Anybody else disillusioned already?

[coffeebeing]

Two months into internship, I'm already disillusioned. I've heard of the "Intern Blues" that set in around November, but it's already happening to me. Every day, I find it harder to get up in the morning, and I feel like I'm just getting by doing a half-assed job. The sad part is, I'm not even working close to 80 hours a wekk so I shouldn't have anything to complain about. In med school I was busy thinking about getting into residency, but now that I'm here and I see how hard the attendings work, I don't know if I want to be a doctor anymore. I don't think I'm depressed, I just want to start living life outside the hospital.

Please tell me I'm not alone in feeling this way.

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[pillowhead]

Please tell me I'm not alone in feeling this way.

pillowhead raises hand.

no, you are not alone in feeling this way.

 

[excalibur]

excalibur raises hand as well

the sad part for me is that for the most part, I feel I haven't learned that much more about medicine. the "learning" i do is how to do the discharge summaries on this hospital computer's system, how to type in the orders..."now at this hospital, if you want to order lovenox for DVT prophylaxis, there's a new pathway that's being implemented...", "make sure that you remember here at this hospital, we do pre-discharge orders where you type out the instructions and the time of the anticipated discharge the following day, oh but don't forget, when you are prepared to discharge him, you MUST hit the proceed with discharge button. Nothing will get done unless you click proceed". "Now once discharge takes place, make sure you type in a note. You STILL have to type in a not, and it MUST be labeled DISCHARGE INSTRUCTIONS. To do this, you click A, scroll down to B, then look in the corner of the window and you'll see it" "Good morning docs, meet the team, we have the dietician, the pharmd's, the social workers, the case coordinator, the step down unit supervisor, the bed mgmt supervisor, the floor coordinator, and of course, our social services consultant......Is there anything the team would like to share with the docs for the one month they're gonna be here to help their transition be a little smoother........Dietician: If you need TPN, the Ensures, Calorie counts, make sure you do it in fashions A, B, or C, and pay particular attention to which choice you click on the computer, if you click choice 1 that indicates a certain time, and patient won't get hiis ensure until 6 pm the next day, if you want him to get his ensure for lunch it has to be done this way, if you want him to get them as snacks click the button on your computer that is in that drop down menu..........this is followed by every other team member giving a similar spiel................I sit there, and I think to myself, is anyone ever going to teach me anything about medicine anymore. I just PRAY that when I start anesthesiology in July that I will be taught MEDICINE, I focus my time on studying ANESTHESIOLOGY, I hone my skills on my PROCEDURES, and then start forgetting everything there is to the horror of intern year.

 

[countdookie]

excalibur raises hand as well

I sit there, and I think to myself, is anyone ever going to teach me anything about medicine anymore.

Nope. Who cares about learning medicine when you could be learning how to enter orders and follow administrative procedures? Not I! Also, it's great how everyone is sitting there lecturing you on how to do their job. I thought the nutritionist was there to handle the nutrition but she's just there to monitor you handling the nutrition. I love her though! Just like I love you! I love everyone!!!!!!!

 

[pillowhead]

excalibur raises hand as well

the sad part for me is that for the most part, I feel I haven't learned that much more about medicine. the "learning" i do is how to do the discharge summaries on this hospital computer's system, how to type in the orders..."now at this hospital, if you want to order lovenox for DVT prophylaxis, there's a new pathway that's being implemented...", "make sure that you remember here at this hospital, we do pre-discharge orders where you type out the instructions and the time of the anticipated discharge the following day, oh but don't forget, when you are prepared to discharge him, you MUST hit the proceed with discharge button. Nothing will get done unless you click proceed". "Now once discharge takes place, make sure you type in a note. You STILL have to type in a not, and it MUST be labeled DISCHARGE INSTRUCTIONS. To do this, you click A, scroll down to B, then look in the corner of the window and you'll see it" "Good morning docs, meet the team, we have the dietician, the pharmd's, the social workers, the case coordinator, the step down unit supervisor, the bed mgmt supervisor, the floor coordinator, and of course, our social services consultant......Is there anything the team would like to share with the docs for the one month they're gonna be here to help their transition be a little smoother........Dietician: If you need TPN, the Ensures, Calorie counts, make sure you do it in fashions A, B, or C, and pay particular attention to which choice you click on the computer, if you click choice 1 that indicates a certain time, and patient won't get hiis ensure until 6 pm the next day, if you want him to get his ensure for lunch it has to be done this way, if you want him to get them as snacks click the button on your computer that is in that drop down menu..........this is followed by every other team member giving a similar spiel................I sit there, and I think to myself, is anyone ever going to teach me anything about medicine anymore. I just PRAY that when I start anesthesiology in July that I will be taught MEDICINE, I focus my time on studying ANESTHESIOLOGY, I hone my skills on my PROCEDURES, and then start forgetting everything there is to the horror of intern year.

