Webill contacted me about one of my posts.
She warned me that she had been able to come up with my identity in about 5 minutes from reading the post.
While I do post anonymously, I have never tried to hide things about who I am. I suspect anybody who knew me would be able to figure out who I am in about 5 minutes just by reading the blog and figuring out my nationality, province of residence, city, profession, subspecialty, political views, musical tastes, favourite hockey team etc.
I am not certain whether it is better to post anonymously and be outed or to post using my name or otherwise identifying myself.
Anyway I thank her for pointing this out; I am glad anybody actually reads my blog. I don't like to knit but my mother does (further clues to who I am).
Sunday, June 1, 2008
Wednesday, May 7, 2008
I fought the lab and ... hey I won this time
One of my favourite tasks as an intern was acting as the after hours (and frequently during hours) blood collection service. Right up there with IVs and manual disempactions.
We all remember being called to draw blood from a patient. The patient was either:
1. A little old lady covered in bruises on all four limbs from IV and blood collections.
2. A heavy smoker with no veins.
3. A child on chemo with a severe needle phobia.
So after multiple stabs and tears you would fill the multiple different coloured tubes that the nurse handed you. An hour later you would be paged back to the same patient to draw more blood because:
1. There wasn't enough blood in the tube
2. There was too much blood in the tube
3. You collected blood in the wrong coloured tube (I used to fill one of each colour just in case)
4. The specimen was not properly labelled
5. The sample was "hemolyzed".
Of course it is over 25 years since I was an intern so I should have gotten over it by now. I still of course collect blood from patients under anaesthesia, and very rarely get called to the floor because no-one else can get blood. I also collect blood from nurses who got a needle stick which brings me to my story.
Now for several years I have resolved to wear gloves when starting IVs but this year I actually started doing so. The other day I went to start on IV on my first patient of the day. He was a little difficult and I had to try a second time but I got the second IV in. I am not the neatest person but I do make a point of being responsible for my own sharps. I picked up the two IV needles with me gloved hand and walked back towards my sharps container. That was when I felt a little prick (not the surgeon) and when I took off my glove I could see a little break in the skin.
Oh shit.
The patient had no obvious risk factors and no visible tattoos. Nevertheless I felt that I should draw blood from him and myself. At our hospital we have a needlestick protocol. You get a ziplocked bag with two tubes, one for the patient and one for you. There are two reqs one for the patient and one for you. You put everything in the same bag and it goes off to staff health.
The patient was still under some I drew some blood from a vein and put it into one of the tubes which I labelled with a sticker. I put his sticker on the req. Finding somebody to draw blood from me was harder. The OR nurses didn't want to do it. Recovery room nurses are good at drawing blood but the req had written across it in handwriting "please do not ask recovery room to draw blood". I finally found another anesthetist between cases. I labelled the tube with my name, filled out the req including my name, my date of birth and my healthcare number. Everything, mine and patient's blood went into the ziplock bag and off to staff health. Now as I was labelling my tube, I thought back to those happy times as an intern acting as the afterhours blood collection and recollection service.
Not much to my surprise, I got a call from the staff health nurse about 30 minutes later stating that the lab would not process my sample because it was not labelled properly. I suggested maybe she should call the lab and straighten things out with them as there were only two samples in a zip-locked bag and one was labelled with the patient's label, the other one had my name it. She asked if I was concerned about the patient's risk factors. I asked if she had never heard of universal precautions?
Now I could have just found somebody to draw another sample, but hey it's my blood, my integrity was violated to get the sample, they should process it. So I phoned the lab director who actually had heard about the fuss already. He said he would bring the sample to the OR and I could label it properly. About five minutes later he phoned back saying that the lab tech had told him, there was no way even if it was relabelled that they would process it.
I asked him, "Are you a physician?" He said "yes". I asked "and you have done a pathology residency?" Yes again. So says I. You have over ten years of post high school training and you are letting someone who graduated from a two year technical school telling you what you can do.
One hour later, he brought the tube to the OR and we relabled it.
2
Score: Lab 217 BH 1. But at least I'm on the board.
And by the way the patient was negative.
