clinical medicine sucketh

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You just wanted Honors...you gunner. :laugh:

Did you offer to get your resident coffee?
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deschutes said:
Are you nuts?

He said "You and me'll go do this tap". Try getting out of that one.
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Um...yeah, you could've simply said, "I'm gonna be a pathologist. We don't do taps on dead people. This is meaningless to me. I'm going home."

How easy is that?

You wanted Honors....gunner.
 
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AndyMilonakis said:
Um...yeah, you could've simply said, "I'm gonna be a pathologist. We don't do taps on dead people. This is meaningless to me. I'm going home."

How easy is that?
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You should have coached me before. I will work at acquiring a thicker layer of skin so I can say that next time ;)
 
deschutes said:
You should have coached me before. I will work at acquiring a thicker layer of skin so I can say that next time ;)
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It's OK. The first time you say wise-ass **** to someone in clinical medicine requires guts. But the more you do it, you realize that it's easier and easier. It's especially great when you say stuff like that to interns, who have no say in your grade :laugh:

"Do you wanna watch me do put in a central line?"
"Yeah, no thanks. Thanks for the offer though."
 
The IM people always use that **** like, "You should have read more" or the other stuff they said to you because everyone can always read more, and they have to give honors to the people who suck up, and they need excuses.
 
Part of foreplay for many medical specialties is praising their diagnostic acumen and doing a proper cardiac exam. Oh yeah, and citing obscure papers.
 
yaah said:
Part of foreplay for many medical specialties is praising their diagnostic acumen and doing a proper cardiac exam. Oh yeah, and citing obscure papers.
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That damned JAMA Rational Clinical Exam series.

"Depending on the auscultation of wheeze to determine respiratory compromise has a sensitivity of 20% and a specificity of 30% but we do it anyway...."
 
That's pretty poor. I thought Homan's sign was one of the most useless physical exam maneuvers. It still has crappy sensitivity and specificity but I think it was greater than 20-30%. Oh then there's the breast exam...I think it was concluded that breast exams in the doctors office are not all that useful too.
 
AndyMilonakis said:
That's pretty poor. I thought Homan's sign was one of the most useless physical exam maneuvers. It still has crappy sensitivity and specificity but I think it was greater than 20-30%. Oh then there's the breast exam...I think it was concluded that breast exams in the doctors office are not all that useful too.
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I was making the numbers up. I don't routinely keep sensitivities and specificities in my head :laugh:

I did not know what Homan's sign was until I did Ob, believe it or not.

All those eponymous "signs"! Kernig's and Brudzinski's - must you really pimp me on which one is which? I can always look it up before I write it down.
 
deschutes said:
All those eponymous "signs"! Kernig's and Brudzinski's - must you really pimp me on which one is which? I can always look it up before I write it down.
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I could never keep those two signs straight (the names that is) although I could perform those maneuvers. I was too lazy to look up which was which so I would just write down something to the effect of no signs of meningial irritation
 
deschutes said:
I did not know what Homan's sign was until I did Ob, believe it or not.

All those eponymous "signs"! Kernig's and Brudzinski's - must you really pimp me on which one is which? I can always look it up before I write it down.
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I do not know what any of these signs are. Two more days of blissful medical ignorance. I cannot believe that I ever actually passed Step I. :laugh:
 
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beary said:
I do not know what any of these signs are. Two more days of blissful medical ignorance. I cannot believe that I ever actually passed Step I. :laugh:
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The memory of Step 1 is a haze, but I don't believe you need to know very many eponyms for it. They'll probably say something really obvious like "neck stiffness" anyway.
 
Kernig and Brudzinski, whatever. Touch the belly, if it's an acute abdomen, you don't have to do those tests generally to figure it out. Plus, all these tests were done and useful before the advent of sophistimacated radiology which have obviated their usefulness.