How ironic. I was just sitting next to a 4th year med student in some conference the other day and told her the exact same thing. I think I'm actually getting dumber with regards to medicine knowledge. I couldn't even remember subarachnoid hemorrhage and temporal arteritis on my headache differential the other day in the ER. I mean, I graduated with honors--I'm not an idiot but those are big things to miss. I'm too busy figuiring out how to get an urgent IR procedure done and trying to get patients into clinics and dealing with obnoxious clerks (lots of people seem to like to complain about the nurses but IMHO, it's the clerks that make my life miserable). Actually learning medicine seesm way down on the priority list when it comes to patient care.

 

[countdookie]

dealing with obnoxious clerks (lots of people seem to like to complain about the nurses but IMHO, it's the clerks that make my life miserable).

I don't think you realize how much work clerks do! Shame on you! Clerks and nurses are both very important members of the healthcare team!! It is disappointing to me that some of my peers have such nasty thoughts! I will give you a hug and you will stop thinking ill of clerks.

 

[Faebinder]

We should hire premeds to type our discharges for 2 dollars per report.

 

[Blade28]

It gets better. Really.

I know it sucks at times, but just try to remember what you liked about medicine that made you apply to med school in the first place.

 

[divinemsm]

...I have become an angry person during the past two months. I never cease to be amazed by nursing staff who page me prior to reading a chart, seeing who the actual intern on call is, or merely because they want to be passive aggressive and refuse to push D50 but will start a vasopressin drip as ordered. I am tired of patients who voluntarily came to the hospital but refuse all interventions except pain meds, meals , and sleeping pills. Please. Not a day goes by when I dont query my fellow interns ,who are categorical medicine , why the hell they chose it voluntarily. Come on anesthesia....the prospect of no more H&P's, admissions blah blah blah sustains me through these sucky times...

 

[Samoa]

I'm actually pretty happy where I am. Granted, the workload is oppressive and grinds you down day by day. But then, I expected to work like crazy and learn on my own time. So I haven't been disappointed.

Also I think the nurses like me, which is odd, because I do absolutely nothing to suck up to them and generally don't let myself get pushed around much. But whenever I carry the service pager and return a page, the first thing they say is, "Oh I'm so glad it's you today!" So that's another reason I'm still in good spirits despite the grind.

Sorry to bust out the sunshine --I know it's annoying but I couldn't help it. It's a pretty day here and I got home while it was still light outside. So I'm in a good mood.

Ahem, carry on...

 

[coffeebeing]

and then start forgetting everything there is to the horror of intern year.

Bless you Pillowhead and Excalibur for rasing your hands. I think horror is the best word to describe internship. I wish someone had told me internship would be like this and I had the sense to run far, far away. But it's too late now, and all I can do is take each day as it comes and hope it will get better. I sure would like to pull a Peter from Office Space though.

I uh, I don't like my job, and, uh, I don't think I'm gonna go anymore.

 

[coffeebeing]

I just thought of another appropriate Office Space line:

I realized, ever since I started working, every single day of my life has been worse than the day before it. So that means that every single day that you see me, that's on the worst day of my life.

 

[smq123]

We should hire premeds to type our discharges for 2 dollars per report.

Actually, what's sad is that you could call it "quality clinical exposure," and you'd have dozens of premeds volunteering to type them up for free.

 

[countdookie]

If you told premeds that it's something you can put on an application, they'd have sex with a dog.

