After discussing the phenomenon of hot oil explosions after combining frozen turkeys with boiling grease…
Resident: This lady has been seizure free for 2 years. Can I go ahead and stop her Keppra or do I need to taper it?
Attending: Better taper it. You can’t quit that cold turkey. She’ll explode in seizures.
"Hey, will you real quick sign this lab order for Mr. Not-Your-Patient? Dr. AlwaysLate isn’t here yet to sign it and the patient is already in the lab."
"Hey, before you go in that exam room, can you shoot a quick refill Rx to CVS for Ms. ElderlyPatient since Dr. GeriAtric is on night float?"
"Hey, Dr. NeverAnswersHisPhoneMessages has 3 call backs from this patient and he still hasn’t called them back. Do you mind calling them? It looks like a simple enough matter."
"Ugh, why don’t you tell the attending that he isn’t answering messages? But sure, I’ll get to it sometime today."
"Hey Wayfaring, this patient is here for her appointment with Dr. XY, but wants to see a female provider today. Can you squeeze her in?"
" *sigh* I reckon. Hopefully someone else will no-show."
"It’s the good ones that get dumped on," Jamie, the floater nurse, said as she forwarded me yet ANOTHER phone note on someone else’s patient. Doctor not in office today. Patient has called twice already, does not want to wait for PCP.
"Don’t start with me, Jamie! You think this is funny, but it’s not," I replied. "Seriously, is anyone else around here answering phone messages and calling in refills, or am I covering everyone’s patients now?"
"Oh Dr. Wayfaring, it’s just little things here and there. You’re one of the few who doesn’t give us a hard time when we ask you to cover other people’s stuff."
OB Clerkship director: Guys, don’t forget about your OSCEs tomorrow afternoon.
Me: When do I do mine?
OBCD: Tomorrow afternoon with everyone else.
Me: But I’m on call tonight. So I’m going home at noon tomorrow.
OBCD: And you can come back in at 3 for your OSCE with everyone else.
Me: What? Even if I’m up all night?
OBCD: Yup. Sucks to be you.
Nurse Yankee working up one of my well-child check patients: Any concerns about baby today?
Patient with infant: Hers got a sick muu muu.
Patient: You know, a sick…down there.
Nurse Yankee: ma’am, you’re an adult, your kid is too young to know what you’re saying, and I don’t have a damn clue what you’re talking about. What is wrong with her?
Patient: she’s scratching her privates.
Nurse Yankee: again, be specific here. Are we talking front? Back? Everywhere? Help me out here.
Patient: See I got this discharge…
Me: Mmmkay, what color is it?
Me: does it have an odor?
Patient: It smells like trash.
Shout out to all my homies who are working Thanksgiving. I will be night floating it up tonight.
I feel like if I throw out my thanks in advance, my night will be better, yes? So I’m thankful for:
Attending: Hey everyone, don’t forget to review your insurance plans this week because we’re up for renewal. There’s a lady stationed in the cafeteria to answer questions about your plans if you need help.
Me (thinking): Surely I can figure this out on my own. I’m a doctor, dangit.
Get home and open benefits package informational packet:
Reading about copays and coinsurance and gold and silver and bronze and platinum plans:
Looking at the “high option” dental plan:
Reviewing the “high option” vision plan:
Finding out that weight loss programs aren’t covered but bariatric surgery is:
WHAT?! Plastic surgery isn’t covered?
Seriously though, I just want the “she is blind and has bad teeth but never gets sick and never gets pelvic exams” plan. Is that too much to ask?
1. The urologists wear gloves for every part of the physical exam. I mean they wear gloves when listening to hearts and palpating abdomens, not just feeling prostates and testicles. This is very odd to me.
2. The urologists carry on regular conversations with patients while the patients are butt a** nekkid. And the patients are visibly uncomfortable. Like let them get dressed before you ask about their golf game, dude!
3. The urologists wipe their patients’ butts after violating them. Ain’t that nice.
Ok, #1: If you are outside of the US, you do not follow HIPAA. HIPAA is a US law. Other countries may have their own versions of patient privacy laws, and they probably differ from ours, so be sure and find out what your country’s standards are.
