Monthly Archives: October 2011

Can the Physical Exam Help Decrease Health Care Costs?

If physicians and doctors in training were trained better in the physical exam, could that translate into health care dollars saved?

I’ve written about the Physical Exam and how it’s often at odds against newer technologies in medicine. In today’s world, where labwork, xrays and CT scans are so readily available, many say the physical exam is dead and just a relic of tradition.

Case Review: This thought was provoked by a patient I saw in the emergency department recently. A 76 year old lady presented with a distended abdomen that had been growing the last 5 days. On history, she also developed shortness of breath on exertion, orthopnea, PND, all classic signs for congestive heart failure. Looking through her records, she had been admitted previously for an episode of CHF two years ago secondary to ischemic heart disease. On physical examination she had an audible S3 heart sound, distended JVP and leg edema. Chest Xray showed bilateral pleural effusions and vascular redistribution typical of CHF. This was a lady who’s classic findings were pointing to to a diagnosis of exacerbation of her CHF.

Question: for this patient, should we order a BNP? A BNP is a good marker that is highly sensitive for CHF. It costs about $25 to run. [www.ccjm.org/content/70/4/333.full.pdf]

I had recently been trying to go through the JAMA Rational Clinical Exam  Series and had just finished  ”Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure?” According to the article, in a patient with clear history and physical suggestive of CHF, doing a BNP was not recommended as it would not change management.

I didnt’ want to order a BNP as I knew it would come back positive anyway, but in the age of “defensive medicine” the ER doc ordered a BNP, along with a complete panel of bloodwork that was probably unnecessary. The results came back as expected with an elevated BNP of 680 and the rest of the labwork unremarkable.

Futuredocsblog, an internist from the University of Chicago, writes about certain things doctors could do to help reduce health care costs. Listening to the patient, doing a proper physical exam, thinking about indications for a test and knowing the costs of the tests that are ordered.

As doctors, we are entrusted to be good stewards of the finite resources available. Perhaps I’m just young and naive, and all it takes is one lawsuit to change my opinion. But right now, I believe good history taking and physical exams can help reduce the number of unnecessary tests and therapeutics.

What do you think? Is the physical exam dead? Can a good history and physical exam hold up against the available labwork and technology of today?

Update (Mar 2013) – an excellent journal article on the Utility of the Clinical Examination at JAMA Network

 

Why Being Rejected from McMaster Health Sciences is Good for You

If you’re never heard of McMaster University’s Bachelor of Health Sciences Program, you should know it is one of the “elite” undergraduate programs in Canada. With an applicant pool of over 2000 students for roughly 150 spots, getting into McMaster’s Health Sci program is as competitive as getting into medical school.

This is a program where on average, more than 40% of their graduates will go on to pursue medicine. When the average Canadian medical school acceptance rate hovers around 10%, McMaster’s BHSc stands out.

In high school, I had really wanted to go to McMaster’s program. I tried my best to get high grades and spent lots of time writing my supplementary applications. It was the only program I knew I really wanted to get into. It was the hottest ticket, with it’s problem based learning and inquiry courses, I thought it would be a great fit for me.

Unfortunately when the acceptances rolled out later that year, I found out I had been rejected from their program. With a program that rejects applicants with average of 95+%, being rejected was the norm. [Medhopeful writes a very good post about the program here.] I was initially devastated and felt like I had failed. I ended up choosing to do a life science program at another university.

You Learn More from Your Failures than Your Successes

In hindsight, being rejected from McMaster’s Health Science (and several other programs) turned out to be one of the best things for me in the long run. I was humbled by the experience. It taught me many lessons of life that were more important for me to mature.

Being rejected taught me humility, something I lacked before. I went to a high school with an enriched learning curriculum. I was went to classes with other “gifted” students who were to complete a more rigorous curriculum. I felt proud that our program was considered better than others.

I now know that if I had been accepted into Health Sci, I would have been too proud. I would have felt entitled or superior to my peers just because I had gotten into the most selective program in the country. I have nothing against the program, I know lots of friends who are graduates, but I also know of many arrogant students who were in Health Sci who had that same sense of entitlement.

