A lot of dopers seem to ask about medical stuff. This here is a thread for frank opinions about that sort of thing as well as perspectives on medicine, docotrs, nurses and suchlike in general. Go nuts.
What is the proper procedure after accidentally knocking a tray of surgical tools into an open patient during his/her surgery?
Are the laws of The House of God still true?
GOMERS DON’T DIE.
GOMERS GO TO GROUND.
AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
THE PATIENT IS THE ONE WITH THE DISEASE.
PLACEMENT COMES FIRST.
THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM.
AGE + BUN = LASIX DOSE.
THEY CAN ALWAYS HURT YOU MORE.
THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
SHOW ME A MEDICAL STUDENT WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY,THERE CAN BE NO LESION THERE.
THE DELIVERY OF MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.
They were certainly applicable while I was training, but that was 20 years ago now. Any updates?
Oops, forgot this part!
from House of God
by Samuel Shem,
Richard Marek Publishers, Inc., New York,
©1978 by Samuel Shem
Is there anything a person can do to lessen his/her chances of passing another kidney stone?
(Related question: You are in the process of removing a stint five days after operating on a patient to remove a kidney stone. Is this the appropriate time to make jokes?)
Well, doc, y’see, there’s this pain in the back of my left knee, sort of where that tendon on the outside back of the thigh disappears into my calf. The pain crops up occasionally, and I’m think I’ve narrowed it down to stressful times at work. Am I going to die if I get stressed-out again?
When you’re in medical school, does the school actively teach you about interacting with patients? I have mostly encountered doctors who are very professional and compassionate and relate well with their patients, but I have seen a few who could use some serious tips about dealing with people.
I noticed this especially when I was in the hospital. There was one particular doctor who would do his rounds with his students, and he was just awful. His bedside manner made me feel like a lab experiment, and by example, he was teaching these students to behave like that as well. As a for instance, he was having trouble pronouncing my name, so I said it for him, and he said “Whatever.” Another time, he accidently pulled the blanket off of me as he was walking away (it was stuck on his clipboard or something) and instead of picking it up, he called a nurse over to do it. Ok, so it only took her about 30 seconds to stop what she was doing and walk over, but still, it’s a long 30 seconds to be showing the world your undies.
Again, this guy was not the norm, most of the docs were great. And I also realize that this is secondary to receiving quality medical care – nothing about this particular doctor made me think he wasn’t competent. I’m just hoping that at some point in med school, someone is addressing bedside manner issues so that his particular students will see that his behavior is not ideal.
As a doctor, have you ever been in a situation where you were the patient, and realized something that you think could be done better or differently? Is there any truth to the saying that doctors make the worst patients? Have you noticed this when you have treated other doctors?
When a patient comes into the emergency room, do you and the other doctors and nurses make fun of their underwear? I would like to just have to wear my granny panties cause they’re comfortable. I would hate the idea that doctors, nurses and other medical personnel would make place a lot of importance on nice underwear.
delphica,
I’m not the chief resident here, I’ve been out in practice for 15 years. But this is a subject that my wife the social worker and I have had many discussions about.
We had classes on “biopsychosocial medicine”. If the name sounds pretentious, it only begins to give you a sense of the class. Useless. I saw some of the most caring docs-in-training get hurt when patients that they cared about did badly, and then responded with a cold ass wall to protect themselves from getting hurt in the future. Listening skills and what gets called “detached concern” (I care about my patient but it is not me with the disease) are hard to learn and harder to teach. I think the reality is that, if we are lucky, we have a few good role models, and we take the tricks of the trade that match who we are from each of them to cobble together a style of our very own. My wife takes the position that these skills can and should be didacticly taught. It is also true that residency can beat the compassion right out of you. Long hours and no sleep does not really equal bad judgement (most is on autopilot by that point) but it does make for someone who just wants to get the job done with a minimum of connection to the patient.
BTW, I do comment on MY patients underwear. But then I’m a pediatrician, and a discussion about pull-ups vs diapers and Power Puff Girls vs Winnie the Pooh, goes along way to establishing some common ground!
LENIN
What is the proper procedure after accidentally knocking a tray of surgical tools into an open patient during his/her surgery?
The first step is to remain calm and not say anything that would tip off the patient that something is wrong. Say “Good!” in a reassuring voice. Remove tools from the patient and put them in a dark corner of the room so you don’t use them again before they’re put in the dishwasher. Hopefully, none of the tools were contaminated since they were on the tray, which is sterile. Make sure none of the tools caused complications like bleeding. Blame the anesthetist and hard-working scrub nurse regardless of who knocked the tools where.
QADCOP
GOMERS DON’T DIE.
This is still a universal truth.
GOMERS GO TO GROUND.
Neurosurgery and orthopedics are more reluctant to accept these patients than in the past, so it happens far less.
AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
Still good advice.
THE PATIENT IS THE ONE WITH THE DISEASE.
The doctors in the US must be more grounded than the ones here.
PLACEMENT COMES FIRST.
This should be writ large on every medical ward.
THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM.
Never had much luck getting into the fourth ventricle this way, but probably due to a shameful lack of resolve.