 

[countdookie]

sex with a dog

 

[leorl]

Just to let y'all know that this feeling is the same all over the world. Anyone who's an intern is gonna basically experience the same thing. Two months in and you can literally see the black cloud above my head with lightning. I had a week of holidays last week and as soon as I got back to hospital, black cloud returned. I feel like I'm getting dumber by the day. I love the specialty I'm rotating in currently (over here, we rotate for 3 months and right now I'm doing Orthopedics) but I have to do so much stuff that's not medicine that I get into a seriously foul mood. Yesterday, I rang around twenty methadone clinics so that some waste of space kid who was drug dealing in the hospital (!) and threatening to sue could have his methadone clinics switched so he could be turfed to the homeless persons unit. Definitely NOT in my job description.

I'm eating a lot of chocolate cake these days.

 

[leorl]

Oh, and I'm really tired of being exhausted all the time. Especially when you're exhausted even before call starts!

 

[Tired]

.

 

[sga1120]

just for fun....

where is everyone from??? (not that i'm gonna use this to rule out programs that i'll be applying to or anything)

 

[umza]

then we have teaching for 1 hour.....then try to get your 8 patients progress notes done and signover in time to go pick up the kid at daycare, make supper, put the kid to bed and then do it all over again.

Someone mentioned learning, I feel I am only surviving. Barely have time to look up issues surrounding my patients, I am feeling very inadequate.

So far my attendings and residents have been understanding and kind, however maybe my expectations are greater. I feel very stupid here.

Does it really get better?

 

[TicToc22]

Hey i'm an intern here going into ophtho and dealing with my first inpatient medicine month and i have to say i agree with EVERYTHING that you guys are saying about internship. Thank you so much for posting so i don't feel like i'm alone. I havn't learned jack about medicine other than how to fill out paperwork. every day is horrible, i hate d/c summaries and i feel completely inqadequate despite doing very well in med school. I have to do so much damn paperwork on my patients that i cannot even really take the time to think about management and the science behind it. No matter how hard i work there is always something that i havn't done, or havn't done right. I don't understand why anyone would voluntarily choose to do medicine and i can't wait till i never have to deal with admissions or discharges again. The only time i believe it gets better is when internship is done and i never have to see another inpatient rotation again. Good luck to everyone i'm sure we'll all survive

 

[solie]

I'm disillusioned by the total lack of respect patients have for docs in the hospital. I try to be considerate and accomodating and feel like I really go out of my way to make patients as comfortable as they can be and am more often than not repaid with a virtual slap in the face by my patients--they swear at me and scream down the hall at me if they want more Dilaudid than I'm willing to give them, curse me out for trying to examine them and refuse to cooperate with the exam until I get them more pudding or something equally as ridiculous. They're not all like that, of course, but I really feel like there are more patients like that on my service than not. No respect, no appreciation--just demands and abusive remarks. And I'm expected to still remain professional and respectful of them throughout it all. How do other people handle all this, or is it just my hospital that's overflowing with patients like this??

 

[Faebinder]

I'm disillusioned by the total lack of respect patients have for docs in the hospital. I try to be considerate and accomodating and feel like I really go out of my way to make patients as comfortable as they can be and am more often than not repaid with a virtual slap in the face by my patients--they swear at me and scream down the hall at me if they want more Dilaudid than I'm willing to give them, curse me out for trying to examine them and refuse to cooperate with the exam until I get them more pudding or something equally as ridiculous. They're not all like that, of course, but I really feel like there are more patients like that on my service than not. No respect, no appreciation--just demands and abusive remarks. And I'm expected to still remain professional and respectful of them throughout it all. How do other people handle all this, or is it just my hospital that's overflowing with patients like this??

(Begin Rant)

Absolutely... something is wrong with the picture. I got this one lady "who thinks she is funny" that wanted to stay in the hospital a week cause she did not want to stay with her daughter while she was down in this state. She had recovered from her surgery and according to her "is not ready yet to go home to her state up north". I'm like what the heck...you cant stay here, you look great (better than I do)... she was like "I dont wanna pay for a hotel to be here for a week". I was like "So how will i get the insurance to approve your stay in the hospital room for a week? They will ask why is this lady here an extra week spending $2000 each day?" She was the rudest thing I experienced in a while... week before that had an opiate addict postop swearing at my chief (telling him to shut up, infront of the attending too) cause he didnt get his percocet in 2 hours after we stopped his PCA... as if we can control that. The attending brought in the patient advocates and risk management and pretty much softened the situation (but that didnt help cause there were consequences). I could go on with more vague stories but I am pretty much shocked at how much it's okay to belittle the physician managing the patient.