We all remember being called to draw blood from a patient. The patient was either:
1. A little old lady covered in bruises on all four limbs from IV and blood collections.
2. A heavy smoker with no veins.
3. A child on chemo with a severe needle phobia.
So after multiple stabs and tears you would fill the multiple different coloured tubes that the nurse handed you. An hour later you would be paged back to the same patient to draw more blood because:
1. There wasn't enough blood in the tube
2. There was too much blood in the tube
3. You collected blood in the wrong coloured tube (I used to fill one of each colour just in case)
4. The specimen was not properly labelled
5. The sample was "hemolyzed".
Of course it is over 25 years since I was an intern so I should have gotten over it by now. I still of course collect blood from patients under anaesthesia, and very rarely get called to the floor because no-one else can get blood. I also collect blood from nurses who got a needle stick which brings me to my story.
Now for several years I have resolved to wear gloves when starting IVs but this year I actually started doing so. The other day I went to start on IV on my first patient of the day. He was a little difficult and I had to try a second time but I got the second IV in. I am not the neatest person but I do make a point of being responsible for my own sharps. I picked up the two IV needles with me gloved hand and walked back towards my sharps container. That was when I felt a little prick (not the surgeon) and when I took off my glove I could see a little break in the skin.
Oh shit.
The patient had no obvious risk factors and no visible tattoos. Nevertheless I felt that I should draw blood from him and myself. At our hospital we have a needlestick protocol. You get a ziplocked bag with two tubes, one for the patient and one for you. There are two reqs one for the patient and one for you. You put everything in the same bag and it goes off to staff health.
The patient was still under some I drew some blood from a vein and put it into one of the tubes which I labelled with a sticker. I put his sticker on the req. Finding somebody to draw blood from me was harder. The OR nurses didn't want to do it. Recovery room nurses are good at drawing blood but the req had written across it in handwriting "please do not ask recovery room to draw blood". I finally found another anesthetist between cases. I labelled the tube with my name, filled out the req including my name, my date of birth and my healthcare number. Everything, mine and patient's blood went into the ziplock bag and off to staff health. Now as I was labelling my tube, I thought back to those happy times as an intern acting as the afterhours blood collection and recollection service.
Not much to my surprise, I got a call from the staff health nurse about 30 minutes later stating that the lab would not process my sample because it was not labelled properly. I suggested maybe she should call the lab and straighten things out with them as there were only two samples in a zip-locked bag and one was labelled with the patient's label, the other one had my name it. She asked if I was concerned about the patient's risk factors. I asked if she had never heard of universal precautions?
Now I could have just found somebody to draw another sample, but hey it's my blood, my integrity was violated to get the sample, they should process it. So I phoned the lab director who actually had heard about the fuss already. He said he would bring the sample to the OR and I could label it properly. About five minutes later he phoned back saying that the lab tech had told him, there was no way even if it was relabelled that they would process it.
I asked him, "Are you a physician?" He said "yes". I asked "and you have done a pathology residency?" Yes again. So says I. You have over ten years of post high school training and you are letting someone who graduated from a two year technical school telling you what you can do.
One hour later, he brought the tube to the OR and we relabled it.
2
Score: Lab 217 BH 1. But at least I'm on the board.
And by the way the patient was negative.
Sunday, May 4, 2008
Hating the Habs
For me, after last night I can again enjoy the NHL Playoffs.
I am one of the millions of people across Canada who hate the Montreal Canadiens. I have nothing against Montreal, I love visiting there and Montreal Smoked Meat is one of the foods I live for. I have nothing against French people (Montreal actually has very few French players anymore).
Every year I live in dread of another Stanley Cup for Montreal (which has happened 12 times in my life).
My obsession is deep seated.
I grew up in a Habs household. Except when I was six, my older brother told me I wasn't allowed to hope for Montreal because that would be copying him. In a Habs household, hoping for the Leafs was out so I hoped for Chicago first because they had (and still have) the coolest logo in the NHL. Later when the Bruins started making the playoffs I cheered for the Bruins (and still cheer for them, except when they play Edmonton).
Off course being a Bruins fan, I have a lot to hate Montreal for. I like to think my hatred is justified on a wider basis as a hockey fan.
There are a number of legitimate beefs.
1. The arrogance.
After expansion, the Habs became a lot like Central Red Army. Most of the good players were concentrated on the Habs supported by some very good role players. It is well known how this came to be.
