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I love it when medicine gets a case that could easily be diagnosed by a simple biopsy, but instead they screw around for days to weeks to months running nonspecific blood tests. It's like it never occurs to them to just stick a needle in the patient and give them an answer . . .
I love it when medicine gets a case that could easily be diagnosed by a simple biopsy, but instead they screw around for days to weeks to months running nonspecific blood tests. It's like it never occurs to them to just stick a needle in the patient and give them an answer . . .
I love it when medicine gets a case that could easily be diagnosed by a simple biopsy, but instead they screw around for days to weeks to months running nonspecific blood tests. It's like it never occurs to them to just stick a needle in the patient and give them an answer . . .
I have had the same experience as both a student and an intern.
Resident: The skin over the thigh is erythematous and the area is markedly tender. I'm worried about an abscess.
Me: Great, I'll stick a needle in it.
Res: Well, I think we should get a white count, ESR, and CRP. That would give us a hint if this could be an abscess. Also we should get 2 sets of blood cultures. We can get a CT scan after that to confirm its location.
Me: Or I could stick a needle in it and see if stuff comes out.
Res: <sternly> That's a very painful procedure. And it would be a shame to put the patient through it if there's no fluid collection.
Me: You want to stick him twice for blood then give him the equivalent of 100 chest xrays. It'll take three days to get that done. Or I can get you an answer in 20 seconds by sticking this needle in his leg.
Res: We really don't know it's proximity to the neurovascular structures. I think there are some of those in the thigh somewhere. We could get an MRI for a clearer view.
Me: Or I could just stick a needle in it.
Res: I think we need an ID consult, and probably Gen Surg and Ortho. They may want to drain this in the OR under general anesthesia. Let's also get GI on board, since if he's immunocompromised from an undetected malignancy it could be the cause of this infection. Let's also have social work see him, and get the dietician to assess his nutritional status since that could delay healing.
Me: Great. Maybe I can get the social worker to stick a needle in him.
Good Lord...if you made it through the first 4-5 posts, you aren't working hard enough.
I couldn't make it through the 2nd before starting to drool on myself.
Still on vacation.
Good Lord...if you made it through the first 4-5 posts, you aren't working hard enough.
I couldn't make it through the 2nd before starting to drool on myself.
WS, I think the most scary part is that these people think exercises like that are fun.
I love it when medicine gets a case that could easily be diagnosed by a simple biopsy, but instead they screw around for days to weeks to months running nonspecific blood tests.
On a Surgery service:
"POD #1 s/p total thyroid. VSS, wound C/D/I, PE wnl, Ca level nl. D/C planning."
Well, then you also get the opposite consults (like about 4 of these last month):I have had the same experience as both a student and an intern.
Resident: The skin over the thigh is erythematous and the area is markedly tender. I'm worried about an abscess.
Me: Great, I'll stick a needle in it.
Res: Well, I think we should get a white count, ESR, and CRP. That would give us a hint if this could be an abscess. Also we should get 2 sets of blood cultures. We can get a CT scan after that to confirm its location.
Me: Or I could stick a needle in it and see if stuff comes out.
Res: <sternly> That's a very painful procedure. And it would be a shame to put the patient through it if there's no fluid collection.
Me: You want to stick him twice for blood then give him the equivalent of 100 chest xrays. It'll take three days to get that done. Or I can get you an answer in 20 seconds by sticking this needle in his leg.
Res: We really don't know it's proximity to the neurovascular structures. I think there are some of those in the thigh somewhere. We could get an MRI for a clearer view.
Me: Or I could just stick a needle in it.
Res: I think we need an ID consult, and probably Gen Surg and Ortho. They may want to drain this in the OR under general anesthesia. Let's also get GI on board, since if he's immunocompromised from an undetected malignancy it could be the cause of this infection. Let's also have social work see him, and get the dietician to assess his nutritional status since that could delay healing.
Me: Great. Maybe I can get the social worker to stick a needle in him.
On a Surgery service:
"POD #1 s/p total thyroid. VSS, wound C/D/I, PE wnl, Ca level nl. D/C planning."
Fixed it for ya...
