- I am done with my urogyn rotation and I now have three weeks of vacation!
- It turns out I have a ton of work to do in these three weeks, and it all needs to have been done YESTERDAY (eg, residency application, research project)
- I deserve a tiny little break, though, so this weekend is a true weekend, with no worries other than "should I go to the beach now, or wait a couple hours for the sun to get less intense?" (Answer: I went *now* and it was wonderful.)
- On top of that, I have to figure out how to get a huge mountain of stuff, including two cats, back to Kentucky in one little car at the end of these three weeks
- Sarah Palin is a very smart choice for John McCain, and interesting from a political standpoint.
- From a medical standpoint, I am most intrigued by the fact that Palin is 44 with a 4-month-old. I suspect medical intervention, but I suspect it very often these days, so don't take my word for it. And not that there's anything wrong with infertility treatment -- heck, it's a possible career choice for me! My curiosity is purely professional.
- I broke a mirror today. It's not the first I've broken in my lifetime. I had always thought it meant seven years of bad luck, but according to Heidi Klum on this week's Project Runway, it means seven years of no SEX! That's problematic.
- I tried to place a takeout order from a local bar last night. On our copy of their menu, it states that takeout orders will incur a 20% service charge (I guess it's the same as the tip we'd leave if we ate in, so I was willing to do it), and that at busy times, they reserve the right to refuse all takeout orders. So I called, and the guy said they don't do takeout orders at all anymore. Period. I read him the menu and he said they had just changed their policy. No takeout orders. So I asked if the dining room was busy (half thinking maybe we would just go eat there), and he said, "No. The dining room is actually pretty empty." So then I was pissed. Your dining room is empty and you still don't want my money?!?!! They lost our business on principle.
- So instead of eating at this place, we went to Wawa and tried their new BTO (built-to-order) salads. $5.50 gets you a big salad with lots of veggie options, and includes protein (I got grilled chicken). It's a great deal! Definitely going back, and not just for my standard turkey hoagie.
- I bought a cheap bike at Target a couple weeks ago and rode to the hospital every day. It was awesome. You can go pretty much anywhere with a bike, a helmet, and a willingness to be hit by a car on the Walnut Street bridge. I intend to keep biking back in Louisville, if I can figure out how to get the bike back there (one suggestion: return the bike to Target and just buy it again in Kentucky. Slightly sketchy, but I've done worse.).
Sunday, August 31, 2008
Random thoughts
Sunday, August 24, 2008
Urogynecology
That's what I've been doing at Penn the last three weeks, and I'm starting my last week tomorrow. It's been a lot of fun, and I'm really glad I came for this rotation. Here's what I learned that YOU should know:
Water is the best thing for your bladder. Caffeine makes you urinate (which you already knew), and can be irritating to the bladder, as well. Acidic or spicy things can irritate your bladder as well. Colas are probably among the worst thing you can drink, bladder-wise, since they are caffeinated, acidic, and full of all sorts of other chemicals. If you're not having any urinary issues, go ahead and drink whatever you want, but if you do have problems peeing, start cutting out all your non-water beverages.
Hot tea is better for you than iced tea. My attending tells her patients that if you think about it, cultures all over the world have been drinking hot tea for thousands of years, and don't seem to have too many problems. In America, we invented iced tea, and she sees women with all sorts of bladder issues because of it. (Note, this is not a proven fact, but an observation of hers over her career.)
Drinking 8 glasses of water a day is, in the words of my attending, "bullshit." You've probably read lots of stuff in the lay press talking about how the 8 glasses thing is a myth, and we're not really sure where it started. Since we also gain fluid from foods we eat, the total fluid intake most of us probably need is somewhere around 4-5 8-oz glasses a day. And that includes non-water beverages, as well. If you're a young woman who can handle getting up to go to the bathroom every hour because you're drinking 8-12 glasses of water a day, that's fine -- you likely won't suffer any negative effects. But if you're 45 and bothered by the fact that you have the urge to urinate every 30 minutes, then for goodness sakes, stop drinking so much! (That's the first thing to do, anyway.)
Wearing Depends is NOT a normal part of aging! So many women think that urinary incontinence is something they just have to deal with, and that is completely untrue. Go see a urogynecologist -- there are many things that can be done for you.
Kegel exercises are your friend. Start doing them now, no matter how old you are! Doing them before you have your first vaginal delivery is great prevention, and doing them throughout your lifetime will help to prevent further pelvic floor problems as you age, and help reverse pelvic floor problems if you already have them. To do them, squeeze the muscles in your pelvis as though you are trying to hold your urine or stop your urine stream. Do 5 "quick flicks" (squeeze and hold for 1 second) and 5 squeeze-and-holds (hold for 3 seconds) each day. Do them in the car, while you're stopped at a light. Do them in a boring meeting. Just do them whenever. Plus, you know, it's good for your sex life, too.
And speaking of sex, everyone should be having it! One of my favorite patients from this month was a 90 year old (who, first of all, looked not a day over 60) who was complaining of pelvic organ prolapse (something "falling down" from her vagina). As part of my normal screening questions, I asked if she was sexually active. She replied, "I've been widowed for 25 years," and I nodded and began to apologize if I had offended her. "But I was in Puerto Rico with my [female] friend last month on vacation and I met a guy, and let me tell you: I COULD have. But I decided not to." And then she laughed. It was great! I love the thought of this 90-year-old picking up a guy in Puerto Rico.