Case in point: Occasionally they will take someone to the OR with an acute abdomen (obviously acute) without radiology. But they will NEVER take someone to the OR based on the results of the Kernig or Brudzinski test without radiology. And the radiology is what will decide on whether they go to the OR. The complete physical should be changed to a good neuro exam plus listening to the chest and pushing on the belly, as well as just opening your eyes and looking at the patient. :)
 
Chrismander said:
I could take **** like this and the ignorance if it weren't for the attitude that goes along with it--the absolute certainty over medical issues and treatment from high school dropouts, the wild eyes, the pressured speech and nonsequiturs. It's so goddamn surreal sometimes. I can't wait to get as far away from clinics (or at least public healthcare of any kind) as i can. God forbid i do choose a patient care specialty, i'm going for the cushest suburban place I can find, screw people who badmouth "cush".
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Great post! I must say I sympathize with you as I'm battling in the trenches of a city with what sounds like a similar patient population. Makes you wonder how people can do it. God bless the Internal Medicine folks. The ignorance is mind-blowing at times. Worst of all, these are the types of people that threaten to sue (we have a Johnny Cochran firm here in town if ya know what I mean). And I won't pick on ppl in the inner-city as I've run into some not so smart people on my rotations out in the 'burbs' with similar health issues and feelings of entitlement to boot. Gotta love American medicine. I'm soooo ready for path this year.
 
Chrismander said:
I could take **** like this and the ignorance if it weren't for the attitude that goes along with it--the absolute certainty over medical issues and treatment from high school dropouts, the wild eyes, the pressured speech and nonsequiturs. It's so goddamn surreal sometimes. I can't wait to get as far away from clinics (or at least public healthcare of any kind) as i can. God forbid i do choose a patient care specialty, i'm going for the cushest suburban place I can find, screw people who badmouth "cush".
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But how do you really feel about primary care?:D :rolleyes:
 
Things I would rather do than start my OBGYN rotation Monday:

1. Sell Amway 24/7.

2. Eat leftovers from a KFC Buffett every night- for a year.

3. Change adult diapers.

4. A second Peds rotation.

5. Pass med school Biochem all over again.

6. Tutor freshman football players in "general science" courses.

7. Die.
 
DebDynamite said:
2. Eat leftovers from a KFC Buffett every night- for a year.
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As someone who absolutley abhors that foul-smelling grease pit, I can say that this is by far the worst item of your list, including death.
Just remember to "smell the lochia" to make sure your patient isn't developing endometritis.
 
DebDynamite said:
This is downright disturbing. I can hardly wait.
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Our OB/GYN clerkship coordinator (a 60-70s something Jewish man who no longer practices, but instead likes to make us do headstands and silly OB/GYN case presentations) use to tell us this all the time. In fact, on our first day he said, "Now if you come away with nothing else, I want to make sure that you know what infected lochia smells like." I was like wtf is lochia, and I know that whatever it is I dont want to smell it. I never did smell that lochia. I miss those 4:30 am pre-rounds. Ha.
 
UCSFbound said:
Our OB/GYN clerkship coordinator (a 60-70s something Jewish man who no longer practices, but instead likes to make us do headstands and silly OB/GYN case presentations) use to tell us this all the time. In fact, on our first day he said, "Now if you come away with nothing else, I want to make sure that you know what infected lochia smells like." I was like wtf is lochia, and I know that whatever it is I dont want to smell it. I never did smell that lochia. I miss those 4:30 am pre-rounds. Ha.
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Wake up and smell the plasma cells, bitch!
 
DebDynamite said:
Things I would rather do than start my OBGYN rotation Monday:

1. Sell Amway 24/7.

2. Eat leftovers from a KFC Buffett every night- for a year.

3. Change adult diapers.

4. A second Peds rotation.

5. Pass med school Biochem all over again.

6. Tutor freshman football players in "general science" courses.

7. Die.
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:laugh: :laugh: :laugh:

This made my day. I'm on OBGYN, too, and I wholly concur. Although I feel that way about the entirety of third year. In fact, I'd rather repeat 2nd year, including Step 1, twice. Especially after spending a day in clinic doing pelvic exams and PAPs.

Hearing other people who feel the same helps me keep my wits about me. When I was on surgery I would sneak down to Path to check out specimens and listen to the residents' stories about wanting to kill themselves on surgery and obgyn. Misery loves company, I guess... Hang in there and keep telling yourself, "It's temporary..."

-P.
 
Yes PuGan, I agree. I had an opportunity to "smell the lochia" last night at about 2100. The senior was so very into teaching me how to deliver the placenta. This is going to be one long month.
 
I think one of the best parts was asking our Spanish speaking patients if they had busted ass or taken a **** after their C-section, or if they wanted birth control. They would look at you at 5AM with a perplexed face, struggling to comprehend. That was two years ago, and I still have flashbacks. Fnck.
 
