* * Anonymous Doc

Wednesday, May 19, 2010

I told a nurse about this blog. That may have been a dumb thing to do. I'm not sure she's going to remember the address or anything like that, so I probably have nothing to worry about. And even if she read it, what's she really going to do? I don't know, it's tough sometimes to worry about keeping it going when I don't know who I'm writing for. Do me a favor, if you read the blog and like it, send it to a couple of friends or link it or something. Just want to get a sense if anyone's out there who this is resonating with.

I have a 90-year-old patient who used to be a doctor, except he hasn't been a doctor in 35 years so he thinks he knows what we ought to be doing but doesn't actually know. I told him we're giving him a certain drug and he starts yelling that he wants a different one-- but the one he said he wants hasn't been on the market since 1982. So he's not getting that one. I tried to explain that this is a better class of drugs, fewer side effects, matches his problem, it's the standard treatment-- but he thinks he knows better. He named the type of catheter he wanted, I had to Google it-- it exists, and he's probably right that it would be fine for him-- except we don't have it, and we're not going to get it just because he wants it. He's rightly frustrated that we don't seem to be listening to his expertise as a doctor-- but we're the ones responsible for his care, and when he starts telling us things that would have made sense in 1953 but not now, I don't think we should be expected to change what we're doing.

He also seems to think that the doctors have some control over the patient food, which I don't even think was true in 1953. He's on a low-salt diet, which is predictably tasteless, and I can't do anything about that no matter how much he complains. I can't get him white meat instead of dark meat, I can't have them cook the vegetables more, and I can't get him a different dessert. It's not a restaurant, it's a hospital. And even though I feel bad that he's 90 and has no family, I still don't get to make special requests in the hospital kitchen.

But I did sneak him a doughnut.

Why they serve doughnuts to doctors twice a week-- instead of, oh, I don't know, something that isn't nutritionally bankrupt and fried in fat-- I don't know. Nutrition ranks just above, I don't know, dental health on a list of things the medical profession ought to care more about but chooses to ignore. I've gotten into the habit of noticing doctors who neglect their dental hygiene. You'd think doctors would take care of themselves but somehow dentists are seen as beneath us, I guess. I told someone I had a dental appointment for my day off and she told me she hasn't seen a dentist in seven years. Sexy.

31 comments:

  1. What you write definitely resonates with me! I come from a family of physicians and research scientists and when I was younger, I seriously considered medical school. I went to work in biotech managing clinical trials of cancer drugs instead (this was when the industry was very young). Did that for many years, then became a medical writer for biotech (i.e., writing up said clinical trials for submission to FDA). Also pursued my artistic side (MA in Creative Writing, poetry; apprenticed as a sculptor). Also adopted a baby as a single parent. But I always look back on that decision point in my life when I decided NOT to be a doctor, always wondering how my life would have been different if I had decided to do it. When I managed clinical trials, I spent a lot of time in teaching hospitals with the docs, training them on the research protocols, etc. Going over pt charts, writing audit reports, talking to pts who received our drugs. It was an intense experience. So, I enjoy reading your blog because I know that what you are talking about is the real deal, and I actually really appreciate that you take the time to do it because I think it's really important. Please continue with it! --Miss__Tina (on Twitter)

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  2. i've been reading random blogs for 8 years or so, and this one of my favorite of all time. i send random posts to my gf (who is currenly a 1M) all the time. please keep up the writing, as this is an absolutely fascinating window into the other side of the patient/dr relationship.

    e.m.

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  3. I'm out here.
    M1 at U of MN.

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  4. Im reading it but linking on my blog would be useless.

    Vicky

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  5. What you write definitely resonates with me, on several levels. I'm a nerdy type who loves hearing about how the medical profession works in real life, as opposed to what happens on House or Grey's Anatomy. And, as my father has recently had to go into a nursing home, I know how frustrating it is to have to work with the medical system, and it's interesting to see that it can be that way for doctors as well.

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  6. Dunno about this whole resonating thing but this one of the few blogs I read on a regular basis. Keep it up!

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  7. i'm an RN in KY...i love reading your posts....my mom does also :) ...2 or 3 of my PA friends and some of the RNs I work with also read on a sporadic basis.
    i love the issues you bring up. sometimes i run into situations/ideas/happenings in the hospital that i don't think about processing (either that or i'm not sure how to).

    also it's nice to see how the interns/residents MIGHT be thinking, since they're not always the first to communicate with the nurses.