On the other hand, we also see a lot of older women who aren't having sex, and are very frustrated by it. When you question them, there are themes of emotional issues with their husband, or a sense of inadequacy in either the husband or wife that no one has ever had the guts to address, or health issues in the husband that aren't necessarily solved by viagra. From our standpoint, we want everyone to be having sex, and we want to do everything we can to get women to be sexually active again. One of the sadder things I saw was a woman in her 70s who came in with her husband, and when asked if they were sexually active, she quickly replied, "Oh no, honey, we're 75 years old. We don't do that anymore." It was hard to read her, because she clearly didn't want to talk about it any more, and her husband started to say something but didn't want to interrupt after she had made it so clear the subject was closed. They otherwise seemed very emotionally content and apparently had a solid marriage, so it was sad that their sex life had fallen by the wayside. My attending tried to reassure the patient that sex was normal at any age, and that any sort of "fooling around" was completely OK -- oral sex, labial sex (dry rubbing, essentially, if the guy can't achieve an erection), whatever. The patient looked a little uncomfortable at the talk of oral sex, so that was the end of that discussion.
Speaking of uncomfortable, I was also surprised at the number of women who are very uncomfortable with their own bodies. For certain issues, we might prescribe a pessary, which is kind of like a diaphragm but for the purposes of pelvic support. Most pessaries can be worn during intercourse, or can be taken out by the patient before sex if she wants to. Some patients return to the doctor every few months for pessary checks, and one day I saw a woman in her 60s for just such a check. She mentioned that her husband noticed he could feel the pessary during sex, which was new, and she wanted us to check it out. When we asked if she had taken it out herself to check it, she looked mortified and replied that she didn't know how to take it out (directions: stick your finger in your vagina and pull it out). And not only did she not know how, but you could tell that she was completely embarrassed at the thought of taking it out herself. I was shocked. But she -- and many other women of that generation -- have never used a tampon, let alone masturbated, and are really not in touch with their own bodies at all. So the nurse and I taught her how to remove and insert the pessary, and it was so gratifying when she got the hang of it.
Overall, this has been a great rotation, and urogynecology is a very interesting field. I think it's probably not ideal for me, since the patient population is very specific -- middle-aged and older women, almost completely -- and I'd like a little more variation in age. But, urogyns have good hours (no middle-of-the-night deliveries) and do a lot of operating, which I like. So I'll put in the back of my mind and see what happens.
Water is the best thing for your bladder. Caffeine makes you urinate (which you already knew), and can be irritating to the bladder, as well. Acidic or spicy things can irritate your bladder as well. Colas are probably among the worst thing you can drink, bladder-wise, since they are caffeinated, acidic, and full of all sorts of other chemicals. If you're not having any urinary issues, go ahead and drink whatever you want, but if you do have problems peeing, start cutting out all your non-water beverages.
Hot tea is better for you than iced tea. My attending tells her patients that if you think about it, cultures all over the world have been drinking hot tea for thousands of years, and don't seem to have too many problems. In America, we invented iced tea, and she sees women with all sorts of bladder issues because of it. (Note, this is not a proven fact, but an observation of hers over her career.)
Drinking 8 glasses of water a day is, in the words of my attending, "bullshit." You've probably read lots of stuff in the lay press talking about how the 8 glasses thing is a myth, and we're not really sure where it started. Since we also gain fluid from foods we eat, the total fluid intake most of us probably need is somewhere around 4-5 8-oz glasses a day. And that includes non-water beverages, as well. If you're a young woman who can handle getting up to go to the bathroom every hour because you're drinking 8-12 glasses of water a day, that's fine -- you likely won't suffer any negative effects. But if you're 45 and bothered by the fact that you have the urge to urinate every 30 minutes, then for goodness sakes, stop drinking so much! (That's the first thing to do, anyway.)
Wearing Depends is NOT a normal part of aging! So many women think that urinary incontinence is something they just have to deal with, and that is completely untrue. Go see a urogynecologist -- there are many things that can be done for you.
Kegel exercises are your friend. Start doing them now, no matter how old you are! Doing them before you have your first vaginal delivery is great prevention, and doing them throughout your lifetime will help to prevent further pelvic floor problems as you age, and help reverse pelvic floor problems if you already have them. To do them, squeeze the muscles in your pelvis as though you are trying to hold your urine or stop your urine stream. Do 5 "quick flicks" (squeeze and hold for 1 second) and 5 squeeze-and-holds (hold for 3 seconds) each day. Do them in the car, while you're stopped at a light. Do them in a boring meeting. Just do them whenever. Plus, you know, it's good for your sex life, too.
