February 20, 2009 – 2:34 PM
In the hospital setting, we have some rather elaborate and expensive systems in place the sole purpose of which is to increase efficiency. For example, we have a transcription service, thus allowing us to dictate our notes rather than having to type them. This is simple economics. Allowing us to dictate rather than having to type saves time for us doctors, thereby freeing up time to see more patients during the workday resulting in more income for the hospital. The extra revenue this generates more than justifies the added cost of hiring transcriptionists to type out everything for us. Why then do we continue to insist upon deliberately decreasing the efficiency with which we do things? The most prevalent and striking example of this phenomenon in the modern age is using our cell phones to communicate via text rather than voice. Many very smart people were paid very well to labor on the problem of how we might talk to someone who is a great distance away without being dependent on pesky wires which limit our mobility. After much perseverance, they found a solution - the cell phone! So why in God's name do we continue to insult these hard working innovators by taking something which they designed specifically to enable us to communicate very efficiently and deliberately perverting its in such a way as to enable us to communicate less efficiently? Consider, if I get a text from a friend asking WHAT I'M UP 2 DOG? (which took longer for my friend to enter into his phone than it would have for him to simply say) and I reply with NOT MUCH, U?, we've both spent valuable time and money on these messages and we are no closer to having plans for the evening than we were before.
Our textual habits seem to have carried over into the hospital setting. Quite often I'll get a text-page inquiring about whether a particular lab value has come back yet. I will then have to page this person and wait for a call back so we can have a discussion about an abnormal bilirubin value, whereas if they had simply paged me with their callback number, instead of a text message, I could have initiated the bilirubin conversation straight away. Alternatively, I could reply with a text page of my own. I might reply with: YES, IT DID COME BACK. Then perhaps I would receive a later page: WHAT WAS IT? I could respond with 4.5 etc. I could also use a pair of scissors to mow my lawn and Q-tip to paint my kitchen but these things don't make much sense either.
November 2, 2008 – 6:36 PM
I love it whenever I get the opportunity to wear a tux because I just look so damn awesome in it! I had one such opportunity last weekend.
Let me explain by first saying that, on a given Friday night, I am far from the best looking guy in the club. I'm 28 years old, 5'9". I have a somewhat dark complexion which Greeks and Italians will equally claim as a reflection of their selfsame heritage. I have brown hair and eyes and, after having been a resident for over a year, I carry around about 20 pounds more than I need to. And, I think it's precisely because I am neither your handsome stud nor your ugly slob in ordinary life that the tuxedo does so much for me. Put a tux on my buff, 19 year-old, 5'11" cousin with his carelessly tousled hair and winning smile and it almost detracts from his appearance. I'd almost rather see him in a sleeveless tank top and tight-fitting jeans. My 53 year-old uncle suffers from a similar failure of appearance enhancement secondary to tuxedo wearing, but for different reasons. My 53 year-old uncle weighs 270 pounds has 3 chins and what hair he does have left falls in thin, greasy threads on the sides of his head. Sadly, the penguin outfit does no more to disguise his slovenly appearance than the application of lipstick does to disguise a pig.
But for me, the tuxedo is utterly transformative. I have enough imperfections that I can benefit substantially from the outfit's shaping power, but the imperfections are not so severe as to make me a lost cause. I wish I could wear one every day :)
September 10, 2008 – 7:47 PM
Well, if I'm your doctor, chances are probably not. This isn't because my patients are not comical or stupid - they often are. But rather, it's because with all the demands that residency puts on you there is just no frickin' time! To laugh at someone takes extra planning and energy that can much better be spent catching up on discharge summaries, taking in a sporting event, sleeping or laughing at ER Stories's patients. But, for me, the answer is 'no,' I never laugh at my patients. Neither do I tend to engage in other unnecessary and time-consuming activities such as empathizing with my patients. There is generally more than enough patient-related work to keep us residents occupied without piling on these extra tasks.
However, a recent CNN article reported that 17 of doctors had admitted to having made fun of a patient while he or she was under general anesthesia. Such behavior is described by this article as "unprofessional." It continues to irk me to no end that stupid shit like this still gets media coverage. If you want to call this kind of behavior unprofessional, that's fine by me. But do not then write about unprofessional behavior as if you're writing about something meaningful.
