Tag: medical training

Hunting Fentanyl

August, 2016

I saw a patient tonight that was about 40 years old. He came in for other reasons, but in the interview, he said he was on a Fentanyl patch for chronic back pain. My patient commented that he went out in the woods this morning to put up his deer stand.

Fentanyl is a synthetic form of morphine. It is a mind altering substance, meaning that it clouds judgement, alters reaction time and just plain messes with the mind. Yeah, just like alcohol.

I can see it now. Come November my patient will come in from a hunting accident;

“I fell out of my deer stand and broke my neck.” or,

“I thought he looked like a deer so I shot him. I didn’t realize that it was my Brother-in-law.”

or some other ridiculous story.

So, these Doctors (this is not an unusual occurrence) are sending him out to work as a welder and hunt while this trans-dermal patch makes sure he has sufficient narcotic in his body to relieve his pain 24/7

I’m often embarrassed by my colleagues.

Your grumpy Uncle/Brother Dave.

Weary

The Cost of Doing Business

January, 2015

I was very lucky when I started medical school. At that time, Baylor offered it’s Texas-resident medical students the same tuition as the Texas state schools. Baylor was a private Medical school and charged much more for out of state and much, much more for out of country tuition (I think I remember it was $10,000 per semester for foreign students). I paid $500 per semester for the first 2 years. Then the state legislature upped the ante to $2000 per semester. A 4 fold increase hit hard but was nothing compared to today’s rates.

But tuition doesn’t pay the bills. There are billions of dollars from private and government sources that make up the difference in what it costs to put a student through 4 years of medical school. The figures below reflect the dollars at that time.

1979-1983 Medical School $3 million
1983-1987 Residency $6 million
2015 Diagnosing an aphous ulcer (fever blister) in the ED at     12:15 am,  Priceless!

 

Musings from your Grumpy Uncle/Brother Dave.

Weary

YouTube 3 Way Stop Cock

June 2014

At work tonight, I had a patient come in with a common problem that required an uncommon solution. He had prostate problems and required a bladder catheter.  Unfortunately, when the urologist performed a procedure earlier that day,  something tore and the patient had bleeding into the bladder. If there is sufficient bleeding, it will clot and plug up the catheter and cause bladder distention. Believe me, there are few conditions more uncomfortable than urinary retention. We tried the usual remedies but the bleeding continued and required a continuous irrigation catheter. This requires a particular piece of equipment that is not used very often. Of my crew of nurses, only one had ever done this. Before we found her (she wasn’t assigned to this patient), I asked his nurse if she was familiar with this equipment, she said, “No but we can YouTube it.”

I replied, “Search 3 way stop cock from a work computer? I don’t think you want to do that. There is no telling what will come up in that search.”

We found the knowledgeable nurse to teach the procedure, instead.

Greetings from your grumpy Uncle/Brother Dave.

Weary

Better Him Than Me

1/29/18

I think I’ve mentioned before that I do not watch TV doctor-shows.  Because the shows are so ridiculously unreal.

They, those responsible for the show’s existence, take a subject that is otherwise entertaining, good, shocking, and a lot of other adjectives thrown in for good measure, and they apply their license.  Literary license, that oft sought after quality of lying.  As is often said, the only truth is that everybody lies (I specifically did not reference House for this quote because House is not the origin of this saying).

Some of the ones that I am acquainted with include The Doctor, Dr. Kildare, Ben Casey, Marcus Welby, MD, M*A*S*H and MASH (yes they are different), Doogie Howser, MD, St. Elsewhere, House, The Resident.  There are many, many others.  The one thing that they all have in common is fiction.  There isn’t an ounce of truth in any of them.  They stage sanitized scenes, use actors, write scripts with sanitized language, and add drama.  They have to or they wouldn’t have an audience of 1.

I was recently introduced to a new, social media version of TV doctor-show.  ZDoggMD.  I’ll give you 2 links to his work that I did watch and enjoy.  One for entertainment (1) and the other to illustrate what I’m trying to convey here without my having to actually watch one of the above-mentioned pieces of crap  (2).  I only qualify this with the following.

ZDogg does a pretty good job of critiquing The Resident (I’ve never seen the show BTW), he just doesn’t go far enough and actually gives checks (his metaphor for “that’s OK” as opposed to an X for “that’s a fail”) where I would not.

But the times, they do change.  I watched a few ZDogg YouTube productions and laughed my ass off.

Your grumpy Uncle/Brother Dave’s 35 years of experience in The Reality Medical Show.

Weary

1.  A lot like sepsis, an entertaining spoof of It’s starting to look A Lot  Like Christmas; https://www.youtube.com/watch?v=g6q5FGoaxg8

2.  A real doctor watches The Resident, a critique of the newest doctor show, https://www.youtube.com/watch?v=iRzLXH52Vr4

Google Docs

7/2017

For quite some time I have dealt with Google Docs. Both at work and not at work. The not at work are the most abrasive. I think that I have mentioned in a previous post that I use Google and the Google Doc personality tendencies to a therapeutic advantage in caring for my patients.

But, conceited as I might be, I’m surprised to find that I’m not the only Doc to use this technique. We went to see my wife’s doctor last Friday and I was surprised to see him use my technique on her. He acknowledged that she would resort to Google to educate herself about what he was explaining to her and used subliminal suggestions to guide her to where he wanted her learning to go.

There. The secret is out. You know how I/we do it.

But there is a new kid on the block. Tonight, there was a 4th-year medical student working with my coworker and I. As a teaching exercise, my coworker asked her a question that stumped her and he persisted in wanting an answer. In the old days, I would have been told, “You need to go to the library and research the subject and return tomorrow and let us know what you’ve learned (meaning return to give a short lecture to the team).

But, we are now in the digital age. The medical student had to find the answer in real time sitting beside us. So where does she go? Did she pull out a 4” thick textbook from the backpack she carries with her everywhere? Nope, she went straight to Google. Extrinsic factor metabolism in human digestion is on Google. And our lives are dependent on it.

An update from your grumpy Uncle/Brother Dave, not a google doc.

Weary.