And speaking of sex, everyone should be having it! One of my favorite patients from this month was a 90 year old (who, first of all, looked not a day over 60) who was complaining of pelvic organ prolapse (something "falling down" from her vagina). As part of my normal screening questions, I asked if she was sexually active. She replied, "I've been widowed for 25 years," and I nodded and began to apologize if I had offended her. "But I was in Puerto Rico with my [female] friend last month on vacation and I met a guy, and let me tell you: I COULD have. But I decided not to." And then she laughed. It was great! I love the thought of this 90-year-old picking up a guy in Puerto Rico.
On the other hand, we also see a lot of older women who aren't having sex, and are very frustrated by it. When you question them, there are themes of emotional issues with their husband, or a sense of inadequacy in either the husband or wife that no one has ever had the guts to address, or health issues in the husband that aren't necessarily solved by viagra. From our standpoint, we want everyone to be having sex, and we want to do everything we can to get women to be sexually active again. One of the sadder things I saw was a woman in her 70s who came in with her husband, and when asked if they were sexually active, she quickly replied, "Oh no, honey, we're 75 years old. We don't do that anymore." It was hard to read her, because she clearly didn't want to talk about it any more, and her husband started to say something but didn't want to interrupt after she had made it so clear the subject was closed. They otherwise seemed very emotionally content and apparently had a solid marriage, so it was sad that their sex life had fallen by the wayside. My attending tried to reassure the patient that sex was normal at any age, and that any sort of "fooling around" was completely OK -- oral sex, labial sex (dry rubbing, essentially, if the guy can't achieve an erection), whatever. The patient looked a little uncomfortable at the talk of oral sex, so that was the end of that discussion.
Speaking of uncomfortable, I was also surprised at the number of women who are very uncomfortable with their own bodies. For certain issues, we might prescribe a pessary, which is kind of like a diaphragm but for the purposes of pelvic support. Most pessaries can be worn during intercourse, or can be taken out by the patient before sex if she wants to. Some patients return to the doctor every few months for pessary checks, and one day I saw a woman in her 60s for just such a check. She mentioned that her husband noticed he could feel the pessary during sex, which was new, and she wanted us to check it out. When we asked if she had taken it out herself to check it, she looked mortified and replied that she didn't know how to take it out (directions: stick your finger in your vagina and pull it out). And not only did she not know how, but you could tell that she was completely embarrassed at the thought of taking it out herself. I was shocked. But she -- and many other women of that generation -- have never used a tampon, let alone masturbated, and are really not in touch with their own bodies at all. So the nurse and I taught her how to remove and insert the pessary, and it was so gratifying when she got the hang of it.
Overall, this has been a great rotation, and urogynecology is a very interesting field. I think it's probably not ideal for me, since the patient population is very specific -- middle-aged and older women, almost completely -- and I'd like a little more variation in age. But, urogyns have good hours (no middle-of-the-night deliveries) and do a lot of operating, which I like. So I'll put in the back of my mind and see what happens.
Wednesday, August 20, 2008
Project Working Too Hard
Holy crap! I just realized that I haven't watched Project Runway the last two weeks! Partly it's because I've been so damn busy and, as a result, tired, that I've watched hardly any TV at all since I started this rotation. Partly it's because the only TV I have had a chance to watch has been the Olympics.
Luckily, I remembered in time to catch the last bit of the first episode I missed, and next up is last week's episode. Thank goodness for reliably-scheduled reruns, in the face of not having DVR at my disposal!
Also, thank goodness for a low-key night that allows me to watch TV for 2 hours straight!
I'm giving a presentation at 7 am tomorrow for our weekly division teaching/learning session, working a full day, and pulling another overnight shift on the labor deck -- I hope it's another busy night, and that I get to catch a baby and not a placenta. Then, I'll have most of Friday off post-call, which means a long weekend! Woohoo!!!!
Luckily, I remembered in time to catch the last bit of the first episode I missed, and next up is last week's episode. Thank goodness for reliably-scheduled reruns, in the face of not having DVR at my disposal!
Also, thank goodness for a low-key night that allows me to watch TV for 2 hours straight!
I'm giving a presentation at 7 am tomorrow for our weekly division teaching/learning session, working a full day, and pulling another overnight shift on the labor deck -- I hope it's another busy night, and that I get to catch a baby and not a placenta. Then, I'll have most of Friday off post-call, which means a long weekend! Woohoo!!!!
Prejudiced
We were in the OR yesterday, on our last case of the day, when a resident from the Gyn team (who covers our patients when they're in the hospital) popped her head in with a message:
The boyfriend/baby daddy/whatever of our previous case had demanded, on behalf of his girlfriend/baby momma/whatever that she receive a private hospital room, or that if she had to have a shared room, that she only have a black roommate.
(They're both African-American.)
The whole OR was shocked. Seriously? Who in their right mind thinks this is OK?
He apparently told the resident, point blank, "I'm prejudiced. I don't want a white person sharing her room."
Then we all started talking, and it turned out this guy had been weird to all of us. When the fellow met the patient and her guy, he asked her if she was Indian. (She was born and raised in Ethiopa, then moved to Seattle.) No, she replied, I'm black. Black?!?!? he exclaimed. Where are you from? She said she knew what he was getting at (her skin has definite honey undertones to it) so she replied, Seattle, just to piss him off. And when she left the room, she could hear him say to the patient, I don't care what she says, she's not black enough for me. What an idiot. As the fellow said, "I'm from AFRICA. How much more black do you want?"
