Step 1 and Other Bullshit

I've got Step 1 looming over me, and it's totally gnawing away at my sanity (OK, what sanity I still possessed at this point in life). I've been having tiny panic attacks every time I think about it too much. It might not seem so bad, but I've been spending too much time around gunners, who all pull this, "OMG I'VE ONLY SPENT TEN HOURS STUDYING FOR STEP TODAY AND IT'S ONLY FOUR MONTHS AWAY AND OMG I'M SOOO STUPID" bullshit. The only thing that seems to make them feel better is making everyone else around them feel worse than they do (they succeed, because who the fuck else studies that much that early?).

Anyway, the point I'm getting to is...I'm out for a while.

Hopefully I'll have some funny stories worth writing down when clerkships start.

An Old ER Doc's Favorite Story

So an older ER doc told me his favorite story not too long ago. It went something like this:

A woman is brought in by police at 5 am on a week day to be checked out for "being maced in the eyes." Apparently she was drinking earlier and had gotten combative with the cops, leading to her getting maced. The ER doc went into her room to check her out and noticed she wasn't looking too bothered by the whole "mace-to-the-face" thing.

Doc: "Ma'am, I understand you were maced, how are you feeling?"
Mrs. Demeanor: "Fine."
Doc, getting a little confused now: "You aren't feeling any pain?"
Mrs. Demeanor: "Naw, my eyes hurt when they firs' did it, but I took care of it."
Doc: "You took care of it? You were maced. How did you take care of it?"
Mrs. Demeanor: "I put beer in 'em."
Doc, really confused now: "You...put...beer in them? And that worked?"
Mrs. Demeanor, as if this is quite obvious: "Yeah."
Doc: "Can I ask you were you got beer at 4:30 in the morning?"
Mrs. Demeanor, giving him a look of disgust and putting as much condescension as possible into her voice: "From my purse."
She then reached into her purse to prove that she was packin'..cheap beer.

So there it is ladies and gentlemen. If you get maced and your eyes are on fire, just rub some beer in them. Even better than the good old "rub some dirt on it" solution...

Standardized Patients

So my medical school has us work with standardized patients sometimes. This basically allows us to sort of kind of learn to take a history and do a physical exam without actually being let loose on some poor person with real medical problems. These people get paid to spend a couple hours being poked and prodded by a bunch of 20-somethings who feel all kinds of uncomfortable with tasks such as asking obese older women to lift their breasts out of the way and feelin' up femoral pulses on crusty old guys.

Now most of these SP's have been doing this for a while and it's old hat to them. They have their chief complaint, they know their story and what answers they should give to relevant questions, and the feedback they give is usually something along the lines of: "Explained what she was doing well."; "Was very compassionate."; "Know hows to act like a human being."...or some other generic shit like that. But sometimes the feedback is off-topic or even downright crazy-pants, and of course we all like to share those fun stories. A few examples:

Mrs. Old-Fashioned: "Blouse was too low and distracted me."
The student's 'blouse' was a dress with a buttoned-up cardigan over it, but this one's still not too out there. At least it wasn't a male patient talking about how distracting it was.

Mrs. Fashion Police: "She should not have been wearing boots with heels!"
It was 15 degrees outside. Unfortunately she did not share what kind of shoes she would have considered more appropriate.

Mrs. PC: "Beard made me uncomfortable, unless it was for religious or cultural reasons."
10 to 1 odds she clutched her purse closer then he walked in the room.

This gem happened after an encounter where the patient was supposedly angry and the student was supposed to placate him.
Mr. Drug Seeker: "He did an OK job [of apologizing], but he should have offered me free drug samples."

This happened with an actual patient who gave permission to be examined by two students in a group of four.
Mr. Creepster: "Is there a girl in the group? Yeah? She can definitely examine me."
He got two burly male students.

Good Advice

Dr. Obvious: "The key to the test is just to put down the right answers."

THAT'S what I was supposed to be doing? Shit, all this time I thought I was supposed to make a pretty design on my scantron sheet. Now I'll start getting 100's for sure.

Shit Old Surgeons Say

So this grouchy old surgeon came in to give us information about our surgical clerkships next year. He did manage to stay on topic for a little while.

Dr. Inmy Day: "Well, we can't require you to be at the hospital before 5 am anymore. But, dedicated students show up before 5."

Then he somehow got on the subject of his residents.

Dr. Inmy Day: “They already have their damn 80-hour work weeks. And starting July 1^st, our interns are limited to just 16 hour shifts. The only thing they haven’t told us yet is that we have to give them milk and cookies every night.”

Not gonna lie, I laughed. Throw in bed time stories and I'm sold!