I dont get it, when did it become okay to talk crap to your physician? Not because he is just your physician, but he is a person too who is tied up by his relationship to you. Deep in my heart, I almost wish Obama or Clinton will take over and switch to canada stylized social medicine... cause we all see how the patients in the VA are treated...

We need to start making people see that they are paying for the services. That benadryl you want to go to sleep... well that costs money my friend, I will write an order for you but you need to know that you are responsible for some of the bill for it.

(End Rant)

 

[Coastie]

Except that a socialist system will not only make the patients more demanding, but less accountable for their care, leading to a worsening of the situation. Oh, did I mention increased paperwork, decreased physician pay, and absolutely no incentive to work harder by ANY of the staff?

Yeah. Hell on earth.

Internship is hell on earth: complete socialized medicine from obama or hill-dogg is 100000000 X worse. But hey, it's only a year, and for everyone that has something brighter ahead (rads, gas, ophtho, neuro) keep lookin ahead. For all you IM people, it's not too late to switch.

(Begin Rant)

Absolutely... something is wrong with the picture. I got this one lady "who thinks she is funny" that wanted to stay in the hospital a week cause she did not want to stay with her daughter while she was down in this state. She had recovered from her surgery and according to her "is not ready yet to go home to her state up north". I'm like what the heck...you cant stay here, you look great (better than I do)... she was like "I dont wanna pay for a hotel to be here for a week". I was like "So how will i get the insurance to approve your stay in the hospital room for a week? They will ask why is this lady here an extra week spending $2000 each day?" She was the rudest thing I experienced in a while... week before that had an opiate addict postop swearing at my chief (telling him to shut up, infront of the attending too) cause he didnt get his percocet in 2 hours after we stopped his PCA... as if we can control that. The attending brought in the patient advocates and risk management and pretty much softened the situation (but that didnt help cause there were consequences). I could go on with more vague stories but I am pretty much shocked at how much it's okay to belittle the physician managing the patient.

I dont get it, when did it become okay to talk crap to your physician? Not because he is just your physician, but he is a person too who is tied up by his relationship to you. Deep in my heart, I almost wish Obama or Clinton will take over and switch to canada stylized social medicine... cause we all see how the patients in the VA are treated...

We need to start making people see that they are paying for the services. That benadryl you want to go to sleep... well that costs money my friend, I will write an order for you but you need to know that you are responsible for some of the bill for it.

(End Rant)

 

[Discobolus]

I'm one of those categorical medicine people, but my upper levels all tell me it gets better.

I'm so frustrated with my hospitals ordering system. There are like 20 different forms for laboratory and microbiology tests, and then some consults you fill out on a computer and others you fill out a form, and others you just call, and they seem to change each week. On some floors you can write lab orders in the chart and the nurses fill out the requisition forms, and then on other floors you have to fill them out yourself, and if you don't know the difference the blood just doesn't get drawn.

I spend 80 hours a week at the hospital, routinely break the 10 hours between shifts rule, and then do most of my notes and discharge summaries at home which doesn't count toward the 80 hours.

I have patients with "chronic pancreatitis" who are crying for their dilaudid, yet need an IV bolus to catch up because they weren't able to use the PCA while they were sleeping soundly. Same patient claims to have not eaten solid food for the last 2 months yet has a pre-albumin of 40 and gets a colonoscopy where the report calls the prep "horrendous" there was so much stool.

The patients that want to get better are too far gone to ever get better, and the ones that can get better don't care enough about their health to make a simple cardiology follow-up appointment, and are probably still drinking a 30 pack a day to further worsen their alcohol induced cardiomyopathy.

I get yelled at by fellows for both consulting them and not consulting them soon enough. I get chewed out by one of our ERCP guru's for not knowing my patients albumin right off the top of my head.

It's not all bad though. I have good days and I have bad days. Sometimes I'm convinced that I'm the dumbest intern in the program, but thats probably just me having high expectations for myself. I still like internal medicine although I can see myself leaning more toward one of the non-competitive lifestyle subspecialties (rheum or endocrine) these days. I don't generally feel depressed at this point, I'm really happy when I'm not in the hospital, it's just that those days are so few and far between anymore. I just have to make it to November, when I have an ambulatory month (8-5, weekends off) with a vacation week.

