Thursday, February 28, 2008

My Priorities

There's a sick patient in the emergency room right now. He will either be admitted to me or go straight to the ICU. His vitals look horrible,and he's guaranteed to die tonight.

And all I can think about is how I much I hope he goes to the ICU, so I won't have to deal with his paperwork once he dies.

Thursday, February 21, 2008

How To Be A Good Patient

Throughout medical school and residency, we are continuously taught how to be a good doctor. We are taught doctors should be professional, knowledgeable, well-read, and culturally competent (although I still don't know what this ridiculous concept means), all while nothing is expected from the patients.

That needs to change. Patients are as much of a part of their care as are doctors. This sounds obvious, yet you would not believe how uninterested, lazy, and ignorant many patients are. While doctors struggle to adhere to the intense scrutinies of professional requirements (and popular media) many patients do nothing but expect 5-star medical while they sit back and relax.

One thing in particular patients -- all patients -- need to do -- in fact, must do -- is to know their medications. Again, it sounds again obvious, but I am amazed by the number of patients that do not know the details of their medication list. Not just names, but exact dosages, frequencies, and dosing schedules.

It is not sufficient just to know the names of your medication -- although that would be a great start for some of my patients. It is not at all useful to us if you say "I take a little blue pill". Sorry you tool, we don't know what pills look like. We may prescribe pills, but we have no idea what color, shape, or size pills are. So enough of this "a little white pill", "that little square blue pill", or "a really big pill". Pharmacists don't even know that information.

"But doctor", you might say, "my memory isn't good". Or, "I take too many medications to memorize them all". Both are legitimate complaints, but you are not excused. If you cannot remember your med list for whatever reason, then write it down or type it out and -- this part is key -- carry it with you at all times. Yes, all times. You never know when you will have to go to the ER without warning, and have to report this list to your doctors. When your life -- or an improved version of it -- depends on medications, you better be damned sure you know everything about them.

There aren't many situations in this world that are the proverbial black or white; almost everything is grey in this world. Except this. So patients listen up, get involved in your own care, show some responsibility, and learn your meds!

Tuesday, February 05, 2008

You Are Crazy If ...

Every physician has their "oh no" patient. This is the patient with the medical condition that you just cannot bear to deal with, typically because you don’t fully understand their condition and don’t know how to effectively manage it. As an example, gastroenterologists would probably consider patients with irritable bowel syndrome (IBS) as their “oh no” patient. There probably is a legitimate origin causing the symptoms of IBS, but we just haven't discovered them yet. As such we cannot offer good treatment, thus making interactions with those patients difficult and unsatisfying.

As for me, my “oh no” patient is the crazy patient. Yes, the crazy patient. Who is this crazy patient? Here’s a non-exhaustive list of those who quickly get that label. If I know you satisfy one of these, I expect you will be nothing but trouble during your stay at the hospital. So, I’m gonna call you crazy if…
  • You have a pan-positive review of systems – in other words you answer “yes” to everything on the review of systems (our flurry of questions to see if there are any other symptoms you're having: chest pain, shortness of breath, constipation, weakness, etc.) This is a classic one. Those of you who answer yes to everything -- or even 3 items -- have nothing wrong with you ... except your heads.

  • You have an Actiq (Fentanyl lollipop) in your mouth as you walk in through the door, or as you're talking to me as I interview you.

  • You admit to having more than 3 allergies. Very few people are allergic to that many things. Trust me, this is a telltale sign!

  • You have fibromyalgia. Don’t even get me started. I am not denying that pain syndromes don’t exist; it’s just that people who like to have this label have lots of other, um, issues.

  • You ask specifically for IV dilaudid. If you are my patient and you ask for this, please, just get the hell off my service. Your words scream drug seeker. (And briefly, as long as we’re on the topic of drug seekers, it’s not just me … we all hate you.)

  • Finally, the “frequent flyer”. The patient that’s in and out of the hospital every other month, week, or day (yes, day). Words cannot begin to describe how much I loathe you people. Who in the world prefers the hospital to their own home?

Monday, February 04, 2008

Dumbest Page Ever

Capping off a miserable day filled with endless obstacles more pages than I have ever received in one afternoon, I get paged by a nurse saying how a patient was refusing his medications. This didn't bother me per se, but I was annoyed that she didn't specify which med. I returned her page and asked which med it was, only to hear that it was a pain med. A pain med. A PRN medication. She was paging me to tell me a patient was refusing his prn pain med!

I couldn't believe it ... I really couldn't. While I didn't get angry on the phone, I did try to convey my anger with a stern voice. Unfortunately, my logic was completely lost on her.

A prn med ... I still can't believe it.