When the NHL expanded in 1967, the play was that every team would only be able to protect 6 players. This would have allowed expansion teams to draft second and third line players, in other words genuine NHLers. At the last minute Sam Pollock the Habs' GM pursuaded the other GMs that more players should be protected. So teams were able to protect 10 players (in addition to protecting another player for each player drafted). This meant the expansion teams were left with a few third line players, some fourth liners (at that time most teams only used three lines) and minor leagers.
Faced with a team with limitted talent, expansion GMs were now faced with trying to build a competitive team which would attract fans in cities like Oakland and St. Louis with limited hockey experience. Fortunately Sam Pollock was able to come to their aid. Sammie was happy to trade them over the hill players and minor leaguers for draft choices in the new amateur draft (Montreal also got to pick the first two players from Quebec as well). Montreal also was happy to trade players to the expansion teams who happily traded them back when Montreal needed them again. Usually a draft choice changed hands as well. Montreal even traded players to enable to teams to finish ahead of teams whose first round pick they had. On one occasion they traded a draft choice to prevent Boston from drafting a goalie (John Davidson).
The result was that Montreal in addition to winning the Stanley Cup almost every year got 4 first round draft choices. Some of these like Guy Lafleur, Steve Shutt adn Bob Gainey blossomed into stars. Worse were the first rounders who couldn't crack the Habs' line-up who ended up in the press box or the minors. This is at the time when there were at least 4 abysmally bad teams who could have used an NHL grade player. This is not to mention, the career damage to players who could have stepped into the NHL but instead spent 2+ years in the minors.
2. Habs fans.
These people are unfortunately the least knowledgeable and most obnoxious fans. I went to a Habs -Oilers game with my cousin who is a nice guy except when you let him dress up in a Habs jersey and take him to a hockey game. He complained bitterly over every call even the offsides.
Of course most people develop their hockey allegience as children when they first watch hockey. Of course for anybody who started watching hockey in the 60s or 70s, the Habs won just about every year. Now how much of a challenge is it to hope for a team that wins most of its games as well as the Stanley Cup.
The only bright side is that Leafs fans are almost as bad.
3. Refereeing
At the start of every Coach's Corner we get to see a very old clip of a much younger Don Cherry standing on the bench facing the crowd with his arms outstretched. The significance of that clip has been forgotten. Not by my however. Cherry was interviewed before Game 5 of the 1979 series with Montreal, tied 2-2 and predicted that the Bruins could not get a fairly officiated game in Montreal. This clip was taken after Boston's 4th minor penalty in the first period. Needless to say Montreal won the game.
We all remember Montreal players skating through centre ice, no player within 10 feet of him when suddenly his legs would go up in the air, the crowd would roar and the referee's arm would go up. Steve Shutt was a master of this.
Pat Burns after he left the Habs for the Leafs, commented after a Leaf's game, that the refereeing wasn't what he was accustomed to in Montreal.
4. Danny Gallivan / Dick Irvin
It was bad enough in the 70s having to watch Montreal just about every Saturday night (of course the option was Toronto or Vancouver) without having to put up with this dynamic duo. Danny's broadcast was more of a group fellating of the the Canadiens organization than a objective broadcast. Add to that Dick's nasal colour commentary and you wished the mute button had been invented. Back when Vancouver would play Montreal in Montreal, most of us turned the volume on our TVs (a primitive mute button) off and put on the Vancouver radio broadcast. When the Oilers and Flames joined the league which meant you hardly ever got Montreal home games on Saturday night, most of us in Western Canada kissed our TVs in relief.
5. Scotty Bowman
Scotty Bowman is a better than average coach. I give him this.
His main genius however is selecting which team to coach rather than any particular knowledge of hockey.
His record:
St. Louis Blues. Finished first in division and played in Stanley Cup Final (record 0-12) in bizzarre set-up where all 6 expansion teams played in the same division.
Montreal Canadiens. 1971-2 Took over team that had just won Stanley Cup. Finished in 3rd place and eliminated in the first round. 1972-3 Won Stanley Cup next year only because Bruins were decimated by defection to WHA. 1973-4 without Ken Dryden finished second, lost in first round. 1974-5 with Ken Dryden lost in second round.
1975-9 with team that had the advantage of having 4 first round picks for the preceding 4-5 years won 4 straight Stanley Cups. (Harry Neale could have won at least 3 with that line-up). Even the Canadiens are so unimpressed with Bowman that they chose Irving Grundman over him to succeed Sam Pollock.