AGE + BUN = LASIX DOSE.
No one uses this one since that damn RALES study.
THEY CAN ALWAYS HURT YOU MORE.
Not if I have a #14 needle!
THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
Depends who’s looking after the patient. I have heard stories about good admissions who were still living but these are probably apocryphal.
IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
This is the basis of pediatrics and the philosophy of lazy emerg docs who hate consulting infectious disease. No one is lazier than a lazy doctor.
SHOW ME A MEDICAL STUDENT WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
I made my boss an extra $15,000 last month but he is inviting me to his place for turkey.
IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY,THERE CAN BE NO LESION THERE.
I’d agree with the first half. I’d agree with the second half if fingerprints can represent trauma.
THE DELIVERY OF MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.
Now who makes money doing this? Oh… you mean GOOD medical care…
RYSDAD
Is there anything a person can do to lessen his/her chances of passing another kidney stone?
Doctors are always arguing about which stuff is the most painful but this is near the top of the list. Not surprising you don’t want to pass another one. Your doc probably told you to drink more fluids. Depending on the type of stone, you might have been told to drink less milk, but dietary calcium may prevent stones. So there.
If you’ve had more than one kidney stone, you are likely to form another; so prevention is very important. To prevent stones from forming, you must find the type of stone, the laboratory can analyze it to determine its composition, e.g. “kryptonite”.
You may be asked to collect your urine for 24 hours after a stone has passed or been removed. The sample could be used to measure urine volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and creatinine (a product of muscle metabolism). Your doctor could use this information to determine the cause of the stone. But it’s more fun just to throw it away and ask for a second sample.
The doctor may prescribe certain medications to prevent calcium and uric acid stones. These drugs control the amount of acid or alkali in the urine, key factors in crystal formation. The drug allopurinol may also be useful in some cases of hypercalciuria and hyperuricosuria; drugs to make you pee more also help. Some patients with absorptive hypercalciuria may be given the drug sodium cellulose phosphate, which binds calcium in the intestines and prevents it from leaking into the urine. Cystine stones are controlled by drinking a gallon of water daily or with Thiola. If you have struvite stones, your urine may be tested regularly for infection.
LNO
Am I going to die if I get stressed-out again?
No. Just stung by a high-strung hamstring.
DELPHICA
Does the school actively teach you about interacting with patients?
Yes, to the extent these things can be taught. Most med studnts are naturally fairly compassionate. Unfortunately, the admissions process does not do a good job of weeding out sociopaths good at faking compassion.
… I also realize that this is secondary to receiving quality medical care…
I have heard this before, but to me this is merely part of receiving quality medical care and to say otherwise is just making excuses. Learning skills like surgery and medicine is a matter of time and exposure; you could do it given enough motivation. Humility and compassion are much underrated in these times and far more important than most patients realize. A doctor who does these things does them often and without thought… so what else do they do this way?
Have you ever been in a situation where you were the patient, and realized something that you think could be done better or differently?
Absolutely. But doctors who treat themselves have fools for patients and I would avoid saying anything unless I thought it would make a big difference. Every docotr has their own ingrained preferences p[robably no better than other treatments. Also, it is more useful to have a cheap test that reveals very good information than a more expensive test that doesn’t reveal more. Most patients do not understand this.
Is there any truth to the saying that doctors make the worst patients? Have you noticed this when you have treated other doctors?
Doctors expect more complete investigations than the average guy for obscure stuff. Most doctors are obsessive-compulsive to begin with, so yeah, they’re more demanding. They also get better treatment, which they shouldn’t.
MEDSTAR
Do you and the other doctors and nurses make fun of their underwear?
Not usually. I’ve only seen it happen once. You would be safe in your granny pants.
DSEID
We had classes on “biopsychosocial medicine”. If the name sounds pretentious, it only begins to give you a sense of the class. Useless… Listening skills and what gets called “detached concern” (I care about my patient but it is not me with the disease) are hard to learn and harder to teach… My wife takes the position that these skills can and should be didacticly taught.
It becomes obvious very quickly that many medical conditions have psychiatric and social dimensions. Once you realize this, good doctors address these things as part of their history and don’t make a big deal out of it. If these factors are overwhelming and can be modified, they should be addressed with minimum fuss.
Academics love terms like “patient centred medicine”, “biopsychosocial”, “FIFE” (function, ideas, feelings, expectations) and throw them about like they’re new or not already being done. I agree they are pretentious, and they certainly are often useless.
But not completely. I feel a good doctor cares about the patient and that patients like these ideas addressed over the course of time and when relevant. Becoming too close to the patient clouds one’s ability to provide good care, use resources adequately and deal with unexpected complications that will always arise since life is not predictable. Caring is shown by listening well. Knowing how disease limits a patient’s life and what the disease means to the patient is useful to inspire trust, but most patients are not and should not be my “friend”. Knowing what the patient thinks the cause is can be useful if they are worried about a disease that runs in the family. Feelings are useful in psychiatry, but the few patients who enjoy being sick aren’t likely to divulge this so bluntly… and who else enjoys having an illness? Expectations get in the way of good care but should be addressed if unrealistic.
