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.

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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Doc: Do you take blood pressure medicine?

Patient: Only when my sister is in town visiting. 

This might sound dumb but I can not for the life of me find the answer on the Internet. Does a person's heart stay the same size all throughout their life? Like, is a baby's heart the same size as an adults? Could a child get a heart transplant from someone way older? Thanks!
wayfaringmd wayfaringmd Said:

Nope, the heart and every other organ except the thymus grows as you get to adulthood. The thymus actually shrinks to almost nothing in most folks. Once you’re “full grown,” your organs generally stay the same size. But the heart is a muscle, and like your biceps, if the demand for the muscle increases, the muscle gets bigger. Except in the heart, it’s not necessarily a good thing because the muscle gets to a point where it’s too thick for it’s own good and then you end up with heart failure. 

A good estimation for a healthy person—child up to an adult— is that the heart is about the size of the person’s fist. 

I haven’t worked in a transplant center, so I’m not totally sure, but I think that donor hearts are not usually older than the recipient. So a child would get another child’s (of similar age and body size and of course blood group compatibility) heart because the heart will grow with the child. 

A CABG is when they put a stent in, right?

New intern. Lord help us all.

Coronary Artery BYPASS Graft

Pap smears are like pedicures. The people who do them don’t care how weird you look.
 LD, fellow resident
Can you explain to me the relationship between doctors and insurance companies and hospitals. Like say you had your own practice, do you have to buy-in to what patients you can take based on what insurance company you're affiliated with?
wayfaringmd wayfaringmd Said:

So when you go into private practice, most doctors will accept the most common commercial insurance plans in the area and then will limit the percentage of Medicare, Medicaid, and self pay patients they accept into their practice. They will accept more than one commercial insurance plan. Doctors aren’t really “affiliated” with insurance companies. We just choose which ones we want to deal with and try to get payments from.

There are also practices called Federally Qualified Health Centers (FQHCs) which basically have a deal with the government to take a high percentage of Medicaid / Medicare patients in exchange for slightly higher reimbursements from ‘caid and ‘care. That’s an over simplification, but it’s the gist of it.

Hospitals (public hospitals anyway) will take whatever payment source you have. 

Wayfaring: Do you take any other medicines besides the two you brought with you tonight?

Translator: **Russian Russ Rushy Russian**

Patient: **All the Russian**

Translator: Yes, he takes one in the morning and one at night. 

Wayfaring: Yes, I know he takes this medicine in the morning and at night. I’m asking if he takes any other medicines that he did not bring with him today.

Translator: Oh I see. **Russes**

Patient: **Russes back**

Translator: Yes, he takes it two times a day. 

Wayfaring: Ugh, yes, I understand this. How else do I ask this? Am I missing something here? Ok, it says in his history that he has diabetes and high blood pressure. Does he take any medicines for these problems, because he didn’t bring any with him today. 

Translator: **Long, flowing Russing**

Patient: **Short, snappy Russing**

Translator: Yes, he has high blood pressure. Today it is 174/90.

Wayfaring: Ugh! Yes, I know this. I told you he had high blood pressure. The question is: Does he take medicine for this?

Translator: Yes, he has high blood pressure.

Wayfaring: You know what, I give up. We’re going to restart the meds on his home list. Please ask him to have a family member bring in any other meds he may or may not take. 


Allergies: Sweet potatoes.

Reaction: Jugular venous distention.

Attending (with a sly smile): Anyone care to tell us about a common side effect of clarithromycin?

Resident: The way you’re smiling I’m going to say it has something to do with penises. 

Attending: NO! Metallic taste!

Resident: O.M.G. I just said penis to my attending!



Mommy: **struggles to get all the baby crap together and leave the office**

Douchebag Baby Daddy: **plays game on his cell phone while he sits in the corner**

Mommy: You see me struggling here with her and you just gonna sit there and play a video game? Will you please take her so we can go?

Douchebag Baby Daddy: **sucks teeth** but it ain’t even my turn to deal with her!


I went to see the patient in the ED and he was laying with his mouth open and there was a fly buzzing around his mouth. I thought, “oh s***, he dead.”

Intern during morning rounds

Office Manager: We have a problem. The average third year resident here has 20-25 diabetic patients.

Wayfaring: I know I’ve got more than that. All I do is flipping diabetes check ups. Can a girl get a simple knee injection or stuffy nose once in a while?!

Office Manager: You have 37 diabetics. 37. We need to do something about this.

Wayfaring: It’s actually closer to 40. There are a few diet-controlled ones that don’t pop up when you search the computer system. Anyway, what have I been saying at diabetes management conference every quarter?! I have too many! Every time I get a new patient, I’m like

Office Manager: I know, I know. So we’re going to reassign 8-10 of your patients to the new interns to even things out a bit. 


Office Manager: And you get to decide which ones! 


Office Manager: And just between us, if you wanna slip in a non-diabetic or two onto the list that you wanna get rid of, I’ll look the other way. 


Patient: So are you just doing family medicine or are you going to do something special?


Well I think Family Medicine IS pretty special, so I’m sticking with it!

Rheumatologist (in patient’s room): Solid answer! 

Rheumatologist (out of patient’s room): Ugh, I can’t stand those comments. Little does she know that you family medicine residents know WAY more medicine than I ever will. All I have to know is one tiny corner of the world. How do you guys do it?

Specialist attending: Ugh, I’m exhausted from yesterday. I saw a total of 14 patients! That’s the busiest day I’ve had in weeks.

Wayfaring: Really? image

I thought the morning was pretty slow. I saw 9 patients in just 3 hours yesterday afternoon and it wasn’t bad. 

Specialist: WHAT?! How many patients do you guys see in a half day?

Wayfaring: I think the limit for 3rd years is 12 or 15 in a half day. 

Specialist: Whoa! How do you guys do it?! I only have to deal with one problem and you guys have to deal with multiple problems in each visit! How can you see 20-30 patients a day? 

Wayfaring: image

Um, and out in practice it’s more like 30-40.

Specialist: When do you do your notes?!

Wayfaring: In between patients and at home and after work. 

Specialist: You guys amaze me. That’s too much work. I can barely manage work and a baby and I only work 4 days a week.

Wayfaring: Well that’s why they pay us…the little bucks. 


Asker Anonymous Asks:
Are you or any of your colleagues considering concierge care? What's your opinion on that and is it going to die down due to the ACA?
wayfaringmd wayfaringmd Said:

I actually do have a friend who graduated a few years ago who is considering starting their own concierge practice. There is some confusion with the term “concierge practice”, because it makes it sound like those doctors are catering to rich people. Some of those practices do operate that way. But the one that my friend is starting is basically just a cash pay business for people of all walks of life.

They will offer a cash price for walk-in visits, and will also offer a monthly membership fee for individuals, families, and small businesses. My friend lives in a very poor area of the country, where most people do not have insurance. So this design of a practice would actually be helpful in a place like that. It would actually be cheaper for families to pay her membership fee then it would be for them to buy insurance. Of course this membership is only going to cover outpatient costs and not inpatient costs, so there’s a tradeoff there.

I really don’t think any of us really know what is going to happen with the ACA. We’ll just have to wait and see. 

Asker Anonymous Asks:
Can you be a doctor still if you developed depression and BPD in med school? I'm scared to get help in case I'm kicked out...
wayfaringmd wayfaringmd Said:


Your diagnosis is technically your business alone. But if your school notices that your work is being affected by your illness, they may ask you to take some time off to get better before you start back. 

Please get help. NOT getting help will do much more damage to your schoolwork and career than actually getting help.