Instead, being in a large science program, I got to interact with lots of classmates from all types of background. I met many exceptionally bright peers in Biology 101 and General Chemistry. I was lab partners with students who struggeld in high school and was just happy to attend university. And I found out that many undergrad programs are just as rigorous and adequate for gaining an education.

It Doesn’t Matter Where You Go for Your Education, It’s What You Do There that Matters

I entered my university degree with a chip on my shoulder. I had been rejected from all the programs that I truly wanted to be in. I decided that I wouldn’t let my failures dictate my future successes.

I was motivated to be the best student I could be. I wanted to prove to myself that I wasn’t going to let an institution define who I am. In the process, I learned to value hard work and persistence. I didn’t take my education for granted, instead I set out to improve myself.

In the end, I achieved my goal of gaining an acceptance into medical school (and before many of my peers who went into Health Science too!). Along the way, I laid down a foundation of work ethic and study habits I would carry on to my future career.

Medical schools don’t care about where you did your undergrad degree, they care about what you did there.

Looking back, being rejected from Health Science helped me mature as a person. You learn more from your struggles than your successes. Let me know if you have had similar stories, would love to hear them.

 

Clerkship Pearls – How to Get a Consultation

This is another post in the Clerkship Pearls series for medical students going through clerkship, and today I’ll be discussing

How to Effectively Get a Consultation for Your Patient

http://www.flickr.com/photos/elphs_rule/2862960352

One of the scariest things to do as a clerk is to ask another consult service to help you with the care of your patient. A consultant, or consulting service, is usually another doctor or team that specializes in a certain area of medicine. When you ask for a consult, you are asking another doctor to aide in the care of your patient. Whether that’s getting a CT scan approved by the radiologist or asking a busy service such as ortho to come assess for surgery, making that phone call to get a consult isn’t always easy.

I remember a time when my staff in Internal Medicine thought there was an abscess that should be assessed. I was given the ask of finding a surgical service to come see the patient. I was turned down and harshly called out for inappropriate consults by both General Surgery and Plastic Surgery before someone finally agreed to come see the patient.

Sometimes it’s the consultant or their resident that’s rude. But there are a few things I have figured out you can do to make it more likely and easy for a consultant to see your patient.

1. Identify Yourself

When you make a phone call to a consulting service, identify yourself. “Hi, this is medaholic, clinical clerk year 4, from Internal Medicine and I have a patient that I would like you to provide your expertise on and to come and see.” The point is to make a connection with the person on the other end of the line so that you become a person asking them to help you, not just another “consult”

 2. Clear Communication

There is a technique for health care communication called SBAR that you should become familiar with. The acronyms identify a method that you should follow to communicate effectively. SBAR stands for Situation, Background, Assessment and Recommendation.

Situation - encompasses  identifying yourself and identifying your patient. Remember to include the patient’s full name, age, sex, health care number and location. If it’s an urgent call, make sure you let them know right away.

Background - Be brief. Tell the consultant why the patient is here and why you are requiring their consultation. List any information that is pertinent. Past medical history, relevant medications, investigations you have done and treatment.

Assessment – The assessment is always tricky for new learners, but let the consultants know what you think is going on. Explain to them why you think their services are needed.

Recommendation – If you want something explicitly, let them know. If you want their expertise and their opinion, state that’s what you want. Be clear on your expectations and make it possible for them to deliver.

3. Call before Noon or at a Convenient Time

Nobody likes getting a new consult to do just as they are planning to go home. Call as soon as you know you need a consultant’s help. If possible, call before lunch. Don’t call during lunch time unless it’s urgent.

Try to give them as much head’s up as possible so they can plan their day accordingly.

4. Leave Good Notes

Good documentation on your part makes a consultant’s life much easier. If you can provide them with as much information as possible, so they don’t have to start from scratch, you will facilitate patient care. Outline your reason for referral and possible expectations. Remember to leave your contact information so they can get in touch with you.