Not to mention that I'm 9 hours away from my family and the closest thing I have to friends that are not doctors are the med students.

In defense of my program I generally really like it here and the attendings are very nice (my cardiology attending insisted we called him by his first name because we were all doctors), the program is very front heavy and the 2nd and 3rd years are quite good I've been told. Internship is going to suck even in the best of circumstances.

 

[coffeebeing]

We need to start making people see that they are paying for the services. That benadryl you want to go to sleep... well that costs money my friend, I will write an order for you but you need to know that you are responsible for some of the bill for it.

I completely agree. Some people think if they come through the ER they won't have to pay for their care! And don't even get me started on those super morbidly obese patients with every chronic problem under the sun because of their obesity who keep coming in because they can't breathe or have chest pain. Thanks to their disability checks, they can keep sitting on their ass all day and get fatter so we taxpayers can spend even more money on them. The worst part is that as an intern, I have to get my hands under those 300 pound pannuses to examine them. *Shudder*

 

[Derek Zoolander]

I had some big time anxiety issues my 1st month and a half....it's a huge jump going from med student to physician and, despite knowing my stuff and being told flattering complements, I constantly questioned myself and worried to the point of losing 15 lbs.

I sought some help early on b/c I realized that this wasn't healthy. It worked and I'm feeling a lot better now. I'm also counting down the days unti I'm officially in anesthesiology.

I think a lot more interns than not are coping with these types of feelings, but we are conditioned to be stoic in medicine. I think threads like this are healthy as it prevents anguish, anxiety, etc. from building up until it boils over.

 

[Jimmy1]

I did a search looking for something along the lines of "intern, feeling stupid," and I found this thread- perfect.
I was hoping that I was not the only intern feeling grossly inadequate, despite working my ass off everyday. Most days I feel like the attendings and senior residents all think I am the dumbest member of my residency class.

Hopefully these feelings will eventually fade away. sigh.

 

[coffeebeing]

To add insult to injury, I got my evaluations from July and they were lukewarm to say the least. Can things get any more demorolizing? I don't know what I'm doing in medicine anymore.

 

[oompaloompa]

So does anyone else get emailed or handed a couple 20 page+ articles everyday. I keep all of them and in just 2 months I have amassed a large pile waiting to be read. So far as an intern, I don't even have time to do laundry or go to the grocery store, much less read a 45 page article about hyperbilirubinemia. The sad thing is, I would love to read more! I'm at a very high volume children's hopital and sometimes I feel like I serve a mostly secretarial function.

On another note, is anyone else f*cking fed up with the "FYI" pages. They usually go a little something like this:

Intern: Hey, this is the on-call doc, I'm returning a page.

Nurse: Yes, so pt so-and-so has [insert normal lab value, normal VS, or unchanged longstanding issue]

Intern: Umm, okay.................. Well, that's not concerning/unexpected. Is there something you were worried about?

Nurse: Oh no! I was just letting you know.

Now at first, in all my intern ignorance, I actually responded physically to every one of these pages, thinking that the nurse must have intuitively noticed something was wrong even if it didn't appear so at first. I thought these pages were about patient care.

{endures the taunting laughter of more experienced residents}

Yes, now I know that these pages not about patient care, their purpose is so that the nurse can write "MD notified" in her notes. These are "cover-my-ass" pages.
In the highly protocol-driven world of medicine, I do not judge them for doing this, but it doesn't prevent me from being extremely annoyed when notified of a baseline VS in a pt at 4am. At least some nurses have been considerate enough to send their "FYI's" in text page form.

Oh well, just part of the game, I guess. Seeing the overwhelming happiness of the second years gives me hope though.

If anyone else needs to vent, let the b*tching fly, I will agree with you and throw in a few rants myself.

 

[Discobolus]

I'm on cardiology right now and we like to keep potassiums at 4.0 or greater, so there is this one nurse who will check the labs and I will get like 4 text pages in a row letting me know that "Mr. Smiths K is 3.9, do you want to supplement?" At least they are text pages.

I'm also getting really tired of all the drug "allergies". I had a patient today tell me that he had to get Humalin R insulin instead of Novalin R insulin because Novalin gave him hives and a rash once. This is despite the fact that he's been getting Novalin throughout his admission and has done fine, he just noticed the nurse was giving him Novalin today.

