Preferences

I had a pen explode in my lab coat pocket yesterday -- a tragedy, I know. At the end of the day, as I was leaving the office carrying my lab coat home to be washed, one of the other docs said, "I don't know why you still wear that thing. None of us feel the need to wear lab coats anymore. Do you think you're still a resident?"

He was joking, of course, and then we had a short discussion on the the philosophy of a doctor wearing a lab coat while seeing patients in the office. From my perspective, I like my lab coat. Not only is it fashionable, it is practical. I'm able to carry my stethoscope, my prescription pad, a couple of pocket-sized reference books, and a pen (when it doesn't explode).

His points were that the lab coat can make a physical and emotional barrier between you and the patient which can hinder communication. And, it's difficult to continually keep a long white coat clean (I conceded that point).

I'm kind of curious, what do you think? What's your preference? Lab coat or no?

(Notice the new blog title? Why? Leave a comment to find out...)

Leaving things be

Mrs. D came in yesterday for her four month checkup. She just saw her vascular surgeon within the last month and had some questions....

She was the full-time caregiver for her husband until his Alzheimer's disease got to much for her. She was 88 years old when she thought she "gave up" and moved her husband into the nursing home. "I don't think you gave up," I said to her back then. "You're not exactly a spring chicken anymore and he's more than twice your weight. I have no idea how you've been able to take care of him at home by yourself for such a long time."

The other reason she had to place him in a nursing home was that she required surgery to repair an abdominal aortic aneurysm. In addition to recuperating from the surgery, one important restriction she had was absolutely no heavy lifting -- like of her husband when he would fall on the floor at home.

Her husband died peacefully a few months later. A couple of Mrs. D's children moved back to the area to help sell the house and take care of the legal affairs. They all live in the same house here now.

Oh yeah, did I mention that this was the only surgery that she ever had and currently is on no prescription medicines. It's not because she refuses to take medicines, it's because she's THAT healthy and is still very independent.

...."My doctor told me I need an MRA. What's that?" Mrs. D's doctor initially ordered a carotid ultrasound to check for blockages. The findings were questionable, so an MRA was recommended to get more information. I explained what an MRA was and if there was significant blockages, then surgery could be done to repair it.

"Do you really think I need an MRA? I really don't want anymore surgery. If I was your grandmother, what would you say?" This is probably one of my least favorite questions in all of medicine. Usually, I put my lawyer hat on and give a laundry list of potential problems if a critical stenosis is not diagnosed or treated.

"If you were my grandmother, I'd say that you've been getting along for almost your entire life without the need for medications and doctors. Whatever you decide is probably as good or better than anything I would say. I mean, hey, you're healthier than I am. I should be taking health tips from you."

"Well, I think I'll leave things be. You don't think that nice young man," she meant her vascular surgeon, "would be mad at me if I cancelled the MRA." "No, not at all. I think that he'll understand." "Well, then it's settled." "I think it is."

In a mood

I don't know what's quite gotten into me today. I'm in this rapid fire blogging mood today. Anyway, I have a confession I'd like to make (other than I'm a blogaholic). I can't believe I did this, but I consumed about 1200 calories at lunch today. What was I thinking! It's just that Wendy's was calling my name and I couldn't stop myself. Yes, I'm an idiot. Whew! Now, I feel better.

Speaking of moods, I guess Blogger is in the mood for maintenance.

We will have an outage of 90 minutes from 4p to 5:30p (Pacific Time) as we perform some hardware upgrades. At the beginning of this outage (the first five minutes), blogger.com will appear completely inaccessible. Following this, a status message will appear for the remainder of the 90 minute outage during which time users will be unable to update their blogs.

With all the stuff happening with Moof to FD to Cathy to anyone else, who knows what will happen with this scheduled Blogger outage. Maybe this will be my last blog ever. Thanks for the memories. HA!

BA at the beach

Put on your swimsuits and come on over to Carrie's beachhouse for today's meeting. As always, it's BYOB (bring your own BLOG). Don't forget your suntan lotion, and of course, your food and beverage of choice. See you there!

My first grand rounds

Grand rounds 2:42 is hosted by donor cycle and she did a fabulous job. I don't know how people can read all those posts in such a short a period.

Despite what I've been feeling and what I've been telling people, I got up the courage to submit something and it got included in this week's GR. Not only did I get in GR, I even made it into the Top 8 list. Yay me!