#2, if you are a medical person who is working or studying in a country that is not your own, you should adhere to that country’s guidelines for patient privacy. If that country’s guidelines are fairly loose, no one would blame you for following stricter rules. If the country you are in does not have patient privacy guidelines, the ethical thing to do would be to follow cultural norms there while also still protecting patient information. For example, when I travel, I do not share patient information (patient’s name, condition, labs, etc) with anyone other the patient unless the patient tells me I am free to do so. This is a bit hard when you work in hospitals that have large open wards, but it’s still possible.
And now a little summary of HIPAA: the whole point of it is to minimize the number of people who are given access to patient information and identifiers. Protecting patient privacy is a lot more than not sharing their name. It covers any information that could be used to identify a patient. For example, say my practice has a patient with an extremely rare congenital disorder. Now if I were to say what kind of disorder this patient had, or if I told you where my practice was, it would potentially be very easy to identify them, right? This is why in my own blog I often leave out specific details of patients’ stories, or I change their demographics in some way, or I change the time frame that the event occurred (yeah, most of the time when I say something happened “yesterday”… it didn’t) so as to blur the lines a bit and make them even less identifiable.
The easiest way to keep your patients’ identities secret is to keep your own identity secret. I say easy, but trust me, it’s hard to stay anon. I’m certainly no expert on this, and I flub it up all the time. Cranquis would definitely be the best model to follow for blog anonymity out there. That man (or is he?) is paranoid about being identified.
But total anonymity is not required to be HIPAA compliant online.
Here are some major guidelines to follow:
Folie a deux: French for “a madness shared by two”. Also known as shared psychotic disorder or shared delusions, this is a disorder in which one individual passes on a delusional belief to another person. Usually the initiator of the delusion has an underlying psychotic disorder, while the second person is usually not psychotic when left alone. If separated, the delusions generally resolve in the second person without medication. This condition is separate from folie simultanee, where two separately psychotic people adopt and play off of each other’s delusions.
Recently I was scheduled to see a patient in clinic who had a long history of delusions of parasitosis. As I reviewed the patient’s chart, I found that his PCP had already examined “samples” of these parasites, which were found to be sloughed skin under microscopic exam. Luckily for me the patient missed his appointment and had to be rescheduled. And luckily for you, reader, my desk was close enough to the front desk that I got to witness this unfold:
Mr. Ekbom to front desk: I have to see a doctor today. It’s an emergency. Worms are coming out of my skin again and they’re itching me like crazy! See? (shows scabs from picking his skin). My wife saw one come out of my mouth!
Front Desk: Well, you missed your appointment this morning so we will need to reschedule for after lunch.
Mr. Ekbom: No, I need to be seen now! The CDC says this is a parasite they’ve never seen before and there’s no possible treatment! I need to see my doctor!
Front Desk: Sir, according to your chart, this has been fully worked up already and no parasites have been found. Your doctor is not here today and the one you were scheduled to see is now full for the day.
Wife, Mrs. Ekbom: Look lady, I saw the worms coming out of his mouth! And I got ‘em right here in this baggy (holds up bag with a few scabs and skin pickings)! I seen ‘em crawl through his skin. They’re killing him!
Nurse CP and I walk into exam room where mom, dad, (both very young) and young daughter are all playing with various equipment in the room.
Mom is listening to dad’s heart (on the wrong side of his chest) with a stethoscope.
Dad is banging his knees with the reflex hammer.
Child is attempting to examine her own eyes with the ophthalmoscope.
CP: NO MA’AM! Lil girl, put that scope down!! Yo mama can NOT pay for that if you break it. Mama and daddy, you need to put down the toys too and help me hold her for this shot.
Mama and Daddy:
After crawling under my house on my day off…
Attending: I saw your adventures under your house video on Facestagritterblr… Pretty hilarious.
Me: Yeah except it was pretty terrifying.
Attending: It looked pretty clean down there though.
Me: It was cleanish, except it was super dusty so I was coughing and sneezing a lot down there. And pretty much the rest of the day.
Attending: probably from inhaling mouse poo.
Me: Exactly. So if I get some weird lung disease, please take care of me and know that I’m a DNR.
Attending: What diseases can you get from mouse poo?
Me: Are you pimping me? I could have hantavirus right now and you’re pimping me!