The term unprofessional, as it relates to medicine, is currently used as a catch-all term for any behavior that we don't like to see doctors engaging in. Anyone who uses it is invoking his own set of values, biases and opinions which may or may not have any bearing on the topic of discussion. I do think there are certain behaviors we, as a society are entitled to expect from doctors in exchange for granting them a license to practice medicine. For example, we are entitled to expect them to respect confidentiality, to provide medical care based on the most current evidence, to disclose all financial relationship when giving talks on disease management etc. Are we entitled to expect that our doctor won't laugh at us while giving us excellent care? No. Most doctors won't laugh at you - for the reasons I mentioned above. But I find myself under no obligation to refrain from holding my side and bending over in a hearty guffaw over whatever mess you've gotten yourself into. I hope you don't take offense. I am, after all, very sincerely trying to help.
September 5, 2008 – 9:01 AM
A car rear window shade caught my eye in the little shop next to our hospital cafeteria. "Hello sir, may I help you?" The African American lady who ran the shop looked to be in her late fifties. She greeted me with a warm, friendly smile.
"Oh, no thanks," I replied - as it was really a shade for my front windshield I was after. "I'm just looking."
"Ok. Well, you let me know if you have any questions. And have a blessed day."
I thanked her, hoping she felt my appreciation for waking me from my usual 6am state of morning-zombie into a warmer, more colorful world. I imagined that maybe she had a husband. Maybe three or four children and perhaps even a few grandchildren. I imagined her children all coming to visit her on Thanksgiving day, all pitching in to do the dishes, telling stories and laughing late into the evening.
She turned to finish a previous conversation she had been having with one of the cashiers. "Well, I don't know how you just stand by and let something like that happen. I mean, if we still have the bomb - and I was informed we do - and it was up to me, the Middle East would be nothing but a memory. It'd be nothing but sand."
"That's right, just take the whole damn country out," her cashier chimed in.
"Like Sodom and Gomorrah in the bible," she went on. "You gotta just take out the whole God damn country."
I wasn't sure exactly which country she was referring to. Perhaps she believed the Middle East to be its own soverign nation. Such a nation is probably evil, probably wants to destroy the U.S. and probably has Osama Bin Laden is its president. It was beginning to hurt my sould to think about it any more deeply so I sighed, half closed my eyes and continued to shuffle through the day in zombie mode.
I'm currently on one of the hardest rotations our program offers. I had the day off the other day and I went to pick up my first paycheck. My program director happened to be there at the time.
"How's it going?" he asked, with a look of genuine concern.
"Oh, it's ok. I had eight patients on my first day, so that was a little rough. But everyone's really helpful and I'm getting the hang of things."
"Good, glad to hear it. We do our best but for some of these rotations, we seem to be just perpetually short on personnel. I appreciate you're sticking with it."
I almost forgot to pick up my paycheck as I was preoccupied with picking up my jaw off the floor. I'm still getting used to the idea of being in a residency program where the job that they ask you to do is actually reasonable and where your hard work is appreciated. Especially having come for a program where the job you are asked to do is not only unreasonable, but where you're expected to be grateful for the wonderful experience this unreasonable job is affording you. Let me try and give you and idea of the sharp diction between the two.
| QUESTION | RESPONSE |
| | New Program | Old Program |
| Are there any more patients for me to see? | Nope, you've reached your cap! | There are 12 more, and you also need to cover the next three c-sections. |
| My mother died, I have to go to the funeral on Monday. | Ok, we'll have the jeopardy intern fill in for you. | Sorry, we need you to work on Monday. Can you have the funeral when you're on a lighter rotation? |
| I saw your patient, did the appropriate workup and she's all tucked away. | Great, thank you! | Why did you wait so long to tell me she was here! |
| Slouching forward, falling asleep in the computer lab | You look tired, why don't you go rest a couple of hours before your night shift starts? | Since you're not being very productive here, why don't you go help out on labor and delivery? |
Oh, I'm sure I'm in for all kinds of long, crazy nights on call and run-ins with evil attendings over the next three years. But, so far I'm really feelin' it, here at my new home.