5. Do the Proper Workup

If you’re going to enlist the help of a consultant, you are expected to help them out too.

If you’re consulting orthopedics regarding a bone – take an xray of the bone. If you’re consulting nephrology – make sure you order urine tests. Likewise, if you’re consulting surgery, make sure you have the necessary bloodwork drawn such as PTT, INR, Cross & Type.

6. Follow up with the consultation

When you ask a consultant to come see your patient, you create an open loop, a task that is not closed or complete. Sometimes it can take a long time to get a consult, follow up on it until it gets completed and “closed.”

Similarly, it’s always a nice gesture to call them afterwards to see their recommendations and implement their plans accordingly.

7. Sign-off

If you no longer need the assistance of a consultant, contacting them and letting them know that they can sign off is a nice courtesy.

Mystery Tuesday Visitors

One of the neatest things about running a website/blog is all the interesting information you can extract from your visitors. Whether it’s how many people are visiting your website, what search terms they used to find your site, or who’s linking back, Google Analytics let’s you track this all easily.

I’ve posted above a snapshot of the visitors to this site from August 2011 to October 2011. To my surprise, there’s a saw-tooth pattern to the visits to this page. Looking back over the last year, this trend has been the same. So I just have one question I would like to ask and hopefully my readers can help me understand it.

Why are there more blog visitors on Tuesday than on any other day?

A Malaria Vaccine at Last!

In case you haven’t heard yet, they announced today in a paper published in NEJM that scientists have created the world’s first malaria vaccine. This is a landmark paper that will mark a major victory against malaria. The vaccine called RTS, S/AS01 Mosquirix was developed by Joe Cohen, a GSK research scientist over the last quarter decade. In a joint public-private partnership between GSK, Program for Appropriate Technology in Health (PATH) Malaria Vaccine Initiative and grant support from the Bill and Melinda Gates Foundation, the vaccine showed that it had an efficacy rate near 50% for protecting children from clinical malaria. (Full Article Here)

This is super exciting news!!! For a person who’s studied malaria, who understands it’s impact is has to developing countries and the burden it poses to children all over the world, who has seen how terrible it is to have this disease, this is a giant step towards eradicating malaria. Although malaria has been absent from the Western societies for decades, millions of people still face this disabling and horrible pathogen. Malaria kills more than 750,000 people every year.

“But today I feel fabulous. This is a dream of any scientist — to see your life’s work actually translated into a medicine … that can have this great impact on peoples’ lives. How lucky am I?” – Joe Cohen

It really is heart warming to know that dedicated scientists along with generous donors can still make a difference in the world. That pharmaceutical companies aren’t all about the blockbuster hits like lipitor, plavix and celebrex.

I recently saw the movie Contagion starring Matt Damon Gwenyth Paltrow, Jude Law, Kate Winslet and a pretty hefty ensemble cast. The premise of the movie was that a new virus outbreak that spread into a pandemic and the plot follows how society responds to it. From the CDC tracing down the source of the pathogen and trying to contain it with quarantine measures, to the pandemonium and rioting of citizens, Contagion is a movie I would recommend to everyone, especially science/infectious disease geeks. I enjoyed the movie immensely, especially since I have done some lab research with viruses in the past. It may have exaggerated some aspects, but it sticks true to the message that infectious diseases are a risk to everyone. A child sick with flu symptoms in Asia can easily affect you through the contagious spread of diseases in our small connected world.

The Bill Gates and Melinda Foundation has declared this decade as the decade of vaccines. Forty years ago the eradicated smallpox. Today we are at the frontier of eradicating Polio. Tomorrow, it might be Malaria next.

I’m still reading through the paper, but I couldn’t contain my happiness about learning of this breakthrough! Just wanted to spread the good news. Although the inventors of this partial malaria vaccine deserves a congratulation, they know this is just another step in the control and elimination of malaria. It will be interesting to see the full results of this phase III trial in 2014.

