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| HOPI
Subject is a 26 year old female HD1 s/p first day of med 4. Onset of med 4 was acute, lasting about ten hours, and accompanied by confusion and fatigue that have since resolved. Symptoms were a 7 out of 10, exacerbated by darkness, superiors, hunger, and hot air balloons. Nothing made the symptoms better. During this time, she was unable to fulfill her ordinary social roles or complete most ADLs.
PE
On examination, she lies prone in no acute distress. She is disheveled, likely due to neglect of ADLs as mentioned above. She occasionally addresses herself in the third person.
On her left fourth metacarpophalangeal joint, she wears a .5 mm band.
Cranial nerves II-XII grossly intact.
Some evidence of emotional scarring is evident, but prior radiographic studies suggest that these have been stable for at least four years with no signs of progression or inflammation. Scar pattern suggests she was terrorized by velociraptors.
She is short in stature and appears deconditioned, but is mobile. Strength testing is 4/5 in all four extremities. Patient is uncooperative with tendon reflexes or MMSE.
Other attempts at physical exam were thwarted when patient bit her examiner.
Assessment
Unable to assess situation at this time due to poor insight. May be better assessed in hindsight.
Plan
Suggest increased effort in completion of ADLs and follow up appt in 6 months.
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| Most professions should treat people equally regardless of socioeconomic class, but I have always thought that teachers, priests, and doctors ought to be held to a higher standard in this regard. In the same way the rich aren’t entitled to receiving communion before the poor, an indigent patient with pneumonia seeing the same doctor as a tycoon should receive the same amount of attention and treatment. In my brief time in medicine, I have not seen much discrepancy between healthcare for the rich and healthcare for the poor with any given practitioner. But today, I learned about executive health. There is no Wikipedia entry for executive health, but it is the hospital equivalent to flying first class. Executive health caters to the well-to-do, targeting corporate leaders, high-ranking politicians, and the like. When you arrive at the hospital, you are greeted with complimentary valet parking. Instead of the crowded ER, you go to a private waiting area with complimentary snacks, and once admitted, you’re ensured a private room. You are always guaranteed the same physician, regardless of who the attending is when you are admitted. All service is prompt, and on the floor, you are pampered. In the outpatient setting, you are privy to in-depth physical exams and work ups ordinarily reserved for the critically ill, after which you receive personalized exercise, nutrition, and stress management assessments. While executive health’s goals and promises are the ideal standard of healthcare, and it would be an honor to be a part of a team that provides such excellent service, I am bothered by the fact it is only there for those who can afford it. I feel the existence of executive health undermines the egalitarianism of healthcare, and that the opening of each new executive health department, cheapens the altruism of medicine with a taint of elitism. The shortened waiting times for those in executive health keeps the more important people in society from wasting their time. Perhaps what unsettles me about this premise is that if the time of executive health members is more valuable, then can you extrapolate that so are their lives? Do they then deserve limited medical resources, like organ donations, more than an ordinary individual? Once a process for creating a socioeconomic rift in healthcare exists, I fear the discrepancy will inevitably widen. There are many things that I think the rich can be privy to (gourmet food, sports cars, destination weddings) but I don’t think better healthcare should be one of them. Note: This is commentary based solely on my own very limited experience with executive health supplemented with information I found on the web. I have heard no arguments for or against it. I welcome your input. | | |
| Early last week, my roommate came home with a 12 pack of Slim Fast shakes. As I passed by the kitchen she said, "Hey, I put one in the fridge for you." I never drink diet coke, let alone Slim Fast, but I figured she was just being nice and wanted to share her food. I forgot all about it. When she got home the next day, she opened the fridge and said, "Looks like you forgot your shake." Since she had noticed, I drank the chocolate Slim Fast shake for breakfast the following morning during clinical skills lecture. We had a neck brace workshop after lecture. I volunteered to have the brace demonstrated on me. "Alright," said the EMT, "Let's see. First thing you do is look at the neck to pick the right collar. You look like a..." He glances at me, "I'd call you a no-neck." Nervous giggles from my classmates. I am not a health-conscious eater. Last year, my mother bought me a scale as a housewarming gift, but I don't ever use it. I never ever go to the gym or make an