When I introduced myself to the patient before the surgery (and the patient is totally pleasant, by the way), the boyfriend said to me, in a total non-sequitor interjection, You must be from California. California? What makes you think that? I asked him. He responded, Because you're tan and your accent. I just smiled and told him I felt very pale (I do) and that I was from the Philly area (not a lie). He really didn't know what to make of it, but was obviously confused -- and ignorant. Anyone who knows anybody from California knows that I couldn't fit in there at all. I'm too high-strung and rude :)
So when we were close to being done, the attending left the OR to go talk to the guy. Of course, he was totally nice and respectful to her, even though he had already abused all the residents and nurses (not unusual), and all he said to her was that he wanted his girlfriend to have a private room. She laid the issue to rest, saying that if the patient got worse over night, they would move her to a private room, and told him to go home and let his girlfriend recuperate. Whew.
Part of what I found so interesting about the whole thing, aside from the ridiculous asshole boyfriend, was the makeup of our OR when we the learned the story. My attending was born in Delhi and came to the U.S. a couple decades ago. My fellow is from Ethiopa. The resident was African-American from the northeast. The anesthesia resident was African-American and from Mississippi. The scrub nurse and the circulator were Filipino, the resident who came in to relay the message was Caucasian with Irish in her background, and I'm half-Chinese.
That's what I miss about the east coast when I'm in Kentucky: the diversity. There just isn't any. It's a small-ish thing, but as the years have passed I've definitely noticed it more and more, and I love being back in Philadelphia right now.
It's the idiots like this who give me good stories to tell, so that's the silver lining. I can't pay too much attention to the dark cloud -- that there are lots of people out there still promoting and perpetrating racism -- or I'll get depressed.
The boyfriend/baby daddy/whatever of our previous case had demanded, on behalf of his girlfriend/baby momma/whatever that she receive a private hospital room, or that if she had to have a shared room, that she only have a black roommate.
(They're both African-American.)
The whole OR was shocked. Seriously? Who in their right mind thinks this is OK?
He apparently told the resident, point blank, "I'm prejudiced. I don't want a white person sharing her room."
Then we all started talking, and it turned out this guy had been weird to all of us. When the fellow met the patient and her guy, he asked her if she was Indian. (She was born and raised in Ethiopa, then moved to Seattle.) No, she replied, I'm black. Black?!?!? he exclaimed. Where are you from? She said she knew what he was getting at (her skin has definite honey undertones to it) so she replied, Seattle, just to piss him off. And when she left the room, she could hear him say to the patient, I don't care what she says, she's not black enough for me. What an idiot. As the fellow said, "I'm from AFRICA. How much more black do you want?"
When I introduced myself to the patient before the surgery (and the patient is totally pleasant, by the way), the boyfriend said to me, in a total non-sequitor interjection, You must be from California. California? What makes you think that? I asked him. He responded, Because you're tan and your accent. I just smiled and told him I felt very pale (I do) and that I was from the Philly area (not a lie). He really didn't know what to make of it, but was obviously confused -- and ignorant. Anyone who knows anybody from California knows that I couldn't fit in there at all. I'm too high-strung and rude :)
So when we were close to being done, the attending left the OR to go talk to the guy. Of course, he was totally nice and respectful to her, even though he had already abused all the residents and nurses (not unusual), and all he said to her was that he wanted his girlfriend to have a private room. She laid the issue to rest, saying that if the patient got worse over night, they would move her to a private room, and told him to go home and let his girlfriend recuperate. Whew.
Part of what I found so interesting about the whole thing, aside from the ridiculous asshole boyfriend, was the makeup of our OR when we the learned the story. My attending was born in Delhi and came to the U.S. a couple decades ago. My fellow is from Ethiopa. The resident was African-American from the northeast. The anesthesia resident was African-American and from Mississippi. The scrub nurse and the circulator were Filipino, the resident who came in to relay the message was Caucasian with Irish in her background, and I'm half-Chinese.
That's what I miss about the east coast when I'm in Kentucky: the diversity. There just isn't any. It's a small-ish thing, but as the years have passed I've definitely noticed it more and more, and I love being back in Philadelphia right now.
It's the idiots like this who give me good stories to tell, so that's the silver lining. I can't pay too much attention to the dark cloud -- that there are lots of people out there still promoting and perpetrating racism -- or I'll get depressed.
Monday, August 18, 2008
Trampoline!!!
Oh my god, trampoline is on the Olympics right now.
SOOOOOOOOOOOOOOOOo jealous.
I took trampoline as a phys ed elective my senior year of college, and it was definitely among the best classes I ever took in undergrad. I kid you not.
I used to dive, as well as swim, on our summer league throughout middle school and high school, but I eventually quit diving because I stalled mentally, unable to get over the fear of doing inverse dives and back flips. I never hit the board, but during a practice session, a lifeguard once "warned" me that I was very close to the board as I was doing my flips, and it freaked me out. Despite my coach's best efforts, I couldn't move forward after that.