Would You Still Be a Doctor if You Didn’t Get Paid as Much

Would you still pursue medicine if the pay was much less? What if it paid nothing at all?

If money wasn’t an issue, would you still be doing what you are doing today? This is a question I came across today and had me thinking. Right now as a medical student, I “work” anywhere from 40-60 hours a week plus studying and I don’t receive any pay at all. In fact, I pay tuition and it’s in the tens of thousands of dollars every year. If being a doctor paid wasn’t such a well paid job, would I still be doing medical school?

I think, for myself, idealistically I would like to say YES, but realistically I would say NO.  Here’s why.

Although I really enjoy what I am doing now and foreseeable into residency, the financial and personal stresses of a medical education make working less difficult. To start off, the costs of education alone can reach over a hundred thousand dollars easily. If you have to borrow money (and most do) to finance your education, paying back that debt with an “average” salary makes medical school an unfavorable choice. A $200,000 debt would make most people reconsider their jobs.

Furthermore, it’s not just the financial cost of education that makes taking a big paycut unrealistic, there’s also the cost of time. Training to be a doctor takes at least 10 years of post-secondary education. These are often the “best” years of your life, when you’re in your prime of your youth, full of energy and opportunity. While others are starting their careers, networking, and starting their family, you’ll most likely be studying or on call. That’s a big sacrifice to take.

To all the pre-meds out there who say they would do it even if they were paid nothing, you don’t have a clue! You might say that now, but how much do you really know about being a doctor?

What if education costs were much lower? Would You still be a Doctor if you were paid an average salary?

If the financial barriers were much lower or non-existent, I think I would be a maybe. Hypothetically, let’s say doctors would be paid the same as teachers. Would I still be a doctor if I was paid a salary of $50,000 a year? Interesting Note: Residents are roughly paid this much.

I think the answer would depend on many factors. Would I still be working the same hours as a regular doctor or would I be working teacher hours? Would I have summer vacations off or would I have to do overnight call? Will I be working in an office/classroom setting or will I be working with really sick patients?

If you had to compare a teacher’s salary to that of a doctors, by their late-twenties and early thirties, a teacher would have made a higher net amount of money because they would have started earning money earlier. Teachers would also have the added benefits pensions and summer vacations.

Doctors work far more hours, with higher levels of responsibilities and stresses compared to a job that would earn an average income. The difficult situations you may be put in and the level of knowledge and skill required certainly should warrant a higher pay in my opinion.

Money isn’t everything

Please don’t misunderstand my position. Money isn’t everything. I wouldn’t be pursuing my dream of being a doctor if it was all about the money. There are plenty of professions that make much more than medical doctors. Investment bankers, business owners, entrepreneurs, etc.

Compared to my peers, I would say money has less influence on my career choices. I live on reasonable means. I grew up in a lower middle-class neighbourhood and know that everyone works hard for a living. I don’t want flashy cars or private vacation homes in the future. I hope I don’t give off the impression of feeling entitled.

I truly believe that money plays into your happiness and wellbeing only up to a threshold amount. Anything above that baseline is a bonus. I’m not sure where my personal financial line is right now. But I eventually want a job that provides me with financial security and means to live comfortably.

Money is a Reflection of Market Demand

A large part why doctors are paid six-figure salaries is because of economic forces. Doctors are in high demand, always have been and will continue to be in demand. Birth, Sickness, Death and Taxes. Things you can’t avoid in life, and a doctor is usually present at the ones that count.

In one way, having high salaries for doctors helps continually attract the best and brightest. In doing so, the profession continue to thrive and medical breakthroughs and high quality patient care continue.

On a similar note, graduate students argueably work as hard as medical students, go through 4-6 years of grueling education and often are left with poor job prospects. The majority of PhD students probably have the same level of intelligence as medicall students. Competition for graduate school is nowhere near that of medical school and I think is due to market forces.

Where is the altruism?

I think it’s quite rare to find a person who will do the work of a doctor for no pay at all. Even people with the biggest kindest hearts have stomaches to feed too.