Moves to Buffalo as coach-GM. Takes team that was a guaranteed dynasty to a series of early playoff exits.
Pittsburg. Takes over Stanley Cup champions after Coach Bob Johnson dies and wins one and only one more Stanley Cup.
Detroit. Joins team as coach AFTER team had already been assembled taking advantage of the NHLs ridiculous free agency rules and with a payroll double some teams. Wins a few but surprisingly not that many Stanley Cups.
Bowman's chief talent aside from chosing which team to coach was his mastery of the referees. This included inviting referees to a video session showing the penalties they should have called against Boston in the previous game (imagine any profesional league in the world allowing this) and as coach of Buffalo getting the NHL to suspend Tiger Williams for alledged slashing Bowman even though nobody saw it and it was not shown on any video replays of the game. I also remember his whine after Buffalo tied the game on a powerplay goal (and won in OT) that that the referee had promised him he would not call any penalties in centre ice.
I am one of the millions of people across Canada who hate the Montreal Canadiens. I have nothing against Montreal, I love visiting there and Montreal Smoked Meat is one of the foods I live for. I have nothing against French people (Montreal actually has very few French players anymore).
Every year I live in dread of another Stanley Cup for Montreal (which has happened 12 times in my life).
My obsession is deep seated.
I grew up in a Habs household. Except when I was six, my older brother told me I wasn't allowed to hope for Montreal because that would be copying him. In a Habs household, hoping for the Leafs was out so I hoped for Chicago first because they had (and still have) the coolest logo in the NHL. Later when the Bruins started making the playoffs I cheered for the Bruins (and still cheer for them, except when they play Edmonton).
Off course being a Bruins fan, I have a lot to hate Montreal for. I like to think my hatred is justified on a wider basis as a hockey fan.
There are a number of legitimate beefs.
1. The arrogance.
After expansion, the Habs became a lot like Central Red Army. Most of the good players were concentrated on the Habs supported by some very good role players. It is well known how this came to be.
When the NHL expanded in 1967, the play was that every team would only be able to protect 6 players. This would have allowed expansion teams to draft second and third line players, in other words genuine NHLers. At the last minute Sam Pollock the Habs' GM pursuaded the other GMs that more players should be protected. So teams were able to protect 10 players (in addition to protecting another player for each player drafted). This meant the expansion teams were left with a few third line players, some fourth liners (at that time most teams only used three lines) and minor leagers.
Faced with a team with limitted talent, expansion GMs were now faced with trying to build a competitive team which would attract fans in cities like Oakland and St. Louis with limited hockey experience. Fortunately Sam Pollock was able to come to their aid. Sammie was happy to trade them over the hill players and minor leaguers for draft choices in the new amateur draft (Montreal also got to pick the first two players from Quebec as well). Montreal also was happy to trade players to the expansion teams who happily traded them back when Montreal needed them again. Usually a draft choice changed hands as well. Montreal even traded players to enable to teams to finish ahead of teams whose first round pick they had. On one occasion they traded a draft choice to prevent Boston from drafting a goalie (John Davidson).
The result was that Montreal in addition to winning the Stanley Cup almost every year got 4 first round draft choices. Some of these like Guy Lafleur, Steve Shutt adn Bob Gainey blossomed into stars. Worse were the first rounders who couldn't crack the Habs' line-up who ended up in the press box or the minors. This is at the time when there were at least 4 abysmally bad teams who could have used an NHL grade player. This is not to mention, the career damage to players who could have stepped into the NHL but instead spent 2+ years in the minors.
2. Habs fans.
These people are unfortunately the least knowledgeable and most obnoxious fans. I went to a Habs -Oilers game with my cousin who is a nice guy except when you let him dress up in a Habs jersey and take him to a hockey game. He complained bitterly over every call even the offsides.
Of course most people develop their hockey allegience as children when they first watch hockey. Of course for anybody who started watching hockey in the 60s or 70s, the Habs won just about every year. Now how much of a challenge is it to hope for a team that wins most of its games as well as the Stanley Cup.
The only bright side is that Leafs fans are almost as bad.
3. Refereeing
At the start of every Coach's Corner we get to see a very old clip of a much younger Don Cherry standing on the bench facing the crowd with his arms outstretched. The significance of that clip has been forgotten. Not by my however. Cherry was interviewed before Game 5 of the 1979 series with Montreal, tied 2-2 and predicted that the Bruins could not get a fairly officiated game in Montreal. This clip was taken after Boston's 4th minor penalty in the first period. Needless to say Montreal won the game.