Sassy's First Night in the ED

I spent a few hours last night sort of shadowing in the ED. I say sort of, because I pretty much wandered at will and followed whichever resident or attending didn't give me the stink eye into the rooms. They're pretty casual about students shadowing at Med School Hospital's ED. It was my maiden voyage in the ED (no one put big red V on my forehead with lipstick, sadly). I saw some really interesting stuff, some OKish stuff, and some "WTF are you doing in the ER for this shit?" stuff.

My favorite, though? A severely autistic patient who was sent in (and by "sent in", I really mean "dumped") by his home with some paperwork. On his chart was written:

"Chronic Illness:          Artistic         "

I'd love to see the DSM IV criteria for that.

Timing

Timing can be a funny thing.

In October, my nurse practitioner cousin asked me about some GI problems just as I wrapped up my GI module. I hypothesized that she maybe had a food allergy based on her history, but hell if I know for sure. And no, I don't know why SHE would ask ME anything, the girl worked in an ER for four years. Clearly she's the one with all the practical knowledge.

In December, I learned about orthopedic injuries and soon after, got a call from my dad about a knee problem. He had a screaming positive McMurray test when I went home and demanded he lay down and let me poke and prod his knee (very patient, my father). He's getting his 35% medial meniscal tear fixed up at the end of the month.

Tomorrow, my grandfather is having a cystoscopy for suspected bladder or prostate cancer while I will sit through a lecture on renal and bladder cancers. This is my least favorite match-up so far.

Think About the Plants!

One of my very favorite professors often gives us notable quotes to breakup his lectures (most of them revolve around Chuck Norris...yes, you read that right). He threw this one on the board recently:

"Never trust a doctor whose office plants are dead."

As someone who loves plants and yet seems to have a black thumb instead of a green one (I killed a cactus in college, y'all), this doesn't bode well for me. I mean, I'm pretty good at keeping animals alive; as long as it can tell me it's hungry (whining, jumping on my face, rattling the food bowl, pawing at my bedroom door at 6am), it will survive my care. But if it doesn't let me know? It might get forgotten for long periods of time. I go through several plants a year, which all seem to invariably die off when I bring them in for the winter because the lady who shares a porch with me is no longer able to take pity on them when watering her own plants.

So only patients who can actually vocalize their problems to me.

NC Giving a "License to Kill" to ED Docs?...Not Quite, Guys

White Coat's Satellite Healthcare Update over at ER Stories earlier this week included a story about a bill proposed in NC that would extend some malpractice immunity to ED providers. If you read the story linked, you won't see any actual info about the bill. But you WILL read a good bit about the  North Carolina Coalition for Patient Safety director and chair member and their medical malpractice woes. Also, you will read a few fearful statements about the ethical ramifications of this act; NC-CPS director Laurie Sanders warns that enacting such a bill " gives every doctor and nurse a green light to commit malpractice in the ER." Damn, how'd she know?! I thought we medical providers did such a great job of concealing our eagerness to commit malpractice.

Don't get me wrong, malpractice DOES happen. And the idea of completely absolving ED workers from all malpractice, no matter what, seems pretty crazy to me. So I actually went and read the bill (guys, always do this, there's usually a spin - negative or positive - in the news article!) Yeah, the article was blowing it all out of proportion, or at least blowing the wrong things out of proportion.

My final conclusions? Damn, I'm glad I didn't go to law school. Also, this bill is shockingly not a giant "Get Out of Malpractice Free" card for ED workers! What it does is:

1. Say that any ED provider can't be held liable until it has been proven that they acted negligently
2. Require a bifurcated trial (first a trial for medical liability and compensation, then a trial for punitive damages) for any malpractice case where the plaintiff is requesting more then $75k in damages.
3. Impose a $250k cap on noneconomic damages - this actually seems like the one that should be making headlines
4. Allow for payment of damages in the form of structured settlements as opposed to only a lump sum
5. Require that it be specified how much of an "award" is for economic and how much is for noneconomic losses
6. Require the jury be instructed on the meaning of economic vs noneconomic ("pain and suffering") damages
7. Limit the amount a defendant who is appealing a ruling in favor the plaintiff must pay to either the amount specified by the jury OR the maximum limit their malpractice insurance covers, whichever is lower; this means that the provider doesn't pay an damages out of pocket until an appeal has been completed (at which point, if still found guilty, they will have to pay the rest of the damages)

Yep, nowhere in there do I see a promotion from "MD" to "007" in there for NC practitioners. Sorry guys, maybe next time!

Med School Is...

...coughing through a viral URI lecture and threatening to cough Rhinovirus all over your classmates who laugh at you.