The question is how much is enough pay for what you do?

God bless the souls of Cuban doctors and MSF doc’s. Cuban doctors make on average $25 U.S. Dollars a month, and most MSF doctors just get by on daily necessities. Although I aspire to be like them, due to my current life plans I don’t think I can right now.

I don’t think it’s wrong to do a job you love and be paid well for it.

For some people, being a doctor/surgeon is the only thing they can think of doing. For myself, if I wasn’t doing medicine, I think I could be happy working in a different profession and earning a respectable income.

For myself, medicine provides a good mix of intellectual curiosity, intrinsic reward, ability to make a difference, financial security and means to live a comfortable life. I’ve immensely enjoyed my time in medical school and feel quite lucky I get to do what I have always wanted to do.

In the future, I would be very happy about making over $100,000 a year. It would be more than enough for me to live comfortably. I don’t think I should feel guilty about it either, especially if I work hard for it and deserve it.

In conclusion, I think I would still pursue being a doctor if it didn’t pay as much, as long as it was enough to live comfortably. One day I do want to start a family, and I would want a job that could provide for them.

Would you still do medicine if it didn’t pay as much?

The Medical Hamsterwheel

Choosing a career of medicine is very much like running in a hamster wheel, except it’s not that easy to get off.

The process of training to become a doctor is quite long. Usually 4 years in an undergraduate degree, 4 years of medical school, 2 to 5 years of residency, a few more years of fellowship. By the time you’re done, your average age of finishing is in the mid-thirties.

There are always hoops to jump through, people to impress and always something to learn. The learning never stops. And often times, new discoveries make what you learned obsolete.

It can be tiring, especially if you’re stuck in a rotation you don’t particularly enjoy or if you end up working with some difficult colleagues. If you end up doing research, there’s always the pressure to publish, publish or perish. But in the end, I think if you enjoy doing medicine, interacting with patients, learning how to treat illnesses, it’s rewarding.

So if you’re at a point, like high school or undergrad, where you’re thinking this might be something you would want to do, give it a long serious thought. Because once you start down this path, you’ll be busy. You’ll always be working towards that next step. Even if you’re done all your training, you’ll always need to update your skills and knowledge. There’s often no end point, just the state of being in motion. And there’s no easy way to stop or get off too. So don’t feel rushed to make a quick decision. Because the time you spend doing things outside medicine will make you a more complete person. After all, another loop in the hamster wheel won’t really be anything new or broaden your horizons.

A post inspired after reflecting on how much “running” around to “do things” you do in medical school. Looking ahead towards residency, I know the wheel will just keep spinning faster.

 

 

Clerkship Pearls – How to Present a Patient Case Effectively

http://www.flickr.com/photos/unlimited___/244726984Presenting a case is an essential skill every medical student will have to master. In fact, it is one of the few things you can easily do to impress your preceptors and staff doctors. It’s a visible and tangible thing that can set you apart from your peers and can distinguish you from an average medical student to an outstanding one. A lot of students, and even some residents, struggle with presenting a case. When it’s done properly, the audience is engaged and their minds are stimulated but if done poorly, people may zone out and patient care might even be compromised.

We are taught a lot about taking histories and physicals, but we rarely get any formal teaching on presentations. I wouldn’t say I’m the best at presentations, but I think I’ve picked up a lot of useful tips. I’ve gotten a lot of help along the way to get to where I am. I can only hope to pass down some of that wisdom. So here is a list of things I learned in this last year on how to give effective patient case presentations.