Trampoline, though, is awesome, because there's no fear of under- or over-rotating and hitting the water badly. You can land on a trampoline without fear of intense pain, and in nearly any position. You can land on your front or your back, or your side. Plus, you can pretty much keep doing trick after trick after trick as long as you keep your momentum up on bounces in between; you don't have to stop after one move and get out of the water, back on the board, and start all over again.
I so wish I could find a way to continue doing trampoline, but it's pretty difficult. Most gymnastics centers don't have adult classes or practice sessions, due to massive liability issues. I did find one in the Philly suburbs when I moved there to start grad school, when my trampoline hunger was highest; they had an adult open session once a week, where you could come and work on whatever skills and equipment you wanted. Unfortunately, I sprained my ankle pretty badly the week of Thanksgiving that year when my ankle turned on landing an otherwise-awesome back flip, and I was out for the fall. Then they shut down the sessions due to liability. Blah.
(That incident also set off a string of events in which Hahnemann Hospital in Philly mischarged me for xrays for my ankle, and it has taken the next four and a half YEARS to get it straightened out. I seriously just got my check a couple months ago.)
The other problem with satiating my trampoline appetite is that those professional trampolines are not the regular black backyard kind. They're more like nets, made of super-stretchy elastic, so you bounce much higher and with much less effort. A backyard trampoline just doesn't do it for me. :(
So I'll just watch the Olympics in jealousy instead.
SOOOOOOOOOOOOOOOOo jealous.
I took trampoline as a phys ed elective my senior year of college, and it was definitely among the best classes I ever took in undergrad. I kid you not.
I used to dive, as well as swim, on our summer league throughout middle school and high school, but I eventually quit diving because I stalled mentally, unable to get over the fear of doing inverse dives and back flips. I never hit the board, but during a practice session, a lifeguard once "warned" me that I was very close to the board as I was doing my flips, and it freaked me out. Despite my coach's best efforts, I couldn't move forward after that.
Trampoline, though, is awesome, because there's no fear of under- or over-rotating and hitting the water badly. You can land on a trampoline without fear of intense pain, and in nearly any position. You can land on your front or your back, or your side. Plus, you can pretty much keep doing trick after trick after trick as long as you keep your momentum up on bounces in between; you don't have to stop after one move and get out of the water, back on the board, and start all over again.
I so wish I could find a way to continue doing trampoline, but it's pretty difficult. Most gymnastics centers don't have adult classes or practice sessions, due to massive liability issues. I did find one in the Philly suburbs when I moved there to start grad school, when my trampoline hunger was highest; they had an adult open session once a week, where you could come and work on whatever skills and equipment you wanted. Unfortunately, I sprained my ankle pretty badly the week of Thanksgiving that year when my ankle turned on landing an otherwise-awesome back flip, and I was out for the fall. Then they shut down the sessions due to liability. Blah.
(That incident also set off a string of events in which Hahnemann Hospital in Philly mischarged me for xrays for my ankle, and it has taken the next four and a half YEARS to get it straightened out. I seriously just got my check a couple months ago.)
The other problem with satiating my trampoline appetite is that those professional trampolines are not the regular black backyard kind. They're more like nets, made of super-stretchy elastic, so you bounce much higher and with much less effort. A backyard trampoline just doesn't do it for me. :(
So I'll just watch the Olympics in jealousy instead.
Too-smart patients
There are a wide variety of difficult patients, who are difficult in different ways, but today I had an encounter with a particularly difficult patient who really ruffled my feathers.
To start with, we were running late (as most doctors' offices usually are), so in those situations I am always 100% prepared to be completely apologetic and assuage any anger over time issues. So I entered the room, introduced myself as the medical student and explained that I would talk to the patient first, and then the attending would come in to examine her (since they all need pelvic exams, I don't do them by myself). She listened to most of my intro, then cut me off to explain that she had a severe allergy to latex and to ask if there was ANY chance I might have latex powder on my hands.
No, I replied; our gloves were all latex-free, and I pointed the boxes out to her.
"What about your coat?" she asked, eyeing my white coat suspiciously. "Is there any chance you have latex powder on your coat?" When I replied that I was fairly sure I didn't, she pressed on. "Have you been in the operating room recently?" (In the OR, we use latex sterile gloves unless the patient has a latex allergy.)
Not since last Tuesday, I told her, and I wore scrubs (I was wearing normal office clothes today, so they obviously hadn't been in the OR), and I had showered multiple times since (yes, I actually went so far as to reassure her that I had showered since last Tuesday, because I could tell she might ask me that on follow-up).
But she still wasn't happy, and continued to grill me -- had I brought my white coat into any part of the OR; had I put on the white coat over my scrubs after surgery was over, etc. -- so I offered to simply take off my coat and leave it in the hallway.
And I could tell it was simply going to get worse from there.
Note, I'm not saying having a latex allergy is in any way a problem, or that her request that I remove my coat inappropriate; it simply would have been more easy, efficient, and pleasant for her to simply, in one sentence, explain her allergy and ask me to leave my coat outside. The whole 20 questions thing was the problem. Plus, she had a very interrogative and condescending way of speaking, which definitely continued to grate on my nerves.
Now, coat off, I attempted to proceed. At this point, she protested about being seen by a medical student and requested to defer my whole interview.
