. Many won't know medical terminology and They WILL take it the wrong way.
 
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I don't think it would be a good idea to look at the patient smiling, and without hesitation sociably saying, "This is my first surgery! I'm excited...So are you ready to go under?"

It's just hypothetical but I got a kick out of reading the rest 😉

Uhm I did
 
dont tell your patients they have a ticking time bomb inside their chest no matter how truthful or urgent you believe that statement to be. crushing their spirits will crush their immune system.

Umm, no. Their ticking time bomb may kill them. Their crushed spirit will likely do as much for their immune system as someone's happy spirit will; which is just about jack. We do probably more harm to patients telling them that they should keep their spirits up or keep a positive attitude than we do them good. Positive attitudes have almost no effect on mortality or morbidity (in fact, I believe there is some evidence [I haven't read the studies so I can't comment on the quality] that the pissy patient is going to do better).
"You have 'X' [bad disease]...but you should try to have a positive attitude."
"F$&k you, I'll have any attitude I goddam well please..."
 
Umm, no. Their ticking time bomb may kill them. Their crushed spirit will likely do as much for their immune system as someone's happy spirit will; which is just about jack. We do probably more harm to patients telling them that they should keep their spirits up or keep a positive attitude than we do them good. Positive attitudes have almost no effect on mortality or morbidity (in fact, I believe there is some evidence [I haven't read the studies so I can't comment on the quality] that the pissy patient is going to do better).
"You have 'X' [bad disease]...but you should try to have a positive attitude."
"F$&k you, I'll have any attitude I goddam well please..."

I appreciate that you're a Fellow and all, but I'm sure I've read studies that say exactly the opposite of what you're claiming.
 
I appreciate that you're a Fellow and all, but I'm sure I've read studies that say exactly the opposite of what you're claiming.

I agree with J-Rad, pretty much. I haven't really studied the topic, but I have heard of studies like this one:
"We anticipated finding that emotional well-being would predict the outcome of cancer. We exhaustively looked for it, and we concluded there is no effect for emotional well-being on cancer outcome," said study author and University of Pennsylvania psychologist James Coyne. "I think [cancer survival] is basically biological. Cancer patients shouldn't blame themselves -- too often we think if cancer were beatable, you should beat it. You can't control your cancer. For some, this news may lead to some level of acceptance."

The study, expected to be published in the Dec. 1 issue of Cancer, culled data from almost 1,100 patients enrolled in two phase III clinical trials for new head and neck cancer treatments.

The patients completed questionnaires about their attitude and social networks at the beginning of the study and at follow-up. The questionnaire included five questions to assess emotional well-being, including such items as "I am sad" and "I am losing hope in my fight against my illness."

By the end of the five-year study, 646 patients died. When the data was analyzed, the researchers found that emotional status had no effect on the course of the cancer or the patient's survival.

Here's another:
The study involved 708 women in the Australian Breast Cancer Family Study who had been newly-diagnosed with localised breast cancer and tracked them over eight years to see whether their cancer relapsed. A quarter died over the period.

Levels of depression, anxiety and other factors like fatalist outlook, avoidance, anger, and feelings of hopelessness also were assessed.

"Essentially, the bottom line is we didn't find any correlation at all between these issues and whether their cancer came back," Professor Phillips said.

"This goes against what the vast majority of patients believe."

Interestingly, women who had an anxious preoccupation with their cancer were more likely to get a relapse, but once the researchers adjusted for all the things known to cause recurrence, like size and grade of the tumour, this association disappeared, she said.

"The women who were anxiously preoccupied were the ones that had the worst tumours, so they were anxious and preoccupied for a reason, Professor Phillips said.
 
I saw a senior resident give the wrong dose of epi because one of his patients was having an anaphylaxes reaction...she ended up having an NSTEMI. Not good.
 
I agree with J-Rad, pretty much. I haven't really studied the topic, but I have heard of studies like this one:


Here's another:


Gloomy and socially inhibited patients with peripheral artery disease (PAD) were at greater risk for all-cause mortality than their more cheerful counterparts, a Dutch pilot study found. After adjusting for independent predictors including age, diabetes, and renal disease, researchers found that patients with so-called "Type D" personalities had a more than threefold greater risk of death (P=0.04), according to Annelies E. Aquarius, PhD, of Tilburg University, and colleagues.

They reported their findings in the August Archives of Surgery.