Here's the quote:

8. What do you do with a non-compliant patient? Go to their Doctor Anonymous.

Thanks DC for hosting and thanks for including my post in GR this week. Next week, GR will be hosted by Chronic Babe and she has a theme, "It's All About The Ladies." Hmmm... I don't know if I'll be able to get into that party. We'll see....

Blogger hopping

Some people call it blogger surfing and others call it blogger hopping. I like seeing what other people are blogging about. I found cathy_bythesea over the weekend (my first Frappr pin in the Philippines!) and she talked about the loss of her father in, "On Losing A Parent:"

I lost my dad when I was sixteen, in the summer before my senior year in high school, on the brink of womanhood. For many years I grieved his loss and looking back now, I realize that I was searching for my father in many of the relationships that I had. Dad, became the yardstick that men had to live up to. Those who knew him well, know that daddy was definitely a hard act to follow. Admittedly perhaps, this is the same reason why I married someone much older, whether fair or not, I was looking for my father when I finally decided to get married. This was something that took me many years to resolve, and when I finally did, through much introspection and by the grace of God, just as the quote above says, it certainly opened doors that I would not have dared walk into many years ago, altered my outlook and changed the dynamics of many of my major relationships.

Fine Art Doctor also talked about the loss of this father in, "Thoughts on July 4th and Memories of My Father:"

My father died when I was seven years old. He woke up one morning with a headache and went to work. While rounding at the hospital he collapsed. He was immediatley taken to the ER but it was too late. He had a ruptured Cerebral anneurysm and the neurosurgeons told my mom there was nothing they could do. As the years pass I find that my memory of my father has faded. I can no longer rememeber the way he smelled, the way he walked, the sound of his voice. If I concentrate I can still see his image in my mind but I often wonder if the recollection is from pictures.

These two selections have really made me reflect upon my own relationship with my father. Even Cathy (not by the sea) recently wrote a cute recollection of her father drinking and singing at her wedding (funny story). What kind of relationship do I have with my father? You always think that you're going to have more time to make great memories, but you never know when your last memory is going to be. I think I'll give my dad a call, maybe he wants to play golf tonight...

Swingers nursing home

Yesterday was my monthly visit to the nursing home. It's probably the closest thing I have to making house calls. Walking up to the nurses station, I saw their big screen TV. Of course, in a nursing home, the volume is turned up. On TBS was the movie Swingers with Vince Vaughn and Jon Favreau. This is one of the best movies EVER! All I heard down the hall was, "Vegas, baby, Vegas!" More quotes here.

I visited some of my patients down the hall and then came back to the nurses station to fill out some paperwork. As I look up, it's the one "quasi" racy part of the movie with Vince Vaughn making out with this hottie. The funny part is that when I looked up from the desk, there are five wheelchairs huddled around the TV, but all the people in the wheelchairs are sleeping! This sight was SO money!

Then, I realized that I was watching a love scene on TV in a nursing home. I had these conflicting emotions -- part of me wanted to bust out laughing, and the other part was getting more and more nauseated. I quickly finished my rounds before my emotions overcame me.

Blog conversations

I appreciate it very much when people include me in their blogroll. I'm even more honored when they mention me on their blog. When I do my "blog rounds," I try to leave witty and thoughtful comments. But, for the following two postings, I felt more than leaving comments, I'll talk about it here.

Dinah from Shrink Rap talked about her experience attending the social function of a patient. I really didn't get into my personal thought process when talking about Jen, so I'll talk about them here. (BTW, I forgot to add Shrink Rap to my blogroll, but I'll do it now).

Setting boundaries in your professional life (and personal life) is difficult. There is no magic recipe or book that you can read to find out how and when to do this. Our town measures 16 square miles and has about 16,000 people. This is significantly smaller than the city where I did my residency. So, I knew coming in that I would have to deal with being a small town doctor -- which for all purposes is a celebrity. People definitely know you, know where you live, and know what car you drive. This really disturbed me for the first months I was here, because I was used to riding underneath the radar all the way from high school, to college, to med school, to residency.