I completely understand that being seen by a student is annoying, and I am always grateful to patients who put up with having me in the process. And normally, if someone requests that I leave, or that they bypass my part of the process, I am happy to oblige. However, we were already running an hour behind, and my attending was running more behind than I was. So I explained that in actuality, my aim was to streamline the process, since the doctor was running so far behind, and that I would make sure things went forward quickly from there. This seemed at least somewhat satisfactory, so she allowed me to proceed.
I can't really explain the way in which she was talking to me, but she was a very low talker, looking mostly at the ground but with her eyes cocked up at me at an angle, and her voice had very little inflection or emotion in it. From a body language point of view, the message I got was, "I am exasperated at having to talk to you, and I disdain your very existence."
Ugh.
Then she started dropping little medical terms here and there, and I actually didn't register them at first (sometimes my brain doesn't switch back and forth between patient-speak and medical-speak, so a patient using medical-speak doesn't register as unusual right away). She was there because she had an incidental finding of microscopic hematuria a few months ago on a routine physical, and she was here as part of her workup. Every time I asked a question, she would sort of sigh in exasperation, answer as though I was a complete moron, and then add way too much medical detail. Finally, when she offered that she had jaw surgery back in January and had been on NSAIDs post-operatively and she knew that NSAIDs can cause microscopic hematuria, and upon my asking what type of NSAID she had been on, responded with, "ibuprofen, 600 mg TID," my brain perked up.
TID? That's prescription-speak for "three times a day," and only healthcare people use it. So I asked what she did for work, and again, she was so suspicious of my reason for asking. "I'm a consultant," she replied.
SERIOUSLY?!?!? Consultant? That term means absolutely nothing, and all of you know it.* It was like pulling teeth getting any reasonable answer from her. Finally, it came out: she was a consultant for a life sciences firm, and she was involved in drug development.
Ahh, it all made sense now. The problem was, she was smart. But unfortunately, not smart enough when it came to this particular situation. As much as I find it exasperating to work with unintelligent patients, there are definitely times when an unintelligent-but-helpful patient is a thousand times better than a PhD who won't listen to what you're trying to tell them.
I tried to screen her for incontinence, which we do for all of our patients, and she wouldn't have any of it. "I filled out your questionnaire, and you can read my answers there. I don't have any of those problems, and that's not why I'm here." Hidden message: you're an idiot. However, in reality, I always ask those questions again, for two reasons: 1) My attending expects me to, and 2) patients change their answers ALL THE TIME.
On I went, reviewing her lab results with her and getting verbal and non-verbal feedback from her that indicated she KNEW all of this and I was clearly an idiot. (I should point out that I could tell that she didn't know all of this and I was trying to be a good doctor by explaining it all to her.) Finally, when she said, non-chalantly, that 11% of the population had this condition and in most it's completely benign, I was finished. People who drop statistics into conversations to impress you are 100% annoying.
There's definitely a problem with being too smart. You think you know everything, and don't want to hear any different from anyone else. If that's the case, then why even go to the doctor? I actually had another doctor as a patient today, and she acted like a totally normal patient (which, granted, is unusual for doctors), not using medical terms unnecessarily or making me feel like a lowly medical student. So why do other people feel the need to put me down or act like they know everything that's going on?
I briefed my attending on the situation, warning her that the patient was rather difficult and would ask her to take off her white coat. In she went with her white coat, and the patient didn't say a thing. Argh. So you're only going to be obnoxious to me? That's even worse. Fortunately/unfortunately, she continued to speak with that same voice and affect, like she was wasting her time being there and was only half-interested in what the doctor had to say. I guess I was glad to see that at least some of her attitude was constant, and not just directed to me.
Again, she cut off the attending and threw out her 11% statistic that made her sound so smart. I mentally rolled my eyes, and then the patient said, in explanation, "I read through the literature to try to ease my mind about all of this."
Oooooooooh, crap.
She's acting like a bitch because she's scared.
Damn, did I feel ashamed of myself. It's a classic defense mechanism, and I didn't pick up on it at all.
In my defense, as the visit continued, it was still clear that she was somewhat obnoxious at baseline, and no matter how much I tried, it was difficult to be fully sympathetic. However, I had probably over-reacted in labeling her as completely difficult.
So, lesson learned.
Thankfully, my attending still thought the patient was annoying enough, and she had a good enough medical reason to justify it, to turf the patient to urology. It takes a lot for a urogynecologist to turf a female patient to a urologist, but it was medically justified, so it will work out for all of us in the end (including the patient, who will likely get her problem diagnosed more quickly through the urologist).
My new goal: learn to deal better with arrogant patients. They're among the most difficult type of patient to deal with, as I learned during psychiatry, but I still need to try harder. I'll put it on my to-do list, along with getting my damned personal statement written.
*I had another patient today who answered, in response to the "what do you do" question, "I'm a trainer." I was stunned silent while I pondered such an unhelpful answer. Was she a dog trainer? A personal trainer? It turned out to be neither; she "trained managers." Please be helpful when you answer, people.