We all remember Montreal players skating through centre ice, no player within 10 feet of him when suddenly his legs would go up in the air, the crowd would roar and the referee's arm would go up. Steve Shutt was a master of this.
Pat Burns after he left the Habs for the Leafs, commented after a Leaf's game, that the refereeing wasn't what he was accustomed to in Montreal.
4. Danny Gallivan / Dick Irvin
It was bad enough in the 70s having to watch Montreal just about every Saturday night (of course the option was Toronto or Vancouver) without having to put up with this dynamic duo. Danny's broadcast was more of a group fellating of the the Canadiens organization than a objective broadcast. Add to that Dick's nasal colour commentary and you wished the mute button had been invented. Back when Vancouver would play Montreal in Montreal, most of us turned the volume on our TVs (a primitive mute button) off and put on the Vancouver radio broadcast. When the Oilers and Flames joined the league which meant you hardly ever got Montreal home games on Saturday night, most of us in Western Canada kissed our TVs in relief.
5. Scotty Bowman
Scotty Bowman is a better than average coach. I give him this.
His main genius however is selecting which team to coach rather than any particular knowledge of hockey.
His record:
St. Louis Blues. Finished first in division and played in Stanley Cup Final (record 0-12) in bizzarre set-up where all 6 expansion teams played in the same division.
Montreal Canadiens. 1971-2 Took over team that had just won Stanley Cup. Finished in 3rd place and eliminated in the first round. 1972-3 Won Stanley Cup next year only because Bruins were decimated by defection to WHA. 1973-4 without Ken Dryden finished second, lost in first round. 1974-5 with Ken Dryden lost in second round.
1975-9 with team that had the advantage of having 4 first round picks for the preceding 4-5 years won 4 straight Stanley Cups. (Harry Neale could have won at least 3 with that line-up). Even the Canadiens are so unimpressed with Bowman that they chose Irving Grundman over him to succeed Sam Pollock.
Moves to Buffalo as coach-GM. Takes team that was a guaranteed dynasty to a series of early playoff exits.
Pittsburg. Takes over Stanley Cup champions after Coach Bob Johnson dies and wins one and only one more Stanley Cup.
Detroit. Joins team as coach AFTER team had already been assembled taking advantage of the NHLs ridiculous free agency rules and with a payroll double some teams. Wins a few but surprisingly not that many Stanley Cups.
Bowman's chief talent aside from chosing which team to coach was his mastery of the referees. This included inviting referees to a video session showing the penalties they should have called against Boston in the previous game (imagine any profesional league in the world allowing this) and as coach of Buffalo getting the NHL to suspend Tiger Williams for alledged slashing Bowman even though nobody saw it and it was not shown on any video replays of the game. I also remember his whine after Buffalo tied the game on a powerplay goal (and won in OT) that that the referee had promised him he would not call any penalties in centre ice.
Monday, April 7, 2008
The Needle and the Damage Done
Most people locally consider me to be a needle guy. I have aquired a reputation as somebody who gives everybody who comes into the clinic some type of needle. I think that is unfair. I do a lot of nerve blocks of various types for patients most of whom come in for repeat injections. Most of these people seem to be happy with their treatment (the other ones post on RateMDs). I also do a lot of medication management including narcotics and methadone. Most of these patients once stabilized I see infrequently and some have been transferred back to their GP.
I still however feel guilty everytime I stick a needle in somebody. I attend all these pain meetings and I know I should be sending them to non-existent multidisciplinary programs. In fact I actually now work in a so-called multidisciplinary pain clinic and almost 100% of the internal referrals are to stick a needle in somebody.
I also do acupuncture. I took a long course which involved some training in traditional Chinese medicine but like most people I just stick the needle where it hurts. Quite frankly I consider acupuncture to be an equivalent treatment to trigger points, however when I do acupuncture I am an open minded practitioner of complementary medicine whereas when I do trigger point injections, I am a money grubbing needle guy.
On the weekend past, I attended a course on fluoroscopically guided injections. I have never done a lot of these mainly due to the inability to access fluoro which the radiologists guard jealously here as if they paid for those expensive machines out of their own pocket. I will be getting more access in the future so I decided I better actually get some training.
