Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, September 02, 2003

    Blogging will be light for awhile, as I have a wedding coming up (my brother's getting married next week) and the Boards are looming over my head with two months to go.

    I spent this weekend studying, shopping for clothes for the rehearsal dinner and seeing nursing home patients - fun, no?

    I do have a few minor events to tell you about. Last week, on my half-day, I was looking forward to a quiet afternoon of phone calls and leaving early. However, fate intervened in the form of an elderly, demented patient of mine who had come in to see our dermatologist; I had seen her for a routine visit at the nursing home the week before and noted an early skin cancer on her right cheek. In came the secretary, Barbara (a.k.a. She Who Must Be Obeyed), thundering, "Why'd those nursing home people drop off that patient without anyone to watch her? She's in the waiting room throwing up and she's about the color of that wall." [i.e., stark white]

    I dashed off down the hall to find the patient indeed diaphoretic, cool, BP 80/50 and vomiting. My best guess is that she got syncopal strapped in the wheelchair, fainted, and threw up. I was afraid she had aspirated (choked), so as soon as the dermatologist had removed the skin cancer (holding her nose all the while), we took her over to the emergency room across the street. Since our hospitalist was tied up with a bunch of other admissions, I finished her exam and took care of the admission orders and history and physical - I took her off the hands of the ER docs as well, since she was basically just sitting there being monitored and waiting for a bed. And that, kiddies, is how I spent my "afternoon off."

    In other, vaguely related news, I noticed this article on Yahoo! today:

    Future Doctors Favor Lifestyle Over Money

    An increasing number of medical students are picking their specialty based on the lifestyle it permits, including more time to spend with family, rather than such traditional factors as pay and prestige, according to a study published on Tuesday in the Journal of the American Medical Association.

    The finding points to potential shortages of doctors in specialties such as family practice, surgery, and obstetrics as medical students shun fields where they are required to be on-call during many off hours, the report said.

    "We're going to have person-power shortages in the next 10 years in critical areas. Where are the primary care doctors going to come from?" said Rutecki, a physician and professor at Northwestern University.

    Where indeed? Why go into a field where you have to spend a lot of time away from your family, get called out in the middle of the night, and don't get paid for your time? In some ways I think this is a good thing as it indicates a healthier attitude toward work and the value of the family... but it may leave the patients up the creek.



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