Systems based care

A while ago, I attended a social event with some of the support staff. I was actually quite surprised to be invited. After all, the staff and the physicians sometimes don't get along so well, and so there's can be a little tension. We talked quite a bit about the different residents and doctors, and it got me thinking about multidisciplinary care, and how sometimes we judge each other on everything but medical ability.

My mom is a nurse, so she always told me that I have to be nice to the staff, and I should always be on my best behavior, and never mean or rude. She would always remind me of my pediatrician growing up, who was a saint of a man.

So I've always tried to be on my best behavior with the nurses and staff, because they are not paid to put up with attitude from me. And I believe that people who like you will help you. Case and point, when I was rounding in the hospital as a resident, one of the interns was presenting, "The patient hasn't had a bowel movement in 2 days and—"

"Wait a minute," I broke in. "Tracy told me that he had a BM yesterday evening, and now he's got diarrhea! I asked her to send a sample." Sure enough, we walk in the room and there is that wonderful smell of melena. The intern asked me after rounds how I knew the patients so well. "The nurse spends all day with the patient. You should try talking to them."

Anyway, back to my original point, whenever I hear nurses complain about doctors, I'm always surprised, because it is often things that the doctor didn't even realize that have earned him such scorn. There's an asshole surgeon who walks around with a coffee all the time the nurses would mock him and his coffee cup behind his back. When I talked to him one day, he thought that he was beloved.

One social worker thanked me profusely for meeting with a family, because another resident was supposed to do it but was called away. Why was she glad it was me? Because the other resident comes from a culture where you don't make a lot of solid eye contact, so he doesn't look patients or family in the eye. And everyone thinks he's pathologically shy or else trying to hide something.

I have seen excellent physicians hated, and incompetent physicians loved by staff, as well as the converse: I've seen great nurses despised and horrible nurses loved by doctors. It took me a while to realize that our ability to interact productively with other health professionals is a skill in and of itself, and multidisciplinary care isn't something you can just assume (so much so that systems based care is part of all residency curricula). So for my part, I try always to be polite and cheerful, and only to be critical where it's appropriate.

And sometimes, when I'm not sure, I'll call my mom. One time, a nurse called me with a low BP of 87/53 (so obviously a machine value, since people almost always report even numbers or multiples of five), so I asked if she rechecked it. She acted like I asked her to part the Red Sea. "Why don't you get up here and recheck it?"

When I got home, I called my mom and asked her, "This nurse called me with a low BP on a patient, and so I asked her if she rechecked it but—"

"—and she didn't recheck it, right? Well, I'll bet she didn't check it the first time either. The tech probably did. She probably didn't do a manual either. That's just plain lazy." I love my mom.

Gratuitious post entirely about staring at butts

I'll admit it. I spent a good 20 minutes watching the various health care women going about doing their jobs, ogling quite unashamedly. There are so many different women out there: phlebolomists, radiology techs, IV nurses, floor nurses, patient care techs, nursing students, PT, OT, speech therapists, nutritionists, pharmacists... and there are a pretty decent number of attractive women in each of these groups.

What I don't understand though is that it seems like the radiology techs have far and away the highest proportion of attractive young women. I went down to radiology one day and it was like I was in a sorority. I felt dirty afterwards.

And part of the wonder of health care is that everyone seems okay with wearing scrubs, the flimsiest piece of clothing imaginable, and if tied up or tucked in just right, leaves little to the imagination.

But the uncomfortable point is that as fun as it is to look, it's not what I want. I'm sure there are plenty of attractive women out there who, when presented with the possibility of marrying a doctor, would jump at it. I have in fact had parents introduce their daughters to me, in the wild hope that I might marry them. And if that was all I was looking for, pretty and desperate, the world would be my oyster. But I want more than that. It seems like such a simple request to find someone who shares my interests and we can be passionate about the same things.

And it's a true shame that one cannot determine if a woman likes to go to baseball games or out for sushi or if she likes arty movies or big band music simply by staring at her ass. It would also make for easier conversation starters. "I see you like to go to museums" sounds a lot better than "You have a nice butt."

A rose by any other name

I was talking with some nurses, and a couple of them were pregnant. So, the all important topic of names came up. I'm always so interested in naming, but I was horrified by some of the girls names they were throwing out: names like Mercedes, Jasmine, Crystal, Summer, Taylor, Porsche, Briana, Tiffany, Brandy... it was like a role call at a strip club!

I think that our names say a lot about us, in spite of the fact that most of us had absolutely no input in choosing our names. It's like that line from the Simpsons about gays: "[Gays] ruined all our best names, like Bruce and Lance and Julian! Those were the toughest names we had!" To some extent, our names are who we are.

So, I wonder if in the not so distant future, there will be a flood of strippers. At least it might help combat the obesity problem in America. But then what will be stripper names? Maybe your next lapdance will be from Gertrude or Beatrice.

And how are you, doctor?

I was sitting at the nurses station, minding my own business, and Blondie nurse was walking by. Blondie nurse is probably the hottest nurse in the hospital, and she routinely has physicians wrapped around her finger. I've always been polite to Blondie nurse, but never much more.

She stopped, and we chatted for a few minutes about my life, and then I was paged away. She wanted to know all about my career plans, and was sad to find out that my rotation ends soon. The strange thing was that she was very flirty.

I am entirely unsure of what prompted this. Although I am nice to the nurses, it's not like I do anything novel or exceptional. In fact, some nurses have a pretty dim opinion of my medical abilities. So, it's hard for me to decide whether events like this happen because nurses think I'm approachable, or if it is because they are interested.

Now, I'm not complaining that the sexiest nurse in the hospital is talking to me, but I really wonder. Because I'm not that handsome or dashing. I'm not charming or romantic. I'm not flirtatious. So I have a hard time seeing why any woman would be interested in me.

Some of my friends find this self-assessment infuriating. But I just don't see it. I don't. When I look in the mirror, I see plain, boring, chubby, nerdy. It just doesn't make sense to me why women would be interested.

Chocolate Thunder, he tells me that I lowball myself. I'm a good person, a doctor, dedicated to my work. In a few short months, I will be making six figure salary. On paper, I'm great. But I can't help but see the same self-conscious, scared kid when I see myself. And maybe I'm still mired in the college age mindset, trying to impress these impossible to please 20 year old girls.

Someone told me something very profound: "You're such a funny guy. You're really nice and friendly, hard working, dedicated, and really compassionate, and you don't see any of that. You're always so down on yourself! You need to realize that you're a fantastic guy, and if some girl can't see that, then she doesn't deserve you."