Tag: physician

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

Munchhausen by Internet

12/27/15

I have mentioned Münchhausen Syndrome which is a psychiatric factitious disorder (somatoform disorder) wherein those affected feign disease, illness, injury or psychological trauma to draw attention, sympathy or reassurance to themselves. Münchhausen Syndrome by Proxy refers to the abuse of another person, typically a child, in order to seek attention or sympathy for the abuser using feigned illness or injury of the other person or child to gain the attention.

But, the high tech version is out and this is the digital age!

Münchhausen by Internet is a pattern of behavior akin to Münchhausen Syndrome in which the Internet user seeks attention by feigning illnesses in on-line venues such as chat rooms, message boards, web sites and Internet Relay Chat (IRC).

And Facebook. One case describes a woman that had 72 Facebook accounts to present her factitious cancer with many subscribers/friends duped into donations.

Careful what you say on Facebook. You might end up with a syndrome.

Keeping you abreast of the newest of medical findings, your grumpy Uncle/Brother Dave.

The original Münchhausen Syndrome post.

Communication is Important, For the Record

7/2017

Communication is important in the effective practice of medicine.  Ergo the medical record.  It is a way for one physician to inform other physicians and staff what is being done for this patient by a physician.  One area of importance in the medical record is the “Problem List”.  This is where one can go to look for all the active problems that are being addressed by all of the different physicians treating a patient.  It sort of weeds out all of the old stuff, the fake stuff and the errors and such.

But alas, social media has arrived to the EMR (electronic medical record).

One of my patients, tonight, had 3 listings for a severe medical problem that had a direct impact on what I did or didn’t do.  Listed below in exact representation from the EMR are the following:

1. liver transplant
2. Liver Transplant
3. Unspecified organ or tissue transplant

This may seem confusing and complicated to those not highly trained in the medical profession.

1.  “liver transplant” implies that the patient has had a complete failure of his natural liver and a liver from another individual was transplanted into his body, in a casual voice.

2.  “Liver Transplant” implies that the patient has had a complete failure of his natural liver and a liver from another individual was transplanted into his body, in a firmer, louder voice, but not shouting.  (That would be LIVER TRANSPLANT)

3.  “Unspecified organ or tissue transplant” is a little more complicated. It could mean that the surgeon doing the transplant was totally clueless as to what he was harvesting from the donor and where it was going in the recipient, like in the book Catch Me If You Can, about the Doctor/Airline Pilot impersonator. Or, it could mean that the surgery was done in Colorado or California and that the surgeon was a die-hard Cheech and Chong fan, striving to carry on the principals espoused in Up In Smoke (1978).

To think that the U.S. Congress mandates that we use this efficient, productive and safe method of physician-to-physician communication boggles the mind.

Delusions in the pursuit of absurdity from your grumpy Uncle/Brother Dave.

Weary.

Weary’s New Job

7/2017

I applied for a new job today.  Yeah, I guess 29 years of this emergency room business kind of led to this move in more ways than one.

I’m getting older and could use a slower pace.  I’ve built up a lot of motivation that will apply to the mission of the new position.  It will still provide the 0-190 mph rush in the blink of an eye that I’ve always loved about Emergency Medicine.  It will have a deeply satisfying ambiance that will help soothe my soul.

Chuckle, chuckle.

Having worked for the last 18 years on predominantly night weekend shifts, I have an extreme amount of experience dealing with colleagues that don’t work in the emergency department; calls under very trying conditions.  Meaning, I have had to call them at odd and usually inconvenient hours to discuss convoluted, complex and often baffling situations.  These are not trifling conversations.  These are about transferring care of a patient that usually involve critical thinking and decision making that will affect life or death and at least the well being of the patient.  People could die from wrong decisions.  People have died from wrong decisions.

In making these calls, I have met with irritation at being bothered (even though it is their job), failure/difficulty in communication (on both ends), anger, indifference, petulance, petty one-ups-man-ship, narcissism, sleep talking and even vindictive attitudes that have been so severe that they almost led to physical confrontation.

Just the other night, one of my Emergency Medicine colleagues ran into the well known (to us) ass-chewing situation.  Whatever the wrong perceived by the non-emergency medicine physician, it was felt that an ass-chewing was in order.  My colleague, being the usual emergency department diplomat, apologized profusely, tried (in vain) to explain in various ways what the ass-chewer did not grasp about the situation but in the end proffered contrition. Cowered. Rolled over and peed on the floor.

Yeah, it sounds wimpy but it is only one method of backing out of a situation at 3 am when you have a packed ED and mad inpatient patients (there has got to be a story in that contradiction of meanings) waiting on you to get off the phone.  There are actually several techniques for dealing with these situations.  No medical school teaches them, except for the school of hard knocks.

One of my favorite, learned by chance years ago, is what I can only compare to a “bait and switch” technique.  In this situation, it is quickly obvious that the non-ED physician is going to be a butt-head.  I immediately insert a calm, cool tone to my usual professional manner.  As the conversation/ass-chewing proceeds, I interject comments that are highly relevant to the care of the patient but have nothing to do with the ass-chewing I am getting at that second. I change the subject with redirection. The ass-chewer, partially asleep, takes a second or two to catch up with my thoughts. But as soon as he/she does, I change the direction again. Eventually, they figure out that I am doing this on purpose and calm down, hang up or explode. When they ask if I am doing this on purpose, I say, “Yeah, I Don’t care how long you yell at me, I don’t plan to get any sleep tonight.”

But, I’ve strayed from my topic and need to get back to my new job prospect. There isn’t actually a position for this job, yet. But I’m hoping that the higher-ups will see the advantages and get on board.

I want to be a 24 hour, 7 days a week, on call any time of day or night, anywhere ass-chewer first-responder.

See, how it works is that when an ED physician starts getting what they perceive to be an undeserved ass-chewing, they can hit a button on their smartphone that links my smartphone in a 3-way call mode. Off I go, hell-bent to mirror the chewing of ass. In the other direction. It can be set up so that the ED physician can choose a variety of flavors. For instance, with or without colorful language on my part, depending on their tolerance of such language.

I’ve submitted the proposal so keep your fingers crossed, I hope to hear back soon.

Your grumpy Uncle/Brother Dave.

Weary