I have a ton of work to do, so I thought I would be really diligent and blog a bit instead. I am in psychiatry this month (yes, I know I skipped chronicling a month; a post on that is coming), and it is interesting, in that wow-crazy-people-are-crazy way. I don't think I could do it for a living, but there's something really fun about dealing with schizophrenic people.
There was the guy who sounded totally lucid until he told us very seriously about his affair with Jackie Kennedy.
There was the lady who told us a dog was bleeding on the floor just behind us.
There was the lady who was convinced she had acid on her bra that wouldn't wash out, put there by an attacker who messes up her PJs every night while she sleeps.
There was the not-primarily-English-speaking lady who kept referring to her female case manager as a man; when the, er, discrepancy was pointed out to her, she got irritated and said, "man, woman, I don't care. She is a female man, do you see?" Well... no.
The rotation site I'm at is a nonprofit that offers treatment services to the poor, so of course meth and crack and such make diagnosis and treatment more difficult. But regardless of the etiology, my attending gave me a wonderful piece of advice for talking to psychotic (= limited or no hold on reality) patients: "If you don't know what's going on, neither do they." The lesson being, if you suddenly start wondering, "Wait, what? Is what they're talking about even real?" then chances are the patient doesn't know either. Don't make premature judgments, though, because truth can be stranger than fiction. Jackie Kennedy might in fact have been a terribly loose woman when she came through the homeless areas of the Midwest. We'll never know.
Tuesday, October 25
Wednesday, October 12
August - A Three-Part Screenplay
Scene One
Setting: Rural family practice clinic. Zoe and her boss-of-the-month, Dr. Attending, are going over how to chart. Or perhaps how not to chart...
Zoe: So, uh... how did you... well, know... that she had normal breath sounds when you were listening to her lungs over her sternum, over a sweater, while talking?
Attending: Well, she didn't mention a cough or any trouble breathing, so I just chart everything associated with no trouble breathing. -clickety click- I really just kinda make up stuff until I get to the coding level I need.
Scene Two
Setting: ER hallway. Dr. Attending has just refused to give a patient any medication for his chronic pain, although that is his CC. Patient is old and near tears, and when researched in the state's narcotics database, has no suspicious practices (e.g. getting meds from lots of different doctors, going through huge amounts of narcotics in a short time, etc).
Zoe: So, uh... refusing to give that patient any pain meds just seemed... well... how do you decide when to give patients medication and when to refuse? Is there a hospital protocol? What is your system?
Attending: -brief laughter- Nah, there's no protocol. It really just depends on my mood.
Scene Three
Setting: Rural family practice clinic. Doctor's office. Zoe and Dr. Attending are discussing Medicaid patients and how much everyone should obviously hate how terrible they are. Or... wait, what?
Attending: They're just very difficult. And if you do educate them, it's like it won't even help. Not to mention the billing hassle.
Zoe: Why do you accept Medicaid? If the patients are so difficult and the billing is so difficult, why not just do what the other doctors in the area do and refuse to take it? [Zoe gets a hopeful expression, as though she is expecting an answer indicating some sort of felt responsibility for the poor, especially in a remote area where no one else takes that patient population]
Attending: I didn't want to take them. But after my first year, I wasn't making enough money, so I figured accepting Medicaid would increase my income a lot. And now I need them, and even once I stop accepting new Medicaid patients, which I want to do in the next few years, I can't just fire all the Medicaid patients I already have.
THE END
~~~~
In August, I was under an attending who:
As a nice touch, she had Scripture hanging in all of her exam rooms. -facepalm-
Setting: Rural family practice clinic. Zoe and her boss-of-the-month, Dr. Attending, are going over how to chart. Or perhaps how not to chart...
Zoe: So, uh... how did you... well, know... that she had normal breath sounds when you were listening to her lungs over her sternum, over a sweater, while talking?
Attending: Well, she didn't mention a cough or any trouble breathing, so I just chart everything associated with no trouble breathing. -clickety click- I really just kinda make up stuff until I get to the coding level I need.
Scene Two
Setting: ER hallway. Dr. Attending has just refused to give a patient any medication for his chronic pain, although that is his CC. Patient is old and near tears, and when researched in the state's narcotics database, has no suspicious practices (e.g. getting meds from lots of different doctors, going through huge amounts of narcotics in a short time, etc).
Zoe: So, uh... refusing to give that patient any pain meds just seemed... well... how do you decide when to give patients medication and when to refuse? Is there a hospital protocol? What is your system?
Attending: -brief laughter- Nah, there's no protocol. It really just depends on my mood.
Scene Three
Setting: Rural family practice clinic. Doctor's office. Zoe and Dr. Attending are discussing Medicaid patients and how much everyone should obviously hate how terrible they are. Or... wait, what?
Attending: They're just very difficult. And if you do educate them, it's like it won't even help. Not to mention the billing hassle.
Zoe: Why do you accept Medicaid? If the patients are so difficult and the billing is so difficult, why not just do what the other doctors in the area do and refuse to take it? [Zoe gets a hopeful expression, as though she is expecting an answer indicating some sort of felt responsibility for the poor, especially in a remote area where no one else takes that patient population]
Attending: I didn't want to take them. But after my first year, I wasn't making enough money, so I figured accepting Medicaid would increase my income a lot. And now I need them, and even once I stop accepting new Medicaid patients, which I want to do in the next few years, I can't just fire all the Medicaid patients I already have.
THE END
~~~~
In August, I was under an attending who:
- makes up patient visit information so she can bill for a more involved visit than she actually performed
- sometimes refuses to give old men pain medication because she doesn't feel like it that day, and
- may detest the poor, but they have their uses, so she'll keep them around for a while.
As a nice touch, she had Scripture hanging in all of her exam rooms. -facepalm-
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