Earlier studies have suggested that certain personality traits such as hostility may worsen the course of atherosclerosis. Type D personality, characterized by negative emotions and inhibited self-expression in social interaction, has been associated with morbidity, mortality, and poor quality of life in cardiac patients.

To investigate the relationship between this personality and mortality in PAD, the Dutch investigators followed 184 patients with intermittent claudication for four years after they completed a baseline Type D personality questionnaire.During the follow-up period, 16 patients (8.7%) died. Of those, seven died of cancer, six of cardiovascular disease, and the rest from pneumonia, acute pancreatitis, and emphysema. Cox proportional hazard regression analysis, adjusting for age and sex, found that Type D personality was predictive of all-cause mortality (P=0.03).


Analysis of the differences in survival curves between Type D and non-Type D patients found an all-cause mortality hazard ratio of 3.2 (95% CI 1.2 to 8.6, P=0.02).

Scientists have studied psychological factors such as depression and social avoidance in patients with other atherosclerotic diseases, such as coronary artery disease. But the researchers said this study, for the first time, demonstrated prospectively that a psychological factor was an independent predictor of all-cause mortality in PAD. Aquarius and colleagues suggested that multiple factors may mediate the relationship between Type D personality and poor outcomes in patients with cardiovascular disease. For example, this distressed personality is seen in patients with chronic heart failure, in which increased immune activation is associated with high plasma levels of the pro-inflammatory cytokine tumor necrosis factor and its soluble receptors.

Type D personality also has been associated with disturbances in the hypothalamic-pituitary-adrenocortical axis and elevations in cortisol reactivity.

"In addition to improving awareness of the traditional medical risk factors in PAD, attention should be given to psychological factors that may have an adverse effect on the clinical course of PAD," the investigators commented.They cautioned that their findings were based on a limited number of events, and that multicenter confirmatory research is needed. But they concluded that a "personality-based approach" may be useful in identifying high-risk PAD patients, and that psychological screening may prove helpful.

In an accompanying commentary, Karl A. Illig, MD, of the University of Rochester, called the findings intriguing, and suggested that distressed patients may have poorer health habits and, therefore, worse disease at presentation.
Alternatively, they may have less effective coping strategies for ongoing health difficulties and complications -- an explanation that implies a possible role for intervention. "These findings are of interest and add a bit of objectivity to the concept that the personality of a patient can affect his or her health and well-being," he wrote.The study was supported by the Netherlands Organization for Scientific Research.
The investigators and the commentator reported no financial disclosures."


Primary source: Archives of Surgery
Source reference:
Aquarius A, et al "Type D personality and mortality in peripheral arterial disease" Arch Surg 2009; 144: 728-33.

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And, in addition to that, what neither of our cited research addresses is the relationship between psychological factors and development of illness in the first place.

There's a ton of research out there linking social isolation/loneliness with decreased immune function, etc. (Both animal models & human research). Also, it's clear that our attitudes/emotions (cortisol, anyone?) have real physiologic effects both in the short-term and in the long-term.

I'm sure you can find evidence for a lack of a relationship between social/psychological factors and health (because often times, other factors- such as smoking/lung cancer- simply eclipse these factors).

But that doesn't make them disappear entirely. They just have not been teased out. They're still there!

It just seems silly to look at the mind as being so distinct and separate from the body, when they are one and the same... emotions, attitudes, etc. are all in the BRAIN... and to say that brain function has no effect on health is ridiculous.

Even if these factors have no other effects other than the two I mentioned previously (immune function/cortisol release)- which is far from the truth, but those two are certainly well-proven- that still shows a significant relationship between psychological factors and health. Diminished immune function by itself (devoid other stressors) may not cause pathology... (it's not a direct stressor like smoking --> lung cancer)... but it's the kind of factor that operates in the longterm to increase overall mortality, etc.
 
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In a similar vein, I saw a 3rd year taking a history from a 14y/o girl last night...

M3: "Are you sexually active?"
Pt.: "Yes."
M3: "Sweet."

:smack:

I think that's cool as long as he wasn't fapping.
 
Do not ask a patient out until AFTER they've finished the entire regimen of antibiotics.

Don't believe anything patients tell you, unless they tell you that they're going to sue.
 
It's ok. Having done this twice now, I can say with some certainty that pregnancy comes down to 2 words: design flaw. Lol.

LMAO!!! I just looked at the time and date of this post - my water broke 1/2 an hour later. Omg. :laugh:
 
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