God, how many of us going into path are on OB/GYN now? I just started this week, and it is everything I thought it would be an more. I need some Zoloft or Ativan or something.

My intern criticized me for "not looking ethusiastic" because I don't "smile enough". Mind you, this is after I come in at 5 am to do HER scut and carry out her ridiculous tasks like go down to radiology at 7 am and ask about the official read on a CT that was taken at 10 pm last night when everyone in the hospital knows they won't sign that out with the attending until at least 9 am. When I got home last night I said to myself, "oh man, thank god this rotation is almost over" even though I am two days into it. I guess its some kind of hopeful delusion. I do think they are beginning to realize that I'm a 4th yr going into Path who does not give a flying f*ck about this stuff besides the frozens they send off...hopefully this may ease the pain
 
DebDynamite, you only do a month of OBG? We have 8 weeks :( I did surgery before this and surprisingly I actually like OBG better. But keep in mind that this is just the lesser of 2 extreme evils IMHO. I'm not so hot on the vaginal deliveries, but I don't mind the c-sections. And at least on OB you get to see new dads with these goofy grins on their faces taking tons of pics in the OR or delivery room with their phones.

My first 4 weeks were in a local hospital where about 99% of our patients were spanish-speaking. I do not speak spanish. I picked up some necessities and was able to butcher my way through, but the communication issue was frustrating to say the least, even with our handy-dandy little sheets of common phrases. I actually bought a book and some CDs to try to pick up a bit more. Although the hospital had these double handset translator service phones which saved my a$$. UCSFbound, your experience makes me look back and laugh now, too.

I've been open about my intentions of doing path on both surg and obg. I've gotten the same response from every single resident, 'Path is awesome. That's an excellent field.' Being up-front gave me a lot more leeway to head down to path while on surgery. And I can use it as an excuse for my severely lackluster suturing skills.

I just keep telling myself that I have to get through this year... at least I can try to focus on the clinical aspects of the diseases I will be diagnosing and understand the implications of my diagnoses *sigh*

-P.
 
PuGan, I also get two months of OBGYN- but, it's split up and I can opt to do one month in an underserved area, or come back to the hsopital in the spring and do another month in the "city". I have no idea which I will choose- it's all so weird to me right now.

The OB attendings here have this disturbing way of completely ignoring the med students, as if they aren't even in the room. And we have a resident who is so utterly mad about "catching babies" that she incessantly scoops the vaginal births from the lower level rez and med students. Between the whacked out look in her eyes and the attendings ignoring the med students, I am sort of enjoying the psycho melodrama. It's like being in psych, but it's the OB staff. I guess this is what smelling lochia without sleep for years on end does to people.
 
DebDynamite said:
The OB attendings here have this disturbing way of completely ignoring the med students, as if they aren't even in the room. And we have a resident who is so utterly mad about "catching babies" that she incessantly scoops the vaginal births from the lower level rez and med students.
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Gives them a reason to say "does not appear enthusiastic enough" on your eval.

Maybe I should start using that phrase on med students whom I know are not going into Path and are doing the rotation just to slack off. :idea:
 
deschutes said:
Maybe I should start using that phrase on med students whom I know are not going into Path and are doing the rotation just to slack off. :idea:
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This drives me absolutely nuts. I have done rotations in radiology and anesthesia where I have been informed that I am "not really interested in this" and why dont I just go home. Its as if, no matter how interested you are in learning something about the field (for me intubations and bone/soft tissue imaging), if you arent going into it you are automatically perceived to be doing it so you can "get out early." At least ask, "what do you want to get out of this?". I guess its just easier for them to automatically write a student off because they dont want to take the time to teach anyway. :rolleyes:
 
DebDynamite said:
And we have a resident who is so utterly mad about "catching babies" that she incessantly scoops the vaginal births from the lower level rez and med students.
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I hated those ****ers but they were nice to have around because I had to do less. The worse problem, one that I encountered on my OB rotation, was the resident who was obsessed with seeing all the med students catch a baby. I generally would scope out which patients were highly likely to have C-sections or at the very least a difficult natural birth and take them on as "my patient," that way I wouldn't have to do anything except maybe "help" close the skin or retract on the C-section.

The "prolonged labor" patients, while hell on earth for the future mother, are a boon for the slacker med student. Because you can just keep going in and checking things, look like you're busy. And if by chance they do deliver before you leave, it will be difficult so you "should probably just observe."