At the meeting we learned all kinds of different blocks. What disturbed me was the whole time, I was thinking, "How many of these can I do in a day and how much can I bill for them". (When you go to American Meetings, there is usually about half a day devoted to billing, further some interventional textbooks have chapters on billing). More disturbing was that everybody else taking the course was thinking the same thing.
Now I have been treating chronic pain for over 15 years (longer if you include my 3 years of general practice) and I still haven't figured out what causes back or neck pain, nor what is the best way to treat it. My more recent training has not enlightened me on this.
I can only hope the way I treat back and neck pain will be governed by what I think is best for the patient, and not how much I can get paid or how many fluoro slots I have to fill.
I still however feel guilty everytime I stick a needle in somebody. I attend all these pain meetings and I know I should be sending them to non-existent multidisciplinary programs. In fact I actually now work in a so-called multidisciplinary pain clinic and almost 100% of the internal referrals are to stick a needle in somebody.
I also do acupuncture. I took a long course which involved some training in traditional Chinese medicine but like most people I just stick the needle where it hurts. Quite frankly I consider acupuncture to be an equivalent treatment to trigger points, however when I do acupuncture I am an open minded practitioner of complementary medicine whereas when I do trigger point injections, I am a money grubbing needle guy.
On the weekend past, I attended a course on fluoroscopically guided injections. I have never done a lot of these mainly due to the inability to access fluoro which the radiologists guard jealously here as if they paid for those expensive machines out of their own pocket. I will be getting more access in the future so I decided I better actually get some training.
At the meeting we learned all kinds of different blocks. What disturbed me was the whole time, I was thinking, "How many of these can I do in a day and how much can I bill for them". (When you go to American Meetings, there is usually about half a day devoted to billing, further some interventional textbooks have chapters on billing). More disturbing was that everybody else taking the course was thinking the same thing.
Now I have been treating chronic pain for over 15 years (longer if you include my 3 years of general practice) and I still haven't figured out what causes back or neck pain, nor what is the best way to treat it. My more recent training has not enlightened me on this.
I can only hope the way I treat back and neck pain will be governed by what I think is best for the patient, and not how much I can get paid or how many fluoro slots I have to fill.
Tuesday, April 1, 2008
Privacy
Yesterday and today I am on call which means covering the case room. Now a universal feature of caserooms since I was a medical student in the last millenium was "The Board".
"The Board" was a then a blackboard, now a whiteboard with every labouring patient's last name, status including dilatation, station, NPO status, epidual and whether they were being induced.
In the interest of privacy now, the patient's last names have been replaced with only the first 3 letters of their name. This caused a problem for me right away when I arrived in the morning. The first three letters of the only patient with an epidural made up a name that is not common. So in I went saying "high Ms., I'm Dr. BH" and then went out to the desk to find her chart. After I couldn't find her chart I asked, "who has Ms <3 letter word name>'s chart" and after getting blank looks, "who has room 5's chart". One of the nurses handed me a chart with a six letter last name and when I said no I want <3 letter word>'s chart; they looked at my like I was stupid and told me that they were only putting the first 3 letters of the patient's name on "The Board". I never asked how they proposed to deal with patients whose last name only had 2 or 3 letters something increasingly common now (or two patients with similar three letters).
Most medical and surgical wards used to have boards with everybody's names on and what bed they were in. Alternatively the name was on the door so you could at last walk around looking for the patient you had to see. Unfortunately boards have gone by the way and in several hospitals now there are no names on the door either. This forces you to look for the chart (which if it is in the rack is filed by room number) or ask the ward clerk or a nurse.
At the same time we are very concerned about proper identification of patients to prevent the wrong treatment being done to them. Now I think everybody has had the experience of going in to see the wrong patient and realising half way through talking to them that you really should be talking to someone else. When one wants to estabilish a therapeutic relationship with a patient, the least auspicious way to meet them for the first time, has to be to enter the room and go straight for their arm band to see who they are. Yet with names not on the door, or the patients bed, in patients who are deaf, demented or half asleep, that is now the only way of ensuring you are actually talking to the right patient.
At the same time most units allow patient and their visitors to use the phones at the desk. Of course what are usually sprawled all over the desk for everybody to see. Charts of course, so the patient or their visitors can read whatever is in their visual range. (Maybe that's why nobody writes progress notes anymore).