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  8. Great blog man very entertaining and thought-provoking. In addition, I know you've helped save at least one person from going down the wrong career path!

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  9. This blog is awesome. I send links to it all the time. Keep up the good work.

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  10. I'm a 2nd year (soon to be 3rd year) medical student at MSUCOM. I have your blog bookmarked and check it at least once a day. I've been doing this since the beginning of your blog. It has helped me get through the didactic years reading about "real-life" medicine. Can't wait! I love your wit and insight into the upside-down world of medicine and share your blog all the time to my fellow students. Sometimes in study groups I'll open up your blog and read some postings to them and we'll all get a good chuckle. Keep up the good work!

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  11. This blog and Science-Based Medicine are the 2 sites I check daily. I love the insight and get some weird satisfaction from reading about your struggles and insecurities.It shows the human side of patient care.

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  12. I read that oral health and heart disease are linked. It might just be that the people who brush regularly and go to the dentist just have healthier habits all around. Its really scary once you start thinking about how you only get one set of permanent teeth that has to last you for the rest of your life! Keep writing and keep taking care of your chompers! :D

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  13. I'm a layperson, and I read this blog regularly.

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  14. For what it's worth, I love your blog, and truly hope you keep writing it. The mix of exposing incompetence and exposing how being a doctor affects your life as a balanced human being is amazing.

    Thank you for writing it!

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  15. This is probably my favorite med blog - maybe because it's so honest.

    It's a testament to how good your writing is that I always look forward to reading what you have to say about the hell of residency, despite starting med school this fall. You'd think I'd have the sense to not depress myself about the future like this.

    I get through the mini-depression by reminding myself that I could always try for pathology.

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  16. Yep, i'm here, I've been reading for probably close to 8 months or so, never commented before but I do love it.

    Sometimes funny, "homicidal thoughts about my patient who's having suicidal thoughts"

    Sometimes sad, "I thought he was sleeping" ... "ON THE FLOOR?"

    Sometimes a bit of both, "Yeah, I think we fixed it. But if she ends up dying-- you should know we wasted a ton of time on this for nothing."

    Sometimes downright scary, hematocrit/glass eye/lab mixup story.

    But, overall, I love reading it and i'm sure there are LOTS more out there who do too but like me never commented. Keep it up and good luck with your residency!

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  17. I read your blog first thing in the morning as soon as I get to the office and I don't even live in the USA!! Please keep it up, you put a smile on my face with every piece you write!

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  18. I read it too, and I got here from reddit I think.

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  19. My husband and I enjoy reading your posts. He is starting med school this fall...it gives us a good dose of reality of what's to come.

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  20. Don't remember how I discovered your blog, but I'm reading!

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  21. You sound immature and naive on your blog, which isn't bad per-se, but when combined with that tone of condescension your posts are rife with, you paint a gleaming image of personal douchebaggery. I hope our clinical paths never cross.

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  22. Keep writing, dude. You're doing well.

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  23. I love reading your blog. You are a great writer. I'm a computer programmer at a big corporation. Please don't ever stop posting!

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  24. I very much enjoy your blogs and I'm not even a doctor! Good writing is good writing. It's way better than watching Grey's Anatomy!

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  25. Hello Anonymous Doc - Your writing is very witty and honest. In fact, we liked it so much, we added your link to our blog roll on our corporate blog for CEP America, the largest democratic emergency physicians practice in the U.S. Check it out: http://blog.cep.com/.

    Keep it up!

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  26. Happy to oblige:

    http://breach.knower.org/2010/05/23/shout-out/

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  27. Hey Anon,
    I have been a regular visitor here for some time now. And I think you're doing a great job. Sadly I interned in an age without blogs, but I am sure there are quite a few young medics that will benefit by the way you put your thoughts and anxieties and flaws and successes out there. Keep it up, doc. And we shall come back for more.

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  28. Dietary needs can be important. I have IBS and if I ate dark meat instead of white meat it would lead to intense pain. Maybe you as a doctor don't have the power to change things, but there should be options.

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  29. I linked your blog in a comments thread on Marginal Revolution before you even asked! And it is a nice mix of funny, introspection, and "what's it like to do that job."

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  30. I have a friend on Facebook who's always linking to your blog. Both me and my husband and my friend all read this blog. I'm interested in your experiences; you're a very engaging writer and it's neat to get a real-life sort of sneak peak into what you experience.

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