 

Preparing to Present a Patient Case

  1. Know your Patient – Before you present your patient during rounds, or to a consultation service, or to the handover staff, you have to know your patient. If it’s a patient you admitted, you should know all the details about the patient. Your history and physical should be thorough. You should know what investigations and treatments have been done. Knowing everything about your patient will make you more confident in presenting your case. You should be able to answer all questions about your patient if asked during your presentation.
  2. Practice  – If the patient history is complex, or if things are a bit confusing, practice, practice, practice. If you’re rehearsing the case and things don’t make sense, go back and clarify with the patient and. Preparation really shows. Especially if you’re presenting multiple cases in a row after a night of call.
  3. Know your Audience – Whether you’re talking to an internist or a surgeon, resident or junior student, you should tailor your presentation accordingly. If there are other health care team members who aren’t familiar with the acronyms, use the full terminology. Speak with the right level of language as your audience.
  4. Know the Situation – There’s a big difference between presenting a patient’s complicated social situation and presenting a perforated bowel that needs emergency surgery. Present according to the context of the situation. If it’s an emergency resuscitation, only the immediate pertinent information will be required. If it’s a geriatrics consult for a stable patient, there would be a different level of detail and thoroughness.
  5. Ask how you should present your case – This is a simple tip that really made a big difference in meeting expectations. I had preceptors who wanted every last detail and investigation done, and I had preceptors who only wanted 3 grammatically correct sentences. Ask ahead of time how your preceptors/audience would like a case presented and then do so accordingly!

Presenting the Case

  1. Be Organized – Whenever you present a case, the format of your presentation should make sense. Most of the time you’ll have about 5-7 minutes (maybe 3 minutes in surgery) to summarize a whole story. You want the whole story to flow and make sense to whoever is listening. You should group all the HPI , medical/surgical history, medications, physical findings, investigations and etc. together accordingly. I recommend you writing your notes in a similarly organized fashion.
  2. Tell a Story - Everything you say in a patient presentation should contribute to a larger story. You need to engage the audience with relevant details that will help paint a more vivid story. Although you’ll see the same diseases over and over again, each patient is unique and each disease unique to that patient at least. Try to tell your audience why this information matters and link it all together for them to appreciate.
  3. Start with a strong opening sentence – Your first sentence should be a succinct yet informative sentence that should tell us over almost all we need to know about the patient. That means you’ll have to summarize just the most important facts into this one sentence. Don’t mention details unless they are relevant. A good summary sentence could go something like this, “Mr. A is a 19 years old male previously healthy, who comes in with first time seizures and atrial fibrillation secondary to alcohol/withdrawal, and a history of cocaine abuse.” In this one sentence, you would have told probably over 80% of the story and it helps listeners focus on what’s important. An example of a bad introductory sentence would be, “Mr. A comes in feeling unwell for the last day, had some shakes and chills and came in with seizures.” Although that might have been his original chief complaint, it really doesn’t help listeners know what is happening. At this point, it could be anything including meningitis, epilepsy, hypoglycemia, etc etc. You want your first sentence to start with a bang!
  4. Present a Patient, not just a disease – Mr. G isn’t just another COPD who came in through the ER, he’s a retired pilot who flew in the war and has been smoker since. It’s too easy and too boring to just present a disease. After all, we are treating patients and although at times we focus on just their diseases, they are human beings with a life outside their sickness.
  5. Present in a logical sequence: For most cases, the order will go something like this. ID, Chief complaint, (reason for referral), HPI, Past Med Hx, Past Surg Hx, Meds, Allergies, Social Hx (include Smoke, EtOH, drugs, living situation), Family Hx, ROS, Physical Exam, Lab work, Imaging, Other Investigations, Assessment and Plan. All my rotations have followed that format. As long as you’re not jumping around from labs to social history to treatment plan, you should be ok. The HPI should also be in a chronological order, either starting from the oldest information, or the most recent information.
  6. Include Pertinent Positives and Pertinent Negatives – Only discuss information that is relevant to the case. You may have completed a thorough history, but you don’t have to present every last detail you collected. Only present what matters. Sometimes you may be asked about certain details, and that’s when knowing everything about your patient will save your butt. Be ready to answer any questions you may be asked about your patient.
  7. Summarize the case – Before you go onto management plans, you should summarize the case using a similar sentence as your opening sentence. Just like writing an essay, say what you’re going to say and then say it again!
  8. Include a Differential Diagnosis – Even if the diagnosis is as clear as night and day, having a differential always help. What else could it be? is a favorite question to ask at the end of the case. Remember to talk about findings that rule in or rule out diseases, and what investigations you would like to do to narrow your differential.
  9. Include your Management Plans – For new learners, your management will likely be wrong, but you should get in the habit of including what you’re going to do early. Don’t be afraid to be corrected, that’s one of the ways you’ll learn and remember. Your senior resident or staff will correct you or at the most fine-tune your management. Taking the initiative and taking an educated guess is one of the best ways to show you’re more than just an information gatherer and that you can think independently. It also helps to do some background reading on the disease and management before presenting.