effort to exercise, though my roommate did invite me to do a slim in six video with her two weeks ago, which I declined. Despite my poor eating habits and non-existent exercise regiment, I have never been concerned about my figure, but I did find it suspicious that I'd gotten two remarks in two days. The next day in clinical skills lab, we had to start peripheral IVs. In common med school format, after practicing on the mannequins, we were instructed to practice on each other. I sat down with my partner and we began looking for a good vein. The professor came over, took a look at my arms and said I would be a difficult stick. Then, she turned to the rest of my group and said, "Once in a while, you'll get a fat patient with poor veins like her." She gestured toward me and had me show my arms to the group. Three hints like that are an unlikely coincidence. So, while I was studying with my roommate at Barnes and Noble today, I brought her a health magazine. She flipped through it and came across this inspiring article about two friends who lost 200 lbs combined. We looked at each other and decided that we can be just as awesome. Well, we can't lose 200 lbs combined or we would weigh a total of 40 lbs (which would be fine if we were housecats or small dogs, but is not practical for our purposes). So thank you all for the hints. My roommate and I downloaded the "Lose It" app for our iPhones and have set the goal of losing a combined weight of 35 lbs by mid-May. Hope this committment stops the snarky comments. P.S. Some suggested weight watcher's recipes that did not make it mainstream for obvious reasons. My personal favorite is the Fluffy Mackerel Pudding. http://www.candyboots.com/wwcards.html Credit for finding this site goes to my brother. | | |
| Would you let me be your OB/GYN?
The past 5 years, I've had my heart set on going into psychiatry, but these past two months, I've begun to question that decision. I have enjoyed my OB/GYN rotation far more than I thought I would. At the end of the day, as I walk home from the hospital, I am always glad that I went in and look forward to going in tomorrow. Those who know me well know that losing a close friend to addiction was my primary motivation for pursuing a career in addiction psychiatry. As I talked to my roommate tonight, she perceptively pointed out, "If you went into OB/GYN, you'd be doing it for yourself, and if you went into psychiatry, you'd be doing it for someone else."
When the decision is phrased so astutely: pursue a career for myself or a career for someone I lost a long time ago, the inevitably answer is that I need to hold onto what's mine and let go of what isn't mine anymore.
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| Among my patients and fellow medical students, there are many with doctor parents, myself included. As I've gone through medical school, I've seen there are hard rules (don't break HIPAA) and soft rules (don't treat family members). Instead of taking their child to a colleague, many doctor parents provide the basics of medical care, from the provision of vaccines to the lancing of boils, to their own child for free. There are moral reasons for not treating family members, but I think as long as you're sticking to the simple things, it's about as wrong as choosing plastic over paper at the grocery store.
Today, I suddenly realized that someday, I will have the option of treating my kids, so I gave a little thought as to whether I'd choose paper or plastic. Instinctively, I tried to remember what choice my parents made. My father is a dentist. When I was about six or seven I got my first loose tooth, which was exciting at first, but after weeks of waggling it around with my tongue, I got bored of it and went to see my father. He held my small jaw in his vise like grip and pushed my tooth around with his other hand. The tooth was bending at a greater than ninety degree angle from its previous trajectory. He looked thoughtful for a moment, then said, "Let's tie it to the doorknob."
"We're not going to your office?" I countered warily.
"Nope." And Dad went and got some string. Five minutes later, I was sitting with an eight foot line from my tooth to the doorknob. "Ready?" I closed my eyes. SLAM! When I opened my eyes, the string lay limp by the door and the tooth was still hanging in my mouth, but now it was stinging. "Guess it's not ready to come out," said dad, as he opened the door and observed the situation. It fell out on its own a few weeks later.
Being twenty years older, I now realize that Dad didn't tie my tooth to the doorknob because of his meticulous dental training; he did it because I was his kid and he wanted to try what all the other parents had been trying before they took their kid to him. Which is really kind of a great idea because your kid will trust you, thinking you are an "expert" and you won't get sued unless your spouse really hates you. So to my dilemma of paper or plastic, to treat or not to treat my future children, I have decided the answer is canvas tote. I'll treat them however I want and let the doctors figure out the rest.
Oh, and Konrad, ignore this post. Thanks.
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