Medical Training Stepladder

Doctor: Intern’s Lie

Tomorrow, 7 am sharp, I embark on a new journey. I will be head of the team. This team will encompase one Attending, one Resident (that is I), two Interns (first year residents), one Sub-Intern/ fourth year med-student (from here on the “Sub-I”), and two third year med-students (a.k.a. “Students”).

To serve the readership yet unfamiliar with the medical hierarchy that governs today’s fine medical establishments I will now take the time to explain this stepladder of ass-slurpers. The understanding of this is essential for our future relationship and so if you have any questions feel free to ask.

I’ll second Kevin here: dead on.

Shrinkette Signs Off

Not another one!

shrinkette

I think it’s time
…to say goodbye.

Like Medpundit, I find that I don’t have enough time to devote to this blog.

It’s been a lot of fun.

Great, now I need therapy.

Fun with DSL

I can finally get DSL at my residence (see prior), so for a few more weeks I have two connections.

I have a really nice (and super-zowie expensive) wireless connection, and now a budget DSL. It’s interesting comparing the two, swapping the connections back and forth, etc. The speed differences aren’t really all that great, and for 24 times less money I’m going to be keeping the DSL.

I’m still having email sending difficulties with the DSL service, though I’m pretty sure it’s a flaw on my end, as I’ve read their info and tried everything they offered, so far without success. Mostly this is my fault for not wanting to use a new email address, or more specifically I want to not use the sbc account to send mail, as eventually people will want to reply to that address, and I already have plenty of addresses to collect spam, thanks.

Today’s Adventure in DSL was decidedly odd: none of the *.blogspot.com blogs would load. Any other domain I tried loaded quickly and cleanly, but the blogspots just hung. My DSL connection is a router / wireless gadget, power cycling it didn’t help, nor did rebooting the boxes (one PC, one mac). Nor did cache clearing, etc.

I managed to get the blogspots to load by pushing the ‘master reset’ button on the router, which tells me everything I need to know about its stability. Soon I’ll be turning it into a dumb modem and using the geeked-up router I have now.

The World of Tech continues to deliver amusement here.

Update: email problems solved by the Miracle of Port 465.

Say Again? Episode 2

When interviewing a female about her medical history, specifically as it regarded her reproductive history:

Have you had any pregnancies?

Yes, I have had two pregnancies and have one child.

Oh, what happened with the other pregnancy?

It was a two hole pregnancy, so I had to have a surgery.

Ah. I’m taking from these interactions that 1) docs aren’t very good at explaining things and 2) people need to understand what’s going on, so they use words that make sense to them. Seems reasonable to me, though occasionally amusing.

Some hopeful news on Malaria

Via An Iron Fist Joins the Malaria Wars – New York Times which requires a painful but free registration.

Short version: the WHO has appointed a no-nonsense physician to head up their anti-malaria efforts, and he seems to be making some headway.

I’ve ranted about malaria before (do a search here) but this is the sort of thing we’ve (humanity’s) been needing for 30 years.

Hat tip to Unemployed Jim

Say again?

Tonight, while the patient was rubbing their upper abdomen in pain:

“I have a high anal hernia”.

MedBlogs Grand Rounds 2:40

It’s up: Medviews: Grand Rounds

An Unusual Presentation

Several months ago I went to see a patient in my ED with the Chief Complaint: Altered Mental Status. Fairly common complaint in the ED.

On entering the room was a mid-60′s nice, polite lady and her two daughters, who were visibly nervous about being there.

What seems to be the problem?

“You have to understand that our mom is not a cookies-and-milk grandma. She’s not, she’s actually a piss-and-vinegar type. Usually she’s a little mean, but the last week or so she’s been the nicest little old lady in the world. Something is wrong with our mom.”

So, you think there’s something wrong with your mom because now she’s being nice?

“Very much so. This isn’t her usual self.”

After a pretty unremarkable rest of the history and exam (except for a remarkably nice and polite patient) I had to talk myself into doing a workup, but I did. I ordered blood and urine tests, and a CT scan of the head.

A CT which showed a marble-sized frontal lobe brain tumor with some surrounding edema. A tumor in the region of the brain having to do with personality. I found out why she was nice. Her daughters were actually relieved, not that mom had a tumor but that they hadn’t been wasting everyones’ time.

Amazing thing, being too nice. It took a brain tumor to make her that way.

Opera 9

it’s worth it. And not just because it’s free.

www.opera.com

Realtively Unclear

From my six year old grandson, proudly displaying a photo of a relative:

“This is my second cousin, who was removed from me”.

Well, there you go.

Rads Grand Rounds 1

Sumer’s Radiology Site: Radiology Grand Rounds Volume-I

Radiology Grand Rounds Volume-I

THE CARNIVAL OF MEDICAL IMAGING

Welcome to the debut of Radiology Grand Rounds, the monthly summary of the best of the Radiology blogosphere.

Our pale friends have their own blog carnival!

UK PSA’s

Wow, the Public Service Announcements in the UK are a lot more graphic (and effective) than the ones I’m used to here.

Both are hosted on YouTube:

UK Seatbelt

UK Paramedic

Terrific. I’d love to see the US TV stations pick these up and run them, as is.

Many thanks to Mike at FFM, who found thes at EMTCity.

Dr. Charles (and I) support Special Healthcare Courts

From over in free-pen land: The Examining Room of Dr. Charles

Our lawsuit culture is disgusting. Anyone who stands up to do anything of consequence in our society is at risk of being sued for it. Teachers, policemen, doctors, coaches, ministers – we’re generally trying to make the world a better place, but we’re all living in fear, waiting for the next “privileged and confidential” letter from an attorney stating that we’re about to be raped by an unfair legal system. I live it everyday….

Please read the rest, and consider requesting some help from your elected reps.

Movin’ Meat on EM Reimbursement

Movin’ Meat: BIG news for ER docs

Wow, if this actually happens I could cut back a bit…

You work 13 days, and what do you get?

13 days older, and a little less in debt. (Many, many apologies to the Tennessee Ernie Ford estate).

One thing 13 shifts in a row will do is re-focus the mind, and get all that vacation happiness out of your system. I won’t say I’m February-level bitter, but the edge is back, at least in my mind. Weirdness I thought was quaint last week is now really very irritating.

And now I want to talk about the Theory Of Relativity as it applies to the Medical History:
When a question regarding timing is asked, such as “How long have you had this?” the answer shouldn’t be “I’ve had it since my Uncle got his driver’s license”. We’re all happy for your uncle, but that’s relative timing, and since none of us know your uncle or when he got the license, it’s not only not a helpful answer, it’s actually distracting (who is this person’s uncle; why didn’t he have a license before; is he driving the car parked sideways in the lot?).

The preferred method to answer would be more concrete, like “six days” or “45 minutes”. Please a little less relativity, a little more firm, concrete answers.

For those requiring more direction, I refer you to my original rant on this topic. Now, I’m going to go enjoy my day off.