To start with, we were running late (as most doctors' offices usually are), so in those situations I am always 100% prepared to be completely apologetic and assuage any anger over time issues. So I entered the room, introduced myself as the medical student and explained that I would talk to the patient first, and then the attending would come in to examine her (since they all need pelvic exams, I don't do them by myself). She listened to most of my intro, then cut me off to explain that she had a severe allergy to latex and to ask if there was ANY chance I might have latex powder on my hands.
No, I replied; our gloves were all latex-free, and I pointed the boxes out to her.
"What about your coat?" she asked, eyeing my white coat suspiciously. "Is there any chance you have latex powder on your coat?" When I replied that I was fairly sure I didn't, she pressed on. "Have you been in the operating room recently?" (In the OR, we use latex sterile gloves unless the patient has a latex allergy.)
Not since last Tuesday, I told her, and I wore scrubs (I was wearing normal office clothes today, so they obviously hadn't been in the OR), and I had showered multiple times since (yes, I actually went so far as to reassure her that I had showered since last Tuesday, because I could tell she might ask me that on follow-up).
But she still wasn't happy, and continued to grill me -- had I brought my white coat into any part of the OR; had I put on the white coat over my scrubs after surgery was over, etc. -- so I offered to simply take off my coat and leave it in the hallway.
And I could tell it was simply going to get worse from there.
Note, I'm not saying having a latex allergy is in any way a problem, or that her request that I remove my coat inappropriate; it simply would have been more easy, efficient, and pleasant for her to simply, in one sentence, explain her allergy and ask me to leave my coat outside. The whole 20 questions thing was the problem. Plus, she had a very interrogative and condescending way of speaking, which definitely continued to grate on my nerves.
Now, coat off, I attempted to proceed. At this point, she protested about being seen by a medical student and requested to defer my whole interview.
I completely understand that being seen by a student is annoying, and I am always grateful to patients who put up with having me in the process. And normally, if someone requests that I leave, or that they bypass my part of the process, I am happy to oblige. However, we were already running an hour behind, and my attending was running more behind than I was. So I explained that in actuality, my aim was to streamline the process, since the doctor was running so far behind, and that I would make sure things went forward quickly from there. This seemed at least somewhat satisfactory, so she allowed me to proceed.
I can't really explain the way in which she was talking to me, but she was a very low talker, looking mostly at the ground but with her eyes cocked up at me at an angle, and her voice had very little inflection or emotion in it. From a body language point of view, the message I got was, "I am exasperated at having to talk to you, and I disdain your very existence."
Ugh.
Then she started dropping little medical terms here and there, and I actually didn't register them at first (sometimes my brain doesn't switch back and forth between patient-speak and medical-speak, so a patient using medical-speak doesn't register as unusual right away). She was there because she had an incidental finding of microscopic hematuria a few months ago on a routine physical, and she was here as part of her workup. Every time I asked a question, she would sort of sigh in exasperation, answer as though I was a complete moron, and then add way too much medical detail. Finally, when she offered that she had jaw surgery back in January and had been on NSAIDs post-operatively and she knew that NSAIDs can cause microscopic hematuria, and upon my asking what type of NSAID she had been on, responded with, "ibuprofen, 600 mg TID," my brain perked up.
TID? That's prescription-speak for "three times a day," and only healthcare people use it. So I asked what she did for work, and again, she was so suspicious of my reason for asking. "I'm a consultant," she replied.
SERIOUSLY?!?!? Consultant? That term means absolutely nothing, and all of you know it.* It was like pulling teeth getting any reasonable answer from her. Finally, it came out: she was a consultant for a life sciences firm, and she was involved in drug development.
Ahh, it all made sense now. The problem was, she was smart. But unfortunately, not smart enough when it came to this particular situation. As much as I find it exasperating to work with unintelligent patients, there are definitely times when an unintelligent-but-helpful patient is a thousand times better than a PhD who won't listen to what you're trying to tell them.
I tried to screen her for incontinence, which we do for all of our patients, and she wouldn't have any of it. "I filled out your questionnaire, and you can read my answers there. I don't have any of those problems, and that's not why I'm here." Hidden message: you're an idiot. However, in reality, I always ask those questions again, for two reasons: 1) My attending expects me to, and 2) patients change their answers ALL THE TIME.
On I went, reviewing her lab results with her and getting verbal and non-verbal feedback from her that indicated she KNEW all of this and I was clearly an idiot. (I should point out that I could tell that she didn't know all of this and I was trying to be a good doctor by explaining it all to her.) Finally, when she said, non-chalantly, that 11% of the population had this condition and in most it's completely benign, I was finished. People who drop statistics into conversations to impress you are 100% annoying.
There's definitely a problem with being too smart. You think you know everything, and don't want to hear any different from anyone else. If that's the case, then why even go to the doctor? I actually had another doctor as a patient today, and she acted like a totally normal patient (which, granted, is unusual for doctors), not using medical terms unnecessarily or making me feel like a lowly medical student. So why do other people feel the need to put me down or act like they know everything that's going on?
I briefed my attending on the situation, warning her that the patient was rather difficult and would ask her to take off her white coat. In she went with her white coat, and the patient didn't say a thing. Argh. So you're only going to be obnoxious to me? That's even worse. Fortunately/unfortunately, she continued to speak with that same voice and affect, like she was wasting her time being there and was only half-interested in what the doctor had to say. I guess I was glad to see that at least some of her attitude was constant, and not just directed to me.