Improving Your Presentation

  1. Be Enthusiastic – even if you’re post call. A lively presentation will capture people’s attention much better, and will make you more confident in your presentation.
  2. Use a Loud Voice – be visible, be heard. Don’t be timid. Be confident with your presentation, even if you’re getting a stone face from your preceptor.
  3. Do NOT READ your presentation -  I see this mistake done over and over again! it’s one of the easiest things to do that has the most impact in how you come off in your presentation. Eye contact is a powerful device for capturing someone’s attention. Presenting your case from memory may take some preparation and knowing your patient well, but it will make your presentation that much better. I want to repeat it again DO NOT READ FROM YOUR NOTES
  4. Be Honest – If you forgot to ask a question, or do an examination, don’t lie. Instead be honest and say you did not do it. Preceptors will often test their students to see if they are telling the truth. Integrity matters. You’re doing yourself, your preceptors and your patient a disservice when you make up information.
  5. Ask for feedback – no one gets everything right the first time. Ask for feedback from your peers and from your staff doctor. They’ll point out things you can improve on and things you should stop doing. I still get feedback and I appreciate it a lot. Because one day, when you’re finally done all your training, you’ll be on the other side listening with attentive ears and giving feedback too!

Additional Resources

Let me know if you have any additional tips you found useful when you had to present a patient case!

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Giving It Your Best

I’ve been quite irked at people/humanity lately. I’m not angry with patients, the sick or their family members, more like people that work in the service industry. I’m not sure if it’s burn-out or the fact that I’m giving my clinical work my best effort everyday, but I find it disheartening to find crappy service everywhere.

Whether it’s from waiters with bad attitudes, incompetent police/city employees and apathetic condo management boards, I have been more annoyed than usual. Perhaps I just have more stresses in my life than usual.

In clerkship, I find myself sacrificing a lot of my own personal time, and even basic needs like eating and sleeping, to help others. I’m giving it my all, and as a medical student,  I don’t even get paid. In fact, I pay tuition to work for the hospitals, how absurd! Yet I go to work each day knowing that my attitude and my actions matter. How I present myself reflects my profession. How I communicate to team members and patients makes a difference. In an age where the patient can easily be just another icon on the computer, I strive to still connect with patients and serve them in their best interests.

So getting poor service in restaurants, including being ignored and looked down at, annoys me. Especially when they expect to be tipped 15%

Having people handle your financial/personal matters carelessly even when they are being paid, annoys me. Paid with your future debt.

Having something stolen from you and seeing how selfish and self-serving some people can be, and how little disregard they have for others, makes me lose some faith in humanity.

I can totally sympathize with patients when they are annoyed. Annoyed that they have to wait so long to see someone. Annoyed that they feel like their input doesn’t matter, and that the doctor is always in a rush. Annoyed that no one takes the time to explains things to them. Annoyed that doctors aren’t accomodating and flexible, and are not patient centered. Angry when medical errors occur. Service Matters!

So please forgive my ranting. I just needed to blow off some steam and hopefully start to see the positives in people again. It’s sometimes so hard when you feel like you’re the only one who still gives a damn about doing the right things and doing things right. When you give your best efforts to look after the interests of someone else but find the world doesn’t do the same for you. I just hope I never become a doc who sees so much crap that he just gives up and sees the worst in everyone.

/End Rant

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