So I’m getting ready to present to my attending about a patient with lower back pain, and she pulls out a letter she’s received from the Department of Justice. It names her (as well as about 30 other physicians) as providing vicodin to a woman in the ER.

The following is a two page listing of all the patient’s prescriptions: The patient’s name used, the date, the hospital, the prescription. Prescription after prescription, over the span of a month or two.

So, what the hell? So the Department of Justice is allowed to have access to this data to prosecute the woman and alert the physicians’ to their mistake, but the physicians themselves can’t get access to it to stop the woman’s drug habit?

What a freaking joke. Reason #213 for some sort of nationalized information system.

(The woman had a good story–we went back and looked at the ER note. Said she had a history of Crohn’s, complete with abdominal scar, and had an appointment in 2 days with her doctor, who was out of town.) See also: “I Usually Get Dilaudid and Phenergan.”

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I talk a lot about medicalese and the problems it creates for patients–but I figured I’d go through some lingo we use that’s not necessarily medical in nature, but definitely used by doctors and nurses. (But maybe these are mostly California/West Coast, I’m not sure.)

• To buy: To take an action (order a test, do a procedure) based on a patient’s signs or symptoms. Takes the patient as a direct object. Example: She told me she had black stools, so I felt bad, but I figured that at least bought her a rectal exam.
  Given his complaint of chest pain and risk factors for heart disease, that alone bought him an aspirin.
• To ding: To be chastised or disciplined for not knowing something or not doing something correctly. Example: The hospital got dinged for not having patient privacy guidelines in place.
  My attending dinged me for chewing gum in front of a patient.
  
• To rectalize: To do a rectal exam on a patient. Example: Hey, did you rectalize that patient in 7B?
  So, I tried to rectalize him, but there was so much fat, I couldn’t find the anus!
• Orthopod, noun. An orthopedic surgeon. Example: What’s the difference between an orthopod and a carpenter?
  The carpenter knows the name of more than one antibiotic.
• To spin, to scan. To do a CT scan on a patient. Example: He’s got a lot of chest wall tenderness–if we’re going to spin the abdomen and pelvis, we might as well scan the chest.
• Cards, noun. Cardiology. Example: Cards won’t take the patient–they don’t think it’s heart related.
• Pedi (pee-dee), noun. Pediatrician. Example: The patient’s pedi is Dr. Torrez at Menlo Clinic.
• Appy, noun. Appendix or appendicitis. Example: White count, fever, nausea, rebound tenderness at McBurney’s point–classic appy!

More as I think of them. Feel free to comment with your own.

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After all the talk about Pfizer’s cholesterol drug failing , it got me wondering–what if we’re out of drugs to fix common diseases like high cholesterol and high blood pressure? After all, these drugs work by altering the body’s own enzymes and proteins–and there’s only so many enzymes you can alter. And sure, we can try to develop drugs that target certain enzymes in certain tissues to prevent side effects, but what’s really meant by “target?” It means that we develop a drug that is only active if certain other molecules are around it, or can alter or activate it. Or that there’s a portal on the cell wall that can allow the drug in. What if we’re out of portals? Or that they’re too small to fit our big drugs through?

What if we’re stuck? Sure, we can find more drugs to do more things, but what if they’re all so complex that they cause too many side effects (we’ll call “death” a side effect)?

I kind of actually think this would be a good thing. Now, it would be a terrible thing for older generations who ate Crisco and smoked without knowing any better–but for society overall, it would make us take a more realistic view of our lives. Make us consider the notion that there’s not a magic pill to fix our bad habits. That our actions have consequences for our lives and our health. That the magic doctors won’t be able to necessarily fix me–perhaps I need to fix me.

We would probably eat a little healthier, exercise a little more, feel a little less rushed, and spend more time with our loved ones.

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First time seeing one of these, two weeks ago. Off to the cath lab for him!

(For the non-medical, that’s an acute MI–active heart attack–in progress. The big rounded convex lines look like tombstones for a reason.)

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10 points to my mother, ex-nurse, current photo-stylist, for advising her healthy, 40-something co-worker to go to the hospital for his increasing shortness of breath. He had a pulmonary embolus (for unknown reasons at this point).

Moral of the story: If out of nowhere you start developing symptoms that make no sense, please see a doctor.

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I can’t believe I haven’t written about one of the most evil, most frustrating things about being a med student: the dreaded Attending Effect(tm).

The Attending Effect, by definition, is the magical, mystical powers that the presence of an attending has on your patient’s history. The mere sight of an attending will transform the words that come from your patient’s mouth from those he or she told you to a different story entirely.

You’ll get the story from your patient, “Okay, so it’s been 3 days of vomitting, but you’ve been keeping liquids down fine, and there’s no blood in your stool, or black, tarry stools.”

You go tell this fascinating story to your attending, give your assessment and plan, they agree, and you feel good–“The attending said I’m doing the right things! Yes!”

Then, you either go back with your attending to examine the patient again–or worse, your attending sees the patient without you–and the story the attending gets is totally different. Your attending tells you, “She told me it’s been a week and a half of diarrhea, sometimes bloody, and she can barely drink anything.”

The first few times this happens, your eyes bulge out, your jaw drops. You sweat, your heart races, you panic. You are convinced that the attending thinks you totally lied to him or her, or that you weren’t listened to the patient, or that you’re just a total dumbass. You quickly re-tell the story the patient gave you, and you swear you didn’t make it up. You are so totally pissed at this patient.

Once this has happened a dozen times or so, you just kind of shrug it off. You’re annoyed, wonder what the patient was thinking. But you know it’s just the Attending Effect at work, there’s nothing you can do about it, so you just adjust your assessment/plan and keep on moving. There’s more patients to see.

(Reminded of this by Flea , whose stories are totally depressing lately and really getting to me, and making me wonder “Is this really what being an attending is like?)

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