Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Asker Anonymous Asks:
I just wanted to tell you how much I admire you for taking time to answer peoples' questions, especially those that are health-related. Youve answered some of mine and have given me some peace :)
wayfaringmd wayfaringmd Said:

Thanks friend! But hey, next time show your face!

Asker Anonymous Asks:
Hi! I'm a 30 year old freshman with kids and a husband. Over the last few years It's become clear that I can't shake my interest in medicine. I love the use of science for healing. It's absolutely beautiful. Unfortunately I feel selfish and indulgent considering pre-med with the intention of applying to med school. It's a really long road to drag my family through. In your opinion, at my age, am I fooling myself thinking that I could start a career as a doctor?
wayfaringmd wayfaringmd Said:

It’s certainly not too late to start a career in medicine. There’s a guy in my program who didn’t start college until his mid-30s and is now a 2nd year resident! From what I’ve seen, the non-traditional students tend to be the best ones because they’re the most driven and serious about their studies, plus they have some life experience under their belts. 

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It’s gonna be hard though. It was super hard going through it single, so I’m sure going through it married will be tough. But you have a built-in support system, which is awesome! And people do it all the time, so don’t feel like you’re the only one. 

If going back to school makes you feel selfish, you need to have a talk with your husband and kids. More than once. Like before the beginning of each semester. They’re a part of your life, and their opinions count too. If they are fully supportive of your aspirations, then go for it! You still have several years before you have to decide about med school, so y’all have some time to see how things work with you being in school.  

Asker Anonymous Asks:
i feel immobilized by my fear of not getting into a dermatology residency. sometimes it's hard for me to study because i get lost in my thoughts and worry about my performance never being good enough, or that all my efforts would be wasted. i haven't even taken step 1 yet...I'm not one of those typical gunners/arrogant types, I genuinely want to pursue this field. how can i overcome this, and just accept that whatever happens, I'll still be a doctor. [this is not a troll post btw]. thank you.
wayfaringmd wayfaringmd Said:

Wow, not even through Step 1 and already worrying about residency prospects? 

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Seriously. You haven’t even done any clinical rotations yet. How can you be SURE you wanna do derm? 

Anyway, one way to be sure you won’t get into derm is to spend all your study time worrying about it. Don’t worry about being the best. Focus on doing your best. Study hard and study well for step 1 so you can make a great score and have options when it comes to residency time. 

Also, please have an open mind. Almost EVERYONE changes their minds about their career goals once they reach third year. Don’t go in going derm Derm DERM and miss out on some other great specialties. But even if Derm really is “the one”, you won’t get in through sheer worry. I’d advise you to talk to someone at school about your anxieties about grades on a regular basis so you can get it under control. Find an upperclassmen, a school counselor, or your academic advisor. There isn’t a magic formula to stop worrying. You have to make a concerted effort every day to change your focus from worry to productivity.  

Asker Anonymous Asks:
Advice for choosing a school for undergrad? Does the name of the school matter? Big public vs small liberal arts vs private research? Which choice would you choose if you had to choose again? Also I would like to do research in undergrad, are there better opportunities at a giant school or a smaller one where you might be a top candidate? Thanks:)
wayfaringmd wayfaringmd Said:

Name does potentially matter, but it doesn’t weigh heavily in the big scheme of things. Your grades and extras are what really matter. But if you apply to med schools who know your undergrad, it can help if they know your school’s reputation. Having a “good name” doesn’t necessarily mean big or ivy league or private or state school or whatever. It just means that your school has a reputation for turning out good science graduates and other pre-meds. 

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Any research is good research. It can be easier to get a spot at a smaller school, but you may find more prestigious opportunities at larger universities (though they come with more competition). At my school, research was basically always available if it was wanted. 

If I had to do it all over again, I absolutely would have chosen the same school. It’s a smaller liberal arts school but still has a really great reputation, and the town, campus size, and class size were all perfect for me.

And I didn’t care about research, so I didn’t take it into account in my school choices. 

Remember greyface, even the “best” school on all the lists may be the worst school for you. Find one that fits your wants, personality, and needs. That will be the absolute best school you can go to. 

Asker Anonymous Asks:
I watch House and have seen that the oncologist Dr. Wilson does clinic hours. I know these shows aren't the most accurate, but can specialists diagnose outside of their specialty like that? Btw have you watched house and what do you think of it?
wayfaringmd wayfaringmd Said:

Um, yes and no. I mean, an oncologist has to go through general internal medicine residency before oncology, so if they keep up their certification in both specialties, they can cover both.

You can diagnose outside your specialty. For example, I’m not an oncologist, but I’ve found cancers on several patients. But it would not be right for me to prescribe them their chemo drugs or manage their radiation. We’re supposed to stay within our scope of practice. That is, if you don’t have training in something, you probably shouldn’t practice it. 