Again, she cut off the attending and threw out her 11% statistic that made her sound so smart. I mentally rolled my eyes, and then the patient said, in explanation, "I read through the literature to try to ease my mind about all of this."
Oooooooooh, crap.
She's acting like a bitch because she's scared.
Damn, did I feel ashamed of myself. It's a classic defense mechanism, and I didn't pick up on it at all.
In my defense, as the visit continued, it was still clear that she was somewhat obnoxious at baseline, and no matter how much I tried, it was difficult to be fully sympathetic. However, I had probably over-reacted in labeling her as completely difficult.
So, lesson learned.
Thankfully, my attending still thought the patient was annoying enough, and she had a good enough medical reason to justify it, to turf the patient to urology. It takes a lot for a urogynecologist to turf a female patient to a urologist, but it was medically justified, so it will work out for all of us in the end (including the patient, who will likely get her problem diagnosed more quickly through the urologist).
My new goal: learn to deal better with arrogant patients. They're among the most difficult type of patient to deal with, as I learned during psychiatry, but I still need to try harder. I'll put it on my to-do list, along with getting my damned personal statement written.
*I had another patient today who answered, in response to the "what do you do" question, "I'm a trainer." I was stunned silent while I pondered such an unhelpful answer. Was she a dog trainer? A personal trainer? It turned out to be neither; she "trained managers." Please be helpful when you answer, people.
Monday, August 04, 2008
Exhaustion. Remember that?
Ugh. So now I guess I'm officially a fourth-year med student. I took Step 2 on Friday and it went OK, as far as I can tell. I mean, I stayed awake through the whole thing, my computer didn't crash, no one robbed the bank next door, and Eric was there with Dibs as a finishing present. My left eye started twitching/throbbing about halfway through, but it had been doing that all week, so I wasn't too worried.
Then I packed up all my stuff yesterday and hauled it to Philly and started my new rotation today. Put the Danskos and white coat back on, and voila, I'm a med student again! I have mixed feelings about this development.
Anyway, I think the rotation will be fun. Some of it is office-based, like today, just one-on-one with the attending, seeing patients. Upon meeting her this morning, she immediately started grilling me on my research experiences (in a friendly way), and I thought that was kind of strange. When I mentioned that I was interested in applying to Penn for residency, she said, "Well, we're a very serious academic institution; in addition to grades and scores, we're very interested in research and publications. That's why I was asking you about it before. We'll try to get you a small project you can do in the month that you're here so you can put it on your CV."
So, that's what going to an academic medical school is like. Seriously, though, she's very nice, and I totally know where she's coming from, and this is the different experience I was looking for.
Of course, she also reinforced that I needed to meet the residents (which I'll do in surgery on Wednesday) and get on their good side by taking call at least a few nights this month, and going to "help out" on the labor deck whenever I have free time. So, it's also going to be a busy month, I see.
But seriously, this is good for me. Time to get the brain working again. Time to get the lips all nourished with chapstick and puckered up, ready to go.
By the way: After one day of REI, I was immensely worried about never being able to conceive. After one day of urogyn, I'm worried about what's going to happen to me if I do manage to give birth. It's a lose-lose situation, people.
Then I packed up all my stuff yesterday and hauled it to Philly and started my new rotation today. Put the Danskos and white coat back on, and voila, I'm a med student again! I have mixed feelings about this development.
Anyway, I think the rotation will be fun. Some of it is office-based, like today, just one-on-one with the attending, seeing patients. Upon meeting her this morning, she immediately started grilling me on my research experiences (in a friendly way), and I thought that was kind of strange. When I mentioned that I was interested in applying to Penn for residency, she said, "Well, we're a very serious academic institution; in addition to grades and scores, we're very interested in research and publications. That's why I was asking you about it before. We'll try to get you a small project you can do in the month that you're here so you can put it on your CV."
So, that's what going to an academic medical school is like. Seriously, though, she's very nice, and I totally know where she's coming from, and this is the different experience I was looking for.
Of course, she also reinforced that I needed to meet the residents (which I'll do in surgery on Wednesday) and get on their good side by taking call at least a few nights this month, and going to "help out" on the labor deck whenever I have free time. So, it's also going to be a busy month, I see.
But seriously, this is good for me. Time to get the brain working again. Time to get the lips all nourished with chapstick and puckered up, ready to go.
By the way: After one day of REI, I was immensely worried about never being able to conceive. After one day of urogyn, I'm worried about what's going to happen to me if I do manage to give birth. It's a lose-lose situation, people.
Saturday, August 02, 2008
More Harry Potter!
The trailer for Half-Blood Prince is out -- go watch it NOW (right here), and yesterday I got an email that The Tales of Beedle the Bard will be published and released this winter. You can read the announcement here.
Aahhh, I LOVE Harry Potter. As I'm sure you know. And if you need evidence, here you go.
Aahhh, I LOVE Harry Potter. As I'm sure you know. And if you need evidence, here you go.
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