July 13, 2014

cell phone

Having just upgraded to an iPhone 5 courtesy of my sister-in-law, this comment below is quite amusing, and very disturbing. My iPhone is a combination of a beautiful design and intuitive functionality that makes my life more productive. The EMR I use everyday leaves me cussing. So read this interesting analogy from a comment on KevinMD.com regarding an article about Electronic Medical Records, aka another requirement by the "Affordable" Care Act which is anything but affordable.

The year is 1990. The federal government has made the decision that everyone needs to switch to cell phones. The government claims that landlines are too inefficient and prone to error which may or may not be true. The only thing everyone can agree upon is that it is much easier for the government to monitor cell phones then landlines. In order to coerce people to switch to cell phones the government first provides bribes, but eventually will fine people for not making the switch. However, in order to get the bribe the users have to follow and document certain guidelines and have to do so within a fixed time frame. 
Cell phone carriers rush in provide the phones. With the rush to make the switch, fundamental errors are made such as different carriers working on different frequencies so some phones won't communicate with each other, if you can get a signal at all. Worse still, the market is dictated not by what the users may want or need, but how best to meet the criteria to get the bribe. Phones are made with a 25 digit keyboard so required codes can be entered. Before each call can be made a pop-up question screen appears so that the user can meet the requirements the government has decided are necessary to make the call. 24 years later some users have gone through multiple phones, cursing the day they ever switched from landlines.

July 4, 2014

knocking the rust off

     I look at my text.  There's a patient in the ER who has Pick's Disease.  Pick's Disease is a form of dementia a bit like Alzheimer's except instead of memory loss being the major first symptom, they tend to have personality changes first.  What used to be a prim and proper little old lady will start cussing like a sailor and then not see that they've changed or done anything improper.  Like any dementia, it tends to be hardest on the family members and caregivers.  The spouse had reached their limits and could no longer protect the patient from their self so came to the ER.
     There was nothing I could for them medically.  But being a doctor is more than just being a drug monkey.  I did what their neurologist should've had the guts to do but didn't.  I started to have "the talk" with them.  What does the patient want from their last moments on this earth?  What does each of the family member want?  How can it be arranged that the patient is safe but their final wishes still be honored?  I didn't intend to complete the conversation then and there.  I just wanted to plant the seed and begin to allow the questions be pondered and pontificated over.  They still had time to do that.  But I told them they don't want to have that conversation when the patient gets admitted for pneumonia and the next thing you know, they're in the ICU and everyone is too stunned to know what to do next. 
     Before this June rotation, it had been a good 10 months before I had seen an adult patient.  There was a lot of rust to knock off.  And even then, there wasn't the rhythm and flow that I used to have for the first 9/10 of the rotation.  This patient was the first time I got back into that groove.  I heard their story beyond just the physical problems and connected with them.  The fact that it was on a terminal patient is not lost on me. 

































July 2, 2014

fail

     "Failed?  What do you mean 'failed'?" my wife asked puzzled.  "You never fail."

     But indeed I had.  A clinical exam, no less.  In my defense, it had been 10 months since I'd seen an adult patient and had more than my share of problems on my mind.  But I've been operating that way for years now.  Why did the cracks start to show now?  That's really not quite true.  The cracks have been there all along.  And quite a few more have been added along the way.  It would be akin to breaking my leg in the backcountry.  How far could I hike on it before the broken bone becomes too much?  How long can willpower and adrenaline alone last?  At some point, healing must begin to take place, even if in the most minute spots.

     I passed it on the second try.

June 28, 2014

living with pain


 
Can you tell the difference between these?  Unfortunately, I couldn't.  At 5 am, some things are rocket science until caffeine kicks in.  And I didn't put the deodorant on my back.  I put the icy hot on my armpit.  THAT will wake you up quick.  And I mean jump to it.  I couldn't wash it off quick enough.  My armpit felt burned the rest of the day.

June 20, 2014

how we learn


     The student I'm on with hands me a patient list after a presentation.  "The resident said for us each to pick up one patient."  I grab the list and look at it.  Wait a minute.  These medical record numbers are for a different hospital than the one I'm assigned at.  And the admission date is from 2 months ago.  Something doesn't add up.  I text the resident for some clarification.  He responds, "just read up on their chart.....and good luck finding them."  I look at the schedule and realize we're supposed to be in the morgue in the afternoon.  It slowly dawns on me, these "patients" aren't really patients in any sense of the word anymore.  They are more specimens, really, by this point.

June 13, 2014

does God have a dark sense of humor?

     The resident texts me to go see a particular patient who is new.  That means reviewing everything and getting the full story.  And since I'm on a "consult service" these two weeks, that means I have to figure out why the primary team wants us to see them.  I begin reviewing the chart.  The ER note reads, "A 42 year old male with a recent diagnosis of stage IV squamous cell carcinoma presented to the ER with blah, blah, blah."  Seriously?  My first adult patient in over 10 months and it has to be a terminal cancer patient?  I don't need re-exposure therapy for PTSD.  I'm getting re-exposed plenty fine on my own.

June 7, 2014

     New month, new rotation.  Less than 7 months to go until I am can add those two little extra letters after my name.  My last rotations have been more grad school like classes with seminars and writing papers.  No patients.  It was a nice change for awhile but this month, I'm back to seeing patients.