All that being said, House is a TV show (albeit a good one when I used to watch it). Very little on House is accurate. 

Attending addressing all office staff: As a group, we have lost over 800 pounds during our fitness challenge! 

Attending 2: Whoa, that’s like 2 of our patients!

Asker Anonymous Asks:
In your post about firing patients I saw you mention narcotic contract violations....what is a narcotic contract? And what kind of violations are there?
wayfaringmd wayfaringmd Said:

A narcotic contract is something we do with patients who are on chronic opioid medication. Sometimes we do it with chronic benzodiazepine use as well. It’s all about the terms under which we are willing to prescribe those meds. Every pain management clinic I know of does them.

We write up the contract to say that we agree to prescribe their medication if the patient agrees:

  • the patient must be willing to submit to random urine drug screening
  • if meds are “lost” or “stolen” they cannot be re-prescribed until they are due the next month
  • patient agrees to take their meds only at the dose and frequency prescribed
  • they understand that refills will be given for running out early at the doctor’s discretion.
  • they will not obtain opiates from other doctors or will notify us first if they do
  • they will get all their medications from one pharmacy
  • they agree not to do illegal drugs
  • they will not give away or sell their medications

Most of my patients are very compliant with this agreement, but like I said before, we do fire people over this fairly frequently if they violate any of those terms. Our most common violations are inappropriate urine drug screens (either they show up negative for a drug they should be taking, or have drugs they shouldn’t be taking in their system) or obtaining drugs from other docs. 

Asker Anonymous Asks:
If someone is allergic to penicillin and get a sting from a bee (to which is allergic too) and gets hives. Can metrodinazole work for it?
wayfaringmd wayfaringmd Said:

um, we don’t give antibiotics for hives or for bee stings (unless they get infected, in which case metronidazole still wouldn’t be the right drug anyway). We give antihistamnes like Benadryl or prescribe an epipen for severe allergies.

Sounds like someone’s searching leftover meds to treat themselves at home.

Don’t do that. That’s dangerous. 

Also you should never have leftover antibiotics. You should always finish the whole prescription unless a doctor tells you to stop them.

Do y’all see many anti-vaxxer’s?

Not a bunch, but enough to make me nervous. I personally only have 2 families who are anti-vaxxers. One family is almost militant in their views, whereas the other were initially anti-vax because they come from a country where there is not a big emphasis on preventive care, but eventually they came around to the idea and accepted an alternative schedule for their kid, which to me was not ideal but better than nothing.

How do you feel about "firing" patients? We found out this week that our clinic has a 500% higher incident of patent firings than the rest of our group. The two reasons we fire are repeated no-shows/reschedules, and being rude to front desk or MAs. Opinions? Our providers think the 500% is hilarious.
wayfaringmd wayfaringmd Said:

Personally, I think firing patients is ok. The whole point of firing patients is to remove people who are taking advantage of resources, acting inappropriately, or who do not respect our policies and medical decisions.

My clinic allows us to fire patients for several reasons:

  • multiple no-show appointments Our rule is 3 in a year, and we have to send a letter each time for it to count. Cancelled appointments don’t count against them though.
  • Large unpaid balances. Though we generally accept people back once they’ve paid a certain percentage back. 
  • Violation of narcotics contracts. A contract is a contract, yo. 
  • Signing out Against Medical Advice (AMA) from the hospital. This of course shows that the patient does not respect their doctors’ medical opinions even in the most serious and potentially life-or-death situations, in which case they should have the “opportunity” to find a doctor they do agree with. 
  • Inappropriate behavior in the office or hospital. This one is pretty far reaching but actually doesn’t get used much. We did once fire a patient for coming to the office drunk and peeing in a trash can in front of a nurse. 

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modernathena90:

bulbatsar:

wayfaringmd:

man working out in gray velcro Nike’s with knee-high black dress socks…

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Maybe they’re compression stockings

Bulbatsar has a good point, Auntie
wayfaringmd
!

nope, I knows TED hose when I see ‘em. These were straight up dress socks. 

baffledinbrooklyn:

The residency has made the transition from 24 hour calls to a night float system. There was an awkward transitional phase where interns were on a night float system but PGY-2 and 3s were doing 24 hour calls but that’s over now and the program now fully embraces the night float system that has been…

I’ve done both systems- 30 hour calls in med school, and now a night float system with occasional 26 hour calls as a resident.

Give me long call any day. Night float freakin sucks. You’re ALWAYS tired, and the lovely ACGME rule about not doing more than 6 nights in a row and also ensuring x # of clinic days a month means that just when we start getting use to nights on about day 5, we have to switch back and do one day of clinic, and then go back to nights. It’s exhausting. Give me q4 long call please.

Treat or street?

ER motto

man working out in gray velcro Nike’s with knee-high black dress socks…