My girlfriend and I went to see Iron Man last night. The new glut of superhero movies that began around 1998 makes me wish that I had picked up a Marvel comic book or two as a kid instead of all those "outdoor activities" my parents made me partake in - which seemed like a good idea at the time.
We both really enjoyed it. One of the most refreshing aspects of the movie, is that it successfully avoids the trap which so many post-cgi revolution comic book movies fall into. That is, they don't rely on the cgi too much. Or maybe they do, but cgi has improved to the point where I can't tell the diferrence. That point is that, with few exceptions, the movie never looks like a cartoon. There are many fantastic close-ups of "Iron Man" (which Downey's character builds in the basement of his house in Malibu) with relatively few fast-paced, out-of-focus, night-time action sequences. And I never get tired of Stan Lee's principle theme, no matter how many different ways he packages it: that with the power and gifts we are given comes the responsibility to use them for good.
It was a good time. And it also brought home another point I think worth mentioning: "why will congress not authorize the funding to provide our young men and women in Iraq with the robotic, armor-plated, bullet-proof, rocket-propelled, weaponized suits they need? So many brave soldiers risk their lives every day in the name of freedom and justice and everything that America stands for. And yet the democrats in congress want to deny our troops in harms way the armored, nuclear-powered rocket-suits that they so desperately require. The world changed on 9/11..."
-Ugh. I'm having flashbacks to the nightmare that was 2004. I probably have a little PTSD.
And not to worry, this movie is fun without being a flag-waver (which doesn't seem as fashionable as it used to be anyhow). The thinly veiled representations of Al-Qeda terrorists turn out to be victims - not innocent victims, but victims nonetheless - pawns in the game of an American rogue arms dealer, played by Jeff Bridges. The real enemy, as it is an all good superhero stories, is hubris. For it is hubris that was ultimately responsible for the downfall of, among others: Doctor Frankenstein, Morbius (Forbidden Planet), the first two Spider-Man villans, and of course, the Bush administration.
I hadn't eaten at McDonald's for several months, I have lost 20lbs in the past seven weeks; I decided yesterday that I had earned myself the privelage of a one cheesburger meal for lunch. Not a two cheeseburger meal, not a big mac + a chocolate shake meal - a ONE cheeseburger meal. My girlfriend and I pull up to the drive thru where we are accosted with a $1 menu that includes a double cheeseburger. "That's cool," I think to myself. "Double cheeseburger only costs $1. Therefore a single cheeseburger must cost..." (scanning menu, scanning menu) "ALSO $1?!"
"(static)Good afternoon, McDonald's. Can I take your order?(static)"
"Hi, I think there might be some mistake on your menu out here. How much is your cheeseburger?"
"(static)$1.(static)"
"And your double cheeseburger is also $1?"
"(static)Cheeseburger and a double cheeseburger are the same price.(static)"
Well, paint me green and call me gumby. A cheeseburger and a double cheeseburger are the same price. I spent a minute or two trying to justify to myself how I might decide to get just a cheeseburger. But, in the end, it simply didn't make economic <groan>cents</groan>. Twice as much meat for the same price? I had no alternative but to go with the doublecheeseburger.
Now, I'll be the first to admit that I'm no economics expert. In fact, econ 101 was the only class in which I received below a 'B' throughout my 4 years of college. But, I really think this warrants some further study. If we could only figure out what economic principle is operating here, we could kick this recession once and for good. Clearly there is something far more complex that just ordinary 'supply and demand' at work. If we could only harness that power - just imagine the newscasts...
"The price of crude oil held steady today at $114 a barrel. However, thanks to the administration's bold, new economic initiatives in recent months, the price of two barrel's of crude oil also held steady at $114 a barrel. As a result, gas prices held steady at $4.09 a gallon or $4.09 for two gallons. While the price of a ton of rice in the third world continues to soar, overall food shortages have been greatly aleviated as the price of two tons of rice is now at an all time low. Gwen Ifill reports..."