Caution: If you are on call, do not take this route. Because if you are on call and not involved at all in a prolonged labor patient, they will hesitate to bring you on board because the family isn't familiar with you and bringing you in at the last minute might be too much. But if you are, that's "your patient." If you are on call, take the G5P5 who comes in fully dilated, then say you are going to the bathroom or the cafeteria. With any luck, she will already have delivered by the time you get back, and you still may get credit.

As you can see, I thought about this a lot.
 
yaah said:
As you can see, I thought about this a lot.
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:) :) :)

Medical students are the same all over the world.

My speciality in OB/GYN used to be holding the delivering mom's hand at the opposite end of the actual action.

Specialists be damned.

OB/GYN still gives me nightmares after 8 years.
 
yaah said:
Because if you are on call and not involved at all in a prolonged labor patient, they will hesitate to bring you on board because the family isn't familiar with you and bringing you in at the last minute might be too much. But if you are, that's "your patient." If you are on call, take the G5P5 who comes in fully dilated, then say you are going to the bathroom or the cafeteria. With any luck, she will already have delivered by the time you get back, and you still may get credit.

As you can see, I thought about this a lot.
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Well, I am on call tonight and this is without a doubt good advice. I have some classmates that are downright pissed that this residet keeps "scooping" the babies as they come out. I am just thinking, "Why? Really, why why why?". I am not gonna loose a smidgen of sleep if I don't catch that baby. I am a woman and seeing vaginal childbirth up close once has been quite enough. And as for all of this gyn surgery, all I have to say about it is that it's better than colorectal. Barely.
 
Wow, I really love this thread. I too have contemplated slashing my wrists several times while on my surgery rotation. Of course, I'm almost done now, so I keep telling myself I should give life a chance. The only days I've enjoyed were the pancreatic and liver resections and for two reasons: One, I got to go to the path lab and two I got to eat lunch. Oh and I only got to eat lunch cause I snuck it on my way to the path lab. But, my surgeon did make me feel guilty for wanting to go to the path lab. It was like I was some kind of puddin pop for wanting to break scrub. Ah...such a wonderful month that was.

never-give-up-l.jpg
 
Last week I scrubbed in on a 6-7 hr Urogyn case. Severe cervical and uterine prolapse... basically, the patient had had a really awful prior surgery that actually made everything worse-- didn't fix a thing and caused stress incontinence (the surgeon actually told her and her family post-op that she would need another procedure) and we were going to fix it all, hence the 6-7 hours. To make matters worse, this patient was obese, not only obese but obese with one hell of a deep pelvis and some serious bowel length. I mean, the surgeon and fellow were having trouble reaching the internal structures even with the long instruments and that super-long bovie tip extender, not to mention what they had to rig in order to maintain sufficient retraction.

I have since switched to a different hospital and found out that I am not scheduled for the OR for the rest of the rotation. So this last mother of a procedure was my last as an MS3 :D It feels wonderful knowing that from now on when I go to the OR it will be for the specimen.

On the downside, I don't like floorwork or clinic much either, *blech*, but at least the schedule is better...

I love this thread, too, DruidDoc, allows me to b*tch as much as I want :smuggrin: I really don't get why docs have to get all huffy if you are interested in something other than their specialty. That was the one nice thing about the team I was on for general surgery. The team surgeon was absolutely cool with my interest in path. She thought it was excellent that I knew what I wanted to do already and told me to take every opportunity to go to the path lab. During her residency she actually took a surg path elective so that she could understand her field better and be able to knowledgeably converse with the pathologist.

-P.
 
On a labor and delivery call. please, kill me. put me out of my misery. nothing like sitting between a 300 lb womans leg gushing with blood, feces, and hydrochloric acid for all I know as I get to observe the "miracle" of childbirth. :barf:
 
DW said:
On a labor and delivery call. please, kill me. put me out of my misery. nothing like sitting between a 300 lb womans leg gushing with blood, feces, and hydrochloric acid for all I know as I get to observe the "miracle" of childbirth. :barf:
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Hang in there DW. I made it through and am now comfortably chillin' on a C/L psych rotation. Guess I should enjoy it b/c next month I head to a state psych hospital and have been warned to be extra careful about my safety. Still, I'll take that over OB/Gyn any day.

-P.
 
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