Can these skills be taught? No, just augmented. The classes are wrong in trying to say every patient should have all of these ideas explored. Bringing them up out of context just makes people antsy and weakens the bond. The reason biopsychosocial class was useless is because they didn’t discuss when these things should be used and because the professors don’t understand that doing the best for each patient often precludes close friendship. Medicine is not about being “above” other people… those who get smug satisfaction from claimed medicine performed in this way leads to better care are usually still convinced medicine is about glory. You know better. They don’t.
We’ve had a lot of workshops and such about patient interaction/patient-centered medicine/etc., and I agree with Dr. P about their usefulness. A lot of these occurred during my Family Practice rotation. Here are some clips from my review of that rotation from my Famous M3 Rotation Reviews:
I’d ask for advice on the match, residency interviews, etc., but frankly, I’m sick of thinking about it. Instead, I’ll ask–what do you know now, at the end of your residency, that you wish you had known at the beginning?
Dr. J
Academics crack me up. They give something a new name and think that they’ve created it. And they usually know how to do it the least well. No one knew the value of knowing the whole patient (and family) better than my, may he rest in peace, former senior partner. And I don’t think he was lectured about it either.
Teaching the psychosocial side: Let’s face it. It is commonsense and you all knew it before you got to med school. Usually better than after med school. To lecture about it at the beginning of training is lipservice. You need the experiences to put things in context and perspective. It needs to be integrated into training in clinical rotations, mentored on the field of battle. The nature of residency (in-patient, high intensity service, with brief contacts with quite ill indivdual patients and families, little direct supervision during patient interviews, extreme demands on time, emphasis on technical expertise and efficiency) is not conducive to developing or augmenting these skills. Those who have those skills at the end of training have them DESPITE the training program, not because of it. The most accurate answer to the original question is, no, no one supervises a doc-in-training interact with patients one on one after the very beginning of clinical experiences.
And don’t get me going on what gets, ironically, called “evidence based medicine”, and which, unfortunately is creating a generation of doctors trained to unquestioningly follow protocols, rather than to question and dig for original literature.
Two other comments.
Simple one on stones. The good chief res gave some good info, just one addition. Do NOT limit your calcium intake to prevent calcium oxalate stones. Your urine will steal calcium from your bones and it won’t effect whether or not you get stones. Decreasing oxalate intake might make sense, talk about it with your real doctor.
Second is that the “Rules” change for different specialties. In pediatrics the general rule is “Do nothing but do it well.” I spend a lot of time verifying that the child will be best served by tincture of time, rather than implementing an unneeded course of action. And more time convincing worried parents that it is better to do nothing (more than TLC) than something. Emergency Med docs, for example, would live instead by the rule of “Presume the worst until proven otherwise.” And so on.
I’ll be retiring from the military in about 7 years at the age of 39. When younger, I always thought about a career in medicine, but instead have spent my time in the army doing fun stuff instead.
Question: at 39, will I be too long in the tooth to become a Doctor? Money shouldn’t be too much of an issue. I will have my GI Bill/College fund money (+/-$50,000) to spend on education. Also, I have completed a B.A. although not at all related (B.A. in language studies)
Thanks.
I got my tonsils, adnoids and uvula removed (UPPP) a week ago Thursday (about 10 days ago) and while my throat feels fine, I’m still hacking up a bunch of gunk.
Initially, I had what I’m sure was a sinus infection, chunky-yellow phlem and all that. Now it’s more of that brown-tan snotty stuff.
Since I can’t/shouldn’t blow my nose, the only way I ever see this stuff is by snorting/pulling it back into my throat and hacking/coughing it up. In the mean time, I’m waiting for the scabs to come off and I think they are what is constantly tickling the back of my throat and making me wake up coughing at 5 AM. I’ve got the standard follow-up appt. but that isn’t until the one month mark (three weeks from now.)
Any suggestions on knocking out the phlem?
What’s with the long hours for the young docs in emergency? Isn’t there a correlation between lack of rest and making mistakes?
Truck drivers have strict legal limits on the number of hours they are allowed to work. Same goes for airline pilots. The reasoning is obvious. Tired trucjers and pilots could endanger human lives.
Why are doctores and nurses REQUIRED to work a ridiculously large number of hours? Seems intuitively obvious to me that’s a bad idea.
When I was in labor, I had to deal with a resident who was the worst ass I have ever had the misfortune to be in the same hospital with. This guy was a tool with a capital T. And I don’t care how many times he apologized to me for his behavior (“It’s the end of my shift…I guess I’m just tired…” argh!!) I just hope and pray this guy does NOT become an obstetrician.
So, this is my question. Do all/most residents stick with the speciality they take their residency in? I mean, is this idiot going to make a career in this field, or is there a chance he can and will figure out it’s not for him, and he’ll switch to something else (perhaps pathology)? How common is switching?
And while no one asked me specifically: drillrod, my friend just graduated from a highly-rated med school and he had several older former military personnel in his class. I don’t think your age or your prior life is any strike against you. Probably a plus, actually.
how do you deal with death?
especially as a pediatrician?