Then don't even get me started on family members who read too much but don't have the necessary knowledge to understand what they are reading. Sometimes I want to tell them that the reason their brother has elevated LFTs is because he drinks a 30 pack per day, not because of a drug we are giving him where elevated LFTs makes it into the top 300 side effects.

My biggest rant is probably the pain scale. You would think my patients are member of Spinal Tap because they go to 11. I've never had 10/10 pain in my life, I reserve that level for being disemboweled or something similar. But I will see patients lying in bed in no apparent distress complaining of 13 out of 10 pain.

 

[gutonc]

I'm also getting really tired of all the drug "allergies". I had a patient today tell me that he had to get Humalin R insulin instead of Novalin R insulin because Novalin gave him hives and a rash once. This is despite the fact that he's been getting Novalin throughout his admission and has done fine, he just noticed the nurse was giving him Novalin today.

Drug "allergies" are a helpful Axis II screening tool though. Allergies to more than 3 categories of drugs, more than 3 analgesic/narcotic drugs (and it's never demerol or dilaudid) or more than 5 total allergies has an extremely high sensitivity and specificity (99+% in my experience) for an Axis II disorder. It's just nice to know what you're dealing with before you even go in the room.

My personal favorite was the woman who, among her 9 drug allergies had "normal saline" listed. We told her that wasn't compatible with life as a carbon-based lifeform on planet Earth and quickly moved on to the next admit.

 

[Faebinder]

Drug "allergies" are a helpful Axis II screening tool though. Allergies to more than 3 categories of drugs, more than 3 analgesic/narcotic drugs (and it's never demerol or dilaudid) or more than 5 total allergies has an extremely high sensitivity and specificity (99+% in my experience) for an Axis II disorder. It's just nice to know what you're dealing with before you even go in the room.

My personal favorite was the woman who, among her 9 drug allergies had "normal saline" listed. We told her that wasn't compatible with life as a carbon-based lifeform on planet Earth and quickly moved on to the next admit.

Just had that the other day.. a lady with 13 allergies... including 2 entire families of drugs and included morphine but not dilaudid or demerol!

 

[Discobolus]

I think I've heard if the patient has more than two allergies or two cats you will be dealing with some psychiatric issues.

My fellow intern had a patient this week who was "allergic" to all generic drugs. Our attending finally had a talk with this lady about her "allergy" and a pretty good shouting match ensued!

Drug "allergies" are a helpful Axis II screening tool though. Allergies to more than 3 categories of drugs, more than 3 analgesic/narcotic drugs (and it's never demerol or dilaudid) or more than 5 total allergies has an extremely high sensitivity and specificity (99+% in my experience) for an Axis II disorder. It's just nice to know what you're dealing with before you even go in the room.

My personal favorite was the woman who, among her 9 drug allergies had "normal saline" listed. We told her that wasn't compatible with life as a carbon-based lifeform on planet Earth and quickly moved on to the next admit.

 

[blanche]

Drug "allergies" are a helpful Axis II screening tool though. Allergies to more than 3 categories of drugs, more than 3 analgesic/narcotic drugs (and it's never demerol or dilaudid) or more than 5 total allergies has an extremely high sensitivity and specificity (99+% in my experience) for an Axis II disorder. It's just nice to know what you're dealing with before you even go in the room.

My personal favorite was the woman who, among her 9 drug allergies had "normal saline" listed. We told her that wasn't compatible with life as a carbon-based lifeform on planet Earth and quickly moved on to the next admit.

i'm laughing so hard the coffee came out of my nose.

 

[GoodMonkey]

I think I've heard if the patient has more than two allergies or two cats you will be dealing with some psychiatric issues.

in the ED about 2 weeks ago, i learned about the "stuffed animal sign." if a grown adult comes into the ED and pulls out a stuffed animal, you know there is a psych/PD baseline to her problems.

 

[sophiejane]

in the ED about 2 weeks ago, i learned about the "stuffed animal sign." if a grown adult comes into the ED and pulls out a stuffed animal, you know there is a psych/PD baseline to her problems.

There's also the pink bow and the sunglasses sign. Pink bow tends to be more borderline, where as sunglasses may also have dependence issues involved.