It's definitely been a learning process to me. If you met me, I'm a pretty introverted person. And, as you've seen in my blog, privacy and anonymity are important. When I first started working here, I tried to avoid going to big places like Walmart thinking that my patients may stop me, ask me about a medical problem, or ask me to refill their medication. But, a strange thing happened, I learned that for the most part, people in this town respect my privacy and when I'm not "on the clock" conversations have been social and actually pleasant. Of course, there are the few people out there who will take advantage of anyone at any time, but those are few and far between.

At this point, I've accepted the reality of being a doc in a small town and everything that comes with it. It's been a long road, but I've learned a lot about people and a lot about myself along the way.

The Tundra PA has a very delighful post from the "Way Back Machine" -- like from January of this year. The original post is from The Blog That Ate Manhattan and the title is simply "I Love My Blog." TTPA thought that those from Blogaholics Anonymous would enjoy this post, and I agree. Check it out, you'll like it!

Blogaholics Anonymous

Hello, I'm Dr. A, and I'm a blogaholic....

Before we get started, just a couple of announcements. If you haven't signed up for the map, yet, please do so before you leave today. Also, if anyone forgot their container from their covered dish from the last meeting, I have it in the back of the room.

For me, this week was going pretty good until last night. I was flying around reading and commenting on blogs when I got a message in my e-mail box. I go over there and all of a sudden, I had this feeling of anger and rage. It was a spam alert.

Now, don't get me wrong, this is not my first experience with spam. But, when I set up this blog less than a month ago, I set up a new e-mail account also. I couldn't believe that it only took a few weeks until the spam started flowing in. It took a few minutes of slow, deep breathing and meditation until I calmed down. After that, I continued on the blog patrol.

Does this happen to other people with spam? How do you deal with it?

Against medical advice

I was sitting in my office Monday afternoon after hours getting some paperwork done, when my cell phone goes off, "Doctor, this is the hospital switchboard, is your pager not working?" I quickly grabbed it. "There are no pages on it," I said. "Well, the ER has been looking for you for about an hour." Oh no, I was thinking to myself. I hope there wasn't anything urgent going on. So, I rushed over to the hospital which is only across the street.

"Sorry, I don't think my pager is working," I said. "I thought as much because you usually call back pretty quick," the ER doc said. "We've got a 54 year-old guy that passed out at home and brought in my his wife. I'm thinking that he probably needs to be admitted."

I go into room 10, "Hello, I'm Dr. A. What happened at home today?" "Well," the patient's wife said, "he was just at home watching TV when he stopped breathing and was out for about 30 seconds. I think his eyes may have rolled back, too, but I'm not really sure."

After a few more minutes talking, I said, "What's going to happen now is that I'm going to do some paperwork to get you admitted to the hospital." "Doc, I don't think I need to stay tonight." What! I thought to myself. "Sir, I don't think it's a good idea for you to go home." "Well, doc, I think I have it figured out. My blood sugar must have been low." As I'm looking at his 320 pound frame, I'm not thinking that LOW blood sugar was his problem.

"Here's the thing," I said, "I have no idea what happened to you today, so I recommend that you be admitted for further testing." I was hoping that I didn't have to go into 'bad cop' mode, but I felt the situation escalating quickly. More discussion back and forth occurred for the next 20 minutes.

"Ok sir," I was fed up at this point, "You certainly have the right to be discharged. All you have to do is sign a paper stating that you are leaving the hospital against medical advice, and you're free to go." "Whoa! What does that mean?" "It means that I, as your doctor, am free of all responsibilty for your medical condition. It also means that YOU are accepting of all the possible complications to your condition which include heart attack, stroke, seizure..." I listed a few more and ended with, "....and possible death." I really hate it when I sound like a lawyer.

"YOU are not going to bully me around like that," he barked at me, "All you doctors are the same, just want to scare us and run needless tests that will turn up nothing anyway." "Sir, it looks like you've made your decision. I've said what I need to say. Let me get the nurse. You can sign the paper, and you can be home in an hour."

I left the room really second guessing myself. Was I too hard on the guy? Could I have de-escalated the situation? What should I have done differently? Maybe I should go back in there and apologize for my tone.

The patient's wife then came to the nurses station to talk to me. She looked sullen with her shoulders dropped and soft voice. I finally got through to them and made them understand. I may have been a little forceful about it, but, in the long run, I think I did the right thing.

"Doc, we've got family coming in tonight. When is the nurse coming in so that we can be discharged and go home?"