Category: Work

The cranial arboretum

This blog entry was also going to be entitled “Some people are easy to please”.

Today it was a little chilly when I got up, and so I decided to wear my suit jacket to work.

No sooner had I walked onto the ward than people started looking at me funny and asking what the big occasion was, whether I had an interview, perhaps I had to give a talk, or attend a funeral?

I was only wearing a suit but for some reason people looked at me as though I had a tree growing out of the side of my head! Surely they cannot actually be that easy to impress?

Newbie consultant

I had this amusing situation the other day where we made a referral to a gastroenterologist, and when she came to see our patient it became rapidly obvious that she was only recently qualified as a consultant gastroenterologist.

Now this was not because she wasn’t good at her job, but rather because she kept on saying things like “Where do you keep your consent forms?” and “How do I pull up x-rays on the computers here?”.

Obviously she hadn’t quite switched from the role of registrar (where it would be reasonable to do that kind of thing yourself) to the role of consultant (where she should have just been getting me to do it for her)…

Why doctors hate hospital

There is a quite interesting article in the current Time magazine about Doctors’ experiences of the American health system from the recieving end, either as patients, or a patient’s relative.

It’s quite interesting, as many of the issues raised are the same that I suspect you would experience in Australian or New Zealand hospitals.

It is also interesting though, the startling differences in the way the American health system operates, and most of the differences cast a very very negative light on how the Americans do things. They think that limiting junior doctors to “only” working 80 hour weeks is reasonable and healthy for their professional development, and that junior doctors working with minimal supervision doesn’t adversely affect patient safety (one senior doctor comments in the article “The only thing wrong with 1 in 2 on call is that you miss 50% of the good cases”). It’s frankly terrifying, not to mention blindingly stupid when you consider not only the patient safety issues but also the social and psychological fallout of those practices on doctors lives and health.

There is however a good little sub section entitled “What makes a good patient?” which I think everyone should read. It uses the case of a patient with multiple chronic diseases and conditions, who is medically really difficult, but who listens, ask questions, looks things up, and has reasonable expectations.

A quote I love from the TV show House goes “There you are. The mystery of medicine. Everyone wants your opinion, but nobody wants to listen to what you have to say”. It unfortunately rather nicely sums up most of our interactions with patients, and so when you see on the ward a medically difficult patient who actually listens you know you’re going to have to work really hard, but that it’s going to be a satisfying effort, and one that will ultimately be beneficial for both parties. The doctor will feel satisfied because their efforts are appreciated, and subsequently they will go the extra mile for that patient. The patient will also feel greater satisfaction with the relationship because of the more personal interactions, and will probably ultimately get better medical care.

The morning music predicament

I keep on running into a little dilema.

I’m not the most motivated in the morning, and usual arrive in the hospital car park with 2 or 3 minutes to get up to the ward before start time.

Now the problem is that I listen to CDs or the radio as I drive to work, and I frequently find myself halfway through some really good song or other as I park the car. Now I know I should just jump out and go into work, but my brain keeps on saying “Oh go on. just stay till the end of the song”.

This of course sounds like a completely superficially reasonable proposition, but as previously mentioned I am already running almost late, and besides, what should I do if the next song is really good too. And if it only happened occasionally it’d maybe be OK, but it seems to happen all the time.

I suppose that the other Freudian conclusion to be drawn from this is that maybe I just like music more than I like work…

Welcome to 10 hour days

I’ve started into my surgery rotation, and while I’m enjoying getting to get into theatre a lot and do a fair bit of hands on stuff, both in theatre and on the ward, I’m already a little sick of the fact that because of the way my team functions (or dysfunctions as the case may be) I am basically doing minimum 10 hours each day.

This is good for my credit card repayments, but bad for just about every other aspect of my life.

Creatures of the night

There is a courtyard between the orthopedic and surgical wards which is a designated smoking area, and there are always people out there during the day, but I’m always amused and astonished to see how many people you find out there at night.

Walk past it at 10pm and even though it’s pitch black out there you can still see vague shapes moving in the gloom, and the occasional orange glow as they suck on their cigarettes and cause the ends to light up.

It’s 10pm! I don’t approve of smoking at the best of times, but if you’re outside and smoking at 10pm, it seems as though you can’t really be that sick can you?

Life transitions

On friday night I did ward call, and saw the two ends of life.

I had to declare an old lady dead, after she had passed away as a result of her cancer, in the palliative care ward.

Then as I was leaving the palliative care ward I saw a literally newborn baby being wheeled down the corridor in a crib obviously off to the maternity ward.

It says something about life, but I’m not sure what it is right now.

The wisdom of rotation

One of the features of internship which I’m a little uncertain about is the wisdom of changing departments every 10 weeks.

I have just changed from Orthopedics to general surgery, which is not that big a change, but others have gone from medicine to surgery, or mental health to obstetrics. or visa versa.
I was at a point in orthopedics where I knew the team, I knew the nurses and allied health staff, I knew how things worked in theatre and on the ward and in outpatients. Basically I had gotten to the point where I was good at my job and felt I was being a genuinely useful member of the unit… and then they shifted me.

Now admittedly the learning curve is not as steep this time around, but I’ve still gone back to the situation of not knowing the skills and temparements of my team members or of the nursing and other staff. I also don’t know all the differences in the way the surgery department’s systems and processes work yet either, so basically they have taken a bunch of interns had been trained up to usefulness, and made them inefficient again.

Now as I understand it many countries in the northern hemisphere run their medical internships on a system where you do a 6 month medical term and a 6 month surgical term, and I have to say that I wonder if that isn’t a better arrangement. That way you spend a month or so upskilling, and then 5 months just being good and efficient.

On the other hand however I suppose that people who got stuck for 6 months on a discipline you didn’t like, with a team you didn’t get along with would probably discagree with me on this.

Soft tissue adjustment disorder

One of the things I’m finding quite amusing going from orthopedics to general surgery is that whenever someone puts up a CT scan for me to look at I start looking for the fracture, and almost completely ignore the all the other soft tissues (which in general surgery are bits we are actually interested in).
Its a habbit that’s quite hard to break, not least of all because generally it’s an awful lot easier to spot fractures on CT that the generally rather vague and ambiguous soft tissie changes which constitute general surgical diseases.

Strugling against the machines

We have recently started using a new computer system at work, which allows (to a limited extent) electronic record keeping and note taking for patient charts.

Old chart entries are scanned in, so that you can pull up old charts from any computer in the hospital, and things like xray reports and blood test results are all accessible through it.

I personally find this a godsend, as it allows me to do a fair bit of my work without writing, and from anywhere I want to do it, rather than being tediously paper based from wherever the charts are kept (on the ward, in medical records, etc).

Recently however they added a new feature which allows you to directly add notes into the online charts, with the idea that in certain situations (especially outpatient clinics) doctors would simply type in notes, rather than writing things and having them scanned later.

Brilliant, I thought, and promptly started entering notes left right and centre, and taking to it like I’m sure the IT people were hoping everyone would, however I have been quite bewildered by the fierce resistance I have seen in my fellow doctors to the system.

Even the relatively tech literate and young (comparatively speaking) doctors seem to resist using it, not because they can’t, but seemingly because they don’t want to, and it is new technology. They want to keep on writing illegibly. They want to sort through piles of crusty old paper charts. They like being able to winge about the system, even though it really is quite a good piece of software, and both an improvement on the previous version that was in use last year, and a monumental improvement (in my opinion at least) on the paper systems of old.

I suppose that that is just the way the world works. Some day it will be me being tech illiterate, and some other young upstart winging at my intransigence.