 

[FuzzyBK]

Just had that the other day.. a lady with 13 allergies... including 2 entire families of drugs and included morphine but not dilaudid or demerol!

One of my attendings had a formula:

If the # of allergies was greater than the tens digit in their age = crazy.

 

[Blade28]

One of my attendings had a formula:

If the # of allergies was greater than the tens digit in their age = crazy.

Nice! I like that!

Gotta love the drug seekers who, when asked what meds they're allergic to, rapidly reel off "morphine, Percocet, Vicodin, fentanyl, Demerol..."

So what pain medication does work for you? I ask.

"IV Dilaudid."

Of course.

 

[Tired]

I was taught that location of pain determines sanity:

Radial-sided wrist pain = arthritis
Ulnar-sided wrist pain = crazy

Anterior knee pain = patelofemoral syndrome
Posterior knee pain = crazy

Cervical pain = DJD
Lumbar pain = crazy

Lateral ankle pain = ligamentous insufficiency
Medial ankle pain = crazy

 

[Blade28]

I always cringe when any of the following scenarios happens:

Me: "Do you have any other medical problems?"
Pt: "Yes, I have chronic fatigue syndrome."

Me: "Do you have any other medical problems?"
Pt: "Yes, I have fibromyalgia."

Pt: "Doctor, whatever pain medicine the nurses are giving me, it's not working!"
Me: "Really?"
Pt: "Yes, my body isn't like everyone else's, I have a super-tolerance." Or: "I have a very high pain tolerance, so you know that I need higher doses now."

(During physical exam...)
Me (palpating area of pain): "Does it hurt here?"
Pt: "Yes."
Me (palpating nearby): "Does it hurt here?"
Pt: "Yes."
Me (palpating a random part of the body): "Does it also hurt here?"
Pt: "Yes."
Etc...

Me: "On a scale of 1 to 10, with 1 being almost no pain at all, and 10 being the worst pain you've ever felt in your life, what's your pain right now?"
Pt (sitting upright in bed, watching TV, eating a sandwich, talking on cell phone): "10!"

Me: "On a scale of 1 to 10, with 1 being almost no pain at all, and 10 being the worst pain you've ever felt in your life, what's your pain right now?"
Pt: "30!"
Me: "Um, ma'am, it's on a scale from 1 to 10."
Pt: "30!"
(The following day...)
Me: "What's your pain level now?"
Pt: "12!"

 

[deleted87716]

Me: "Do you have any other medical problems?"
Pt: "Yes, I have chronic fatigue syndrome."

Me: "Do you have any other medical problems?"
Pt: "Yes, I have fibromyalgia."

Pt: "my body isn't like everyone else's, I have a super-tolerance."

Me: "What's your pain level now?"
Pt: "12!"

Or, better yet...all of the above, in the same patient.

 

[Tired]

Me: "On a scale of 1 to 10, with 1 being almost no pain at all, and 10 being the worst pain you've ever felt in your life, what's your pain right now?"
Pt: "30!"
Me: "Um, ma'am, it's on a scale from 1 to 10."
Pt: "30!"
(The following day...)
Me: "What's your pain level now?"
Pt: "12!"

I never ask for a number, so I always know the freaks when they offer one:

Me: How's your pain today?
Pt: It's an 11!
Me: Okay. But how do you feel? Is it better or worse than yesterday morning?
Pt: No kidding doc, it's really an 11 out of 10!
Me: Is that better or worse?
Pt: Better. Yesterday was a 12 out of 10!
Me: Okay. I'm shutting off all your narcotics.
Pt: But then it will be a 15 out of 10!
Me: Yeah, I'm hoping the pain will make it too difficult for us to talk.

 

[Winged Scapula]

(During physical exam...)
Me (palpating area of pain): "Does it hurt here?"
Pt: "Yes."
Me (palpating nearby): "Does it hurt here?"
Pt: "Yes."
Me (palpating a random part of the body): "Does it also hurt here?"
Pt: "Yes."
Etc...

The trick here is to ask again, but without even touching them. Always amuses me when they say "that hurts" when I'm not even near them.

 

[NotAProgDirector]

Me: "Do you have any other medical problems?"
Pt: "Yes, I have chronic fatigue syndrome."