Very few names are unique anyway. If I see a name on a door that is the same as someone I know, I just assume it is someone with the same name. Occasionally much to my surprise it is someone I know. I once ran into the contractor who built my house while on Pain Rounds. The name didn't ring a bell and people surprisingly don't look the same with an ng tube. I was talking to him when he interrupted me and said, "I built your house". I didn't tell him it was a good thing for him that I didn't give him his anaesthetic.
A number of years ago we had a victim of a gang related assault in our trauma unit. The staff were somewhat concerned that someone was going to come in to finish him off so as this was still when there were names on the door, instead of putting his name on the door, they put his hospital number.
Great...
I'm a gang member assigned to finish him off and I learn what ward he is on. So I sneak around the ward and there are 19 rooms with a name on, and one with a number on. I wonder which room I should chose.
I grew up in (what was by today's standards) a small house with three brothers (and two parents). My mother always said, "If you don't have anything to hide, you don't need privacy".
So please put my name on the door.
"The Board" was a then a blackboard, now a whiteboard with every labouring patient's last name, status including dilatation, station, NPO status, epidual and whether they were being induced.
In the interest of privacy now, the patient's last names have been replaced with only the first 3 letters of their name. This caused a problem for me right away when I arrived in the morning. The first three letters of the only patient with an epidural made up a name that is not common. So in I went saying "high Ms.
Most medical and surgical wards used to have boards with everybody's names on and what bed they were in. Alternatively the name was on the door so you could at last walk around looking for the patient you had to see. Unfortunately boards have gone by the way and in several hospitals now there are no names on the door either. This forces you to look for the chart (which if it is in the rack is filed by room number) or ask the ward clerk or a nurse.
At the same time we are very concerned about proper identification of patients to prevent the wrong treatment being done to them. Now I think everybody has had the experience of going in to see the wrong patient and realising half way through talking to them that you really should be talking to someone else. When one wants to estabilish a therapeutic relationship with a patient, the least auspicious way to meet them for the first time, has to be to enter the room and go straight for their arm band to see who they are. Yet with names not on the door, or the patients bed, in patients who are deaf, demented or half asleep, that is now the only way of ensuring you are actually talking to the right patient.
At the same time most units allow patient and their visitors to use the phones at the desk. Of course what are usually sprawled all over the desk for everybody to see. Charts of course, so the patient or their visitors can read whatever is in their visual range. (Maybe that's why nobody writes progress notes anymore).
Very few names are unique anyway. If I see a name on a door that is the same as someone I know, I just assume it is someone with the same name. Occasionally much to my surprise it is someone I know. I once ran into the contractor who built my house while on Pain Rounds. The name didn't ring a bell and people surprisingly don't look the same with an ng tube. I was talking to him when he interrupted me and said, "I built your house". I didn't tell him it was a good thing for him that I didn't give him his anaesthetic.
A number of years ago we had a victim of a gang related assault in our trauma unit. The staff were somewhat concerned that someone was going to come in to finish him off so as this was still when there were names on the door, instead of putting his name on the door, they put his hospital number.
Great...
I'm a gang member assigned to finish him off and I learn what ward he is on. So I sneak around the ward and there are 19 rooms with a name on, and one with a number on. I wonder which room I should chose.
I grew up in (what was by today's standards) a small house with three brothers (and two parents). My mother always said, "If you don't have anything to hide, you don't need privacy".
So please put my name on the door.
Monday, March 31, 2008
Information I really shouldn't be posting on my blog (but that is too juicy not to)
When I worked at the CoE there was a surgeon whose ego was the inverse of his height. Now he was not a modest guy so you can guess he was quite short. He compensated for this by wearing ridiculous cowboy boots with heel lifts and I know everybody (even some short people) made jokes about his height mostly behind his back. Now I am reasonably tall but I have come to realise that outside the NBA, NFL and CFL this is largely a world suited for short people so I couldn't really see what the "big deal" was.
Despite this surgeon's lack of physical attributes he had quite a successful life. (The operative word is had as I will explain below).
He became a successful surgeon, helped pioneer a few new procedures, was well respected in the community (if not by his colleagues), and was a successful political fund raiser for the ruling party. He was incredibly wealthy, had a huge house, and drove what he described as (after one of the nurses' daughters rear-ended him) the most expensive car in the province.