I love it when medicine gets a case that could easily be diagnosed by a simple biopsy, but instead they screw around for days to weeks to months running nonspecific blood tests. It's like it never occurs to them to just stick a needle in the patient and give them an answer . . .
On the other hand, I love seeing crazy long differential lists from the medicine men. I love the medicine guys at my place (we actually get along very well, they're good people). But I have to chuckle when the working theory for a small bowel obstruction in a patient is hypothyroidism (with known belly adhesions and a CT report that says "marked narrowing at mid-jejunum").
.
Alternatively, I "fall" on the patient with an uncapped needle, inadvertently aspirating as I attempt to stand up.
You know, like when you try to explain to your girlfriend how you got that other chick pregnant . . .
What kind of vacations are they giving you kids these days?
Seems like its been at least a week you've been off.
Alternatively, to be fair....I did receive a surgery consult from the team...." his creatinine is rising (now in 2's or 3's) and we have been giving him tons of lasix and he still has no UOP". Ok...so we go down there...and this guy is dry as a frickin bone. No shyt the guy isn't peeing, what do you expect. Give fluids, creatinine comes down. Surgery is kinda psycho about their post-op UOP sometimes.
Thanks.
I wrote really short, abbreviated notes on surgery, like I was supposed to.
Then I went to medicine, where the intern told me to "be sure and account for each medication in the A&P, each day." All 14 of them - "continue albuterol nebulizers for dyspnea, continue metformin for DM II, continue plavix for prophylactic anticoagulation, etc."
I felt bad, but (without really meaning to), I just gawked at him and said, "Why on earth would I want to do that?"
No no, that had to be Gen Surg. We don't know how to write for Lasix.
I actually witnessed the following conversation:
Nurse: Dr. Bone, Mr. Smith's blood sugar is 215 this morning.
Ortho resident: What? Who's that?
Nurse: You operated on him yesterday.
Ortho resident: Oh, right, sure. What were you saying, you called him sugar?
Nurse: No, I said his blood sugar is 215 this morning. Can you write him for sliding scale insulin?
Ortho resident (with a perfectly straight face, looking the nurse in the eye): What's insulin?
Maybe this residents 265 board score also made him/her smart enough realize that if he acted absolutely incompetent with the nurses they would never page him/her again.
No no, that had to be Gen Surg. We don't know how to write for Lasix.
You're getting there. I wish I could get away with this kind of stuff.
Agreed...I think it a MUCH more likely explanation that he was playing dead than actually was brain dead.
I actually witnessed the following conversation:
Nurse: Dr. Bone, Mr. Smith's blood sugar is 215 this morning.
Ortho resident: What? Who's that?
Nurse: You operated on him yesterday.
Ortho resident: Oh, right, sure. What were you saying, you called him sugar?
Nurse: No, I said his blood sugar is 215 this morning. Can you write him for sliding scale insulin?
Ortho resident (with a perfectly straight face, looking the nurse in the eye): What's insulin?
Maybe this resident was smarter than we give him credit. Maybe this residents 265 board score also made him/her smart enough realize that if he acted absolutely incompetent with the nurses they would never page him/her again.
I love it when medicine gets a case that could easily be diagnosed by a simple biopsy, but instead they screw around for days to weeks to months running nonspecific blood tests. It's like it never occurs to them to just stick a needle in the patient and give them an answer . . .
Tired headbutts Res in the junk when asked to go find every article ever written about the relative merits of I & D vs. image-guided drainage.
To be fair to the medicine folks, I do think they are better about evidence based medicine than the surgery folks are.
Thats the luxury of having extra time to think about that stuff, whereas in surgery there's always a case in the OR waiting for you.
Yeah, it makes me laugh to read about it, but I remember wanting to jump out a window and run away as a student on medicine services. The best analogy to the way I feel when I'm around medicine doctors is that scene in "Office Space" where Michael Bolton is trying to get the printer to work and says "PC load letter?! What the **** does that mean?"
Good Lord...if you made it through the first 4-5 posts, you aren't working hard enough.
I couldn't make it through the 2nd before starting to drool on myself.