Last week, one of my patients brought be a full page advertisement about CFS, which led me to this link.

So, let me see if I get this correct.

It’s important for people to recognize the symptoms of CFS and, if you or a loved one has those symptoms… Get informed. Get diagnosed. Get help.

The CDC is spending tax dollars to advertise this.

And, of course, the CDC gives me this helpful advise as far as diagnosing CFS:

Diagnosing chronic fatigue syndrome (CFS) can be challenging for health care professionals. A number of factors add to the complexity of making a CFS diagnosis:
1) there's no diagnostic laboratory test or biomarker for CFS,
2) fatigue and other symptoms of CFS are common to many illnesses,
3) CFS is an invisible illness and many patients don't look sick,
4) the illness has a remitting and relapsing course,
5) symptoms vary from person to person infrequency and severity, and
6) no two CFS patients have exactly the same pattern of symptoms.

And then, I get the following helpful information about treating CFS:

Many CFS patients are sensitive to medications, particularly sedating medications. Therapeutic benefits can often be achieved at lower than normal dosages, so try prescribing a fraction of the usual recommended dose to start and gradually increase as necessary and as tolerated. All medications can cause side effects, which may lead to new symptoms or exacerbate existing symptoms, so it is important to routinely monitor all prescription drugs, OTC therapies and supplements the patient is taking.

So by "get help" above, I guess they don't want me to prescribe anything.

Acupuncture, aquatic therapy, gentle massage, meditation, deep breathing, biofeedback, yoga, tai chi and massage therapy have been found to help some patients and are often prescribed for CFS symptom management.

Ah yes, there is just an abundance of evidence for these interventions.

Most pain therapy begins with simple analgesics like acetaminophen, aspirin or NSAIDS..Additional therapy can be managed by a pain specialist.

Apparently the CDC has access to a Pain Clinic staffed by uber-sensitive anesthesiologists. My pain clinic regularly discharges these patients without further follow up.

Some patients with CFS may also exhibit symptoms of orthostatic instability, in particular frequent dizziness and light-headedness. During office visits, provide a place for CFS patients to recline if they have difficulty staying upright for more than a few minutes at a time.

Great idea. I think I'll get some La-z-boys for the exam rooms and waiting room.

Research shows that CFS is not a form of psychiatric illness or depression. Professionals are advised to use caution in prescribing antidepressants. Antidepressant drugs of various classes have other effects that may act on other CFS symptoms and/or cause side effects.

And they prove this, how?

So, when my patient asked for the cure for CFS (which she conveniently diagnosed herself, saving me the difficulty, thanks to the CDC), she was a bit disappointed.

 

[AlternateSome1]

in the ED about 2 weeks ago, i learned about the "stuffed animal sign." if a grown adult comes into the ED and pulls out a stuffed animal, you know there is a psych/PD baseline to her problems.

Don't forget the luggage sign. If someone arrives at the ED with a suitcase, watch out...they are crazy and planning on staying for a while.

 

[Faebinder]

Chief Complaint: PAO (Pain All Over).

 

[anonodoc]

Everyone hates internship, but it DOES get better. Three months into PGY-2 year, and life is looking SO much brighter. It's not so much that the work load lessens either. It's just that you do know how to get things done, people treat you better, and, at least in my program, there is less call. And when you're on call, it's not so bad, for the most part, because the intern is the one doing the hard work. Sorry. I was doubting my career choice last year about this time, too. For the categorical medicine interns out there, what you do in internship is nothing like what you'll be doing for the rest of your career. It does get much, much better. You'll have to trust me on this-- I didn't believe it last year either, but then July of this year came around, and while I was no different than I'd been in June, things got better. Good luck.

 

[fineline]

So, when my patient asked for the cure for CFS (which she conveniently diagnosed herself, saving me the difficulty, thanks to the CDC), she was a bit disappointed.

You don't know the cure for CFS? It's called "not filling in their disability form." At the minimum it'll get them to go somewhere else.

 

[dynx]

Chief Complaint: PAO (Pain All Over).

And for our illegal immigrant friends who still don't speak english

CC: TBD (total body dolor)

You don't know the cure for CFS? It's called "not filling in their disability form." At the minimum it'll get them to go somewhere else.

I now routinely place these in the trash, with few exceptions.