Fellow Orientation

The new class of fellows is starting next week, so there are a few days of orientation this week, including a "party" yesterday afternoon in the office for the second-years to meet the new ones.

"Oh, this is nice," one of the new fellows said.  "Are there always snacks like this?"

"No.  Pretty much this is it.  And I think the cookies you're eating are leftover from last year's party."

"Oh."

"Also, I wouldn't actually eat them, because I'm pretty sure the fellow who took them out of the box and put them on this plate came right from clinic, and I didn't see her wash her hands."

"Oh."

"Generally, any food you see in the office has probably been touched by someone who has touched something you wouldn't want to put in your mouth."

"Oh."

"But, you know, I don't want to make you think this isn't a great fellowship."

"I was deciding between doing a fellowship and working at a medical start-up -- a concierge practice, sort of.  They had an on-site gym."

"Yeah, we have the stairs."

"They also catered lunch every day."

"There's a vending machine on the third floor.  It has Swedish Fish."

"But I figured, it was such a limited patient population.  I wanted to see a wider variety of issues, especially at this point in my career."

"Yeah, that's great.  Catered lunch, eh?  They still looking?"

"Ha.  I'm sure this job is a lot more interesting.  And at least you don't get paged in the middle of the night for medication refills."

"I actually just got paged at 3AM for a medication refill."

"Oh."

"The patient thought it was 3PM, not 3AM.  She apologized."

"Oh."

"No, at least she apologized."

"Maybe I'll go meet some of the other fellows."

"Okay."

Is 4 AM the night, or the morning?

I'm on this Sunday, so I tracked down the attending, just to check what time he would be coming in.  The typical thing on weekend shifts is you come in around 8 or 8:30, leisurely round on the patients, and are home by lunchtime.

"Hey, I'm on with you this Sunday.  Just wanted to check the plan."

"Great.  I get in around 4, so if you could pre-round before then, we can quickly go through the patients, and be out of there in a few hours."

"4 in the afternoon?"

"Ha, no."

"Oh.  With other attendings, it's been more like 8 or 9."

"Yeah, I like to have most of my day free.  I guess we can say 4:30, if you really want to sleep in."

"You must be a morning person."

"People tell me that, yeah.  I don't really sleep."

"Okay.  It's not daylight savings time this weekend, or anything like that, is it?"

"I don't think so."

"Okay.  So... 4:30...?"

"Yeah, and if you could pre-round by then, that would be great.  See you on Sunday!"

Oops

When all of your patients are doing okay, there isn't much to write about.  As I see more and more of my outpatients, more and more often, I've been noticing there's a big range of home health aide competence, from the ones who barely know their person's name to the ones who take notes, actually pay attention, and act in a warm, caring way toward the patient.  I think it's a pretty painful job, being a home health aide, especially to a demented person who doesn't have a non-demented spouse involved as well.  It's a lonely job, certainly.  And it's very easy to do it poorly, and hard to do it well.  If you are an aide, and you're bringing your person to the doctor's office, you should probably clean them a little bit first, brush their teeth, put fresh clothes on them -- or you seem like a bad aide.  If you ask questions, especially about medication dosing, you seem like a good aide.  If you wait in the waiting room, and act like the doctor's appointment is your time to make a call on your phone, you seem like a very bad aide.  If you bring a medication list, you seem like a very good aide.

Actually, it doesn't just apply to aides.  If you bring a medication list -- an accurate medication list -- to the doctor visit, you win.  The number of people who don't think that knowing what medicine you're taking is a good idea when you visit a doctor for the first time is really staggering.  If I could pass one health care related edict, I think it would be that people should be mandated to bring medication lists everywhere they go.  And if you've typed up a list of your medical conditions, surgeries, hospitalizations, names and phone numbers of the other doctors you see -- well, I want to give you a lollipop, because you are making your doctor's job a lot easier, and increasing the odds that you get decent medical care.

Also, if you're not the patient -- and you'd be surprised how often this happens -- if you're not the patient, I don't want to take your blood pressure, or weigh you, or answer your own medical questions.  Home health aide, if you need someone to listen to your cough, make an appointment with a doctor for yourself.  Spouse who is not my patient, please don't ask me to check your blood sugar.  And no one is getting a medication refill except the patient I'm actually seeing.  That means your sister, in another state, no -- I'm not calling in her refill, not even if you put her on speakerphone.

Who's On Tonight?

How you know you've been working in the hospital too long:

"Are you going to watch the Tony Awards?"

"I didn't know they were on."

"What are you talking about?  I e-mailed you about them."

"What?  No you didn't."

"Sure I did.  You wrote back and said OK, I didn't know.  But I told you, so now you should know.  Are you OK?"

"Oh."

"What?"

"That explains your e-mail.  I thought you were telling me Tony was on tonight."

"Who's Tony?"

"I figured he was a resident.  I didn't know.  That's why I said I didn't know.  I figured you were telling me Tony was on call tonight.  And that I should know who Tony is.  Even though I don't."

"No.  I was telling you the Tony Awards were on TV.  Do you want to come over and watch them?"

"Not really.  So who's on tonight if not Tony?"

"There is no Tony."

"Oh, yeah."

"I think you should come over."

Wrong Liver

"So, your father is scheduled for surgery tomorrow -- I don't know if the surgeon has been by yet to answer any last-minute questions, but if you have any concerns--"

"I just hope this goes better than last time he had surgery."

"What happened last time?"

"They removed the wrong liver."

"He only has one liver."

"Well now he does -- that's right."

"No, he only started with one liver.  There is only one liver."

"Now, sure.  They didn't even apologize."

"They couldn't have removed the wrong liver.  People have one liver.  And his liver wasn't removed."

"Not the remaining one, no -- I should hope not!"

"He did not have his liver removed."

"Not this one.  The other one."

"He only has one liver."

"Exactly, that's what I'm trying to tell you."

"No, there's something confusing here -- when you're born, you have one liver.  Just one."

"So then you know what he's gone through."

"I'm not talking about me.  I'm talking about everyone.  One liver.  There's no wrong one and right one.  There's just one."

"His was the wrong one."

"Okay, forget it -- that's not even the surgery we're talking about.  You know that he's having surgery on his left hip tomorrow, right?  The surgeon explained it."

"And how many hips will he have afterwards?"

The Diabetic 87-year-old who's 63 and not diabetic.

"Doc, we didn't see you yesterday."

"Yeah, I was off yesterday.  But someone should have stopped by -- there's always a doctor covering."

"Someone did, but we didn't like him."

"Why not?"

"He came in and thought our mother was 87 and diabetic."

"He must have had the wrong chart."

"No, he said that was in the chart.  He showed us."

"She's never been diabetic, right?"

"No."

"That's weird.  I don't know how that happened, but I'll check the chart and fix any mistakes I see."

"Also... you don't think she looks 87, do you?"

"Of course not... but it's hard to judge people's age when they're sick.  Everyone looks older than they really are."

"So how old do you think she looks?"

"That's not a fair question, because I know she's 63."

"But if you didn't know."

"I'd say she looks like an ill 63 year old, unfortunately."

"She used to look 40."

"She used to be 40."

"But you're sure she doesn't look 87."

"Yes."

"Good, because then there's no biological way I could be her son."