All was not rosy in his life. About 10 years ago he ran away from a long marriage to a woman who had put him through medical school, bore his children, etc to marry a sales rep. This didn't seem to affect his standing in the community, in fact even before he remarried he was in the social pages accompanied by his new wife-to-be. At his second wedding, his adult children from the first wedding picketed the ceremony and he had them arrested.
Now about 3 years ago I heard that he was going to take the whole summer off to have surgery. He was at that time of the age where people get prostate or colon cancer or require joint replacements so I didn't think much of it. That was around the time I left the CofE.
We were talking one day about him in the OR at my new place and somebody said that the reason he had taken the summer off was to have his legs lengthened in New York. The procedure had not been done. Just the fact that he had even considered such a procedure caused much amusement, although this would not have been out of character for him.
A couple a weeks ago someone came out and told everybody that he had actually gone ahead with the leg lengthening in the US. This is by the way called the Ilazarov procedure and is usually used for leg length discrepancy or occasionally for children of short stature. While this procedure is done on adults (particularily in adults who can afford it), there is generally a cut off at age 50 simply because you stop healing well, forming bone and rehabing well at that age. Being 50 myself, that is a little depressing. Apparently in the US, being able to afford a procedure can take years off your life (in both senses unfortunatley).
To make a long story short, he did terribly. His recovery was complicated by pulmonary emboli requiring an ICU stay, he has an infection, non-union and 60 year old nerves not liking being stretched, has developed causalgia which to my (and his?)relief is being treated by one of my colleagues and not by me.
Personally I blame myself. I should have never made all those short jokes.
But seriously....after the snickering about the shear audaciousness of a mature successful man undergoing mutilating surgery for a slight increase in his height, I really had to feel genuinely sorry for him. Not sorry for the predictable complications but sorry that he felt that his life was not perfect enough that he had to improve himself.
Another issue that came up is the issue of confidentiality. Yesterday in the surgery lounge this was the topic of conversation all day with people hearing the story and getting on the phone to someone they knew with, "did you hear about...".
Technically as a hospital patient, his condition should only have been known to his caregivers. While perhaps because of his actions over the years he has done more than most people to make his personal life less private, in his time of personal crisis, even if this came from a totally irrational decision on his part, he is entitled to privacy.
Still we all love gossip and this is a juicy story.
Friday, March 28, 2008
Stethoscopes
In the election we had last month, a local emergency physician ran and won for the ruling Conservative party. Now I have no issue with a physician running for a party that has eviscerated health care in the province; nor do I have any issue with the fact that physicians who go into politics are innevitably an embarassment to the profession; nor even with the fact that if a physician gets into a position of power they are never a friend to the profession.
What I have an issue that his campaign photo was a head and shoulder shot of him wearing an OR green top with his stethoscope hung over the back of his neck. This large photo is, as far as I know, still adorning a bus shelter I drive past too often. It is saying look at me, I am a doctor, I am cool, I save lives.
The old image of a doctor is of course a stethoscope dangling from the neck like a neck tie (which doctors innevitably wore in those days). I often wonder how often they snagged their stethoscope on something.
When I first started going to into hospitals as a medical student, nurses slung their stethoscopes around their necks which most doctors carried their stethoscopes in the pocket of their coats. (Surgeons never carried a stethoscope why would they?)
Gradually people started slinging their stethoscope over the back of their necks. Even I did. We thought it looked cool. Except you still snagged it on things plus the rubber irritated your neck (some people had cloth sleeves made for that purpose). In fact after a while with everybody doing it, it was no longer cool so I stopped as did most people and my stethoscope went back into my pocket. Somewhere along the way, I lost it or it was stolen. I now borrow stethscopes when I need one and I rely on the ETCO2 for tube placement (I still make medical students and residents listen!)
The image of a doctor used to be, a clean white coat, shirt, tie and nice pants. (These doctors were by the way always male). There seems lately to be a trend where doctors are photographed wearing OR greens and with a stethoscope or further props. The stethscope is after all only one of many tools a physician uses. Why didn't he have his picture taken using an otoscope, or a rectal glove?
Anyway why should it matter whether he is a doctor as to whether he will be a good member of the legislature. And certainly there are better ways to advertise your professional qualifications than to have your photo taken wearing your stethoscope.
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