Patient: I got Sometimers disease.
Wayfaring: What’s that now?
Patient: Cuz I forget stuff sometimes so I’ve got Sometimers, not Allthetimers.
Patient: I lay around all day… and then I can’t sleep at night.
Wayfaring: Well maybe we need to work on some sleep hygiene techniques to get your sleep cycle back on track.
Patient: But I used to be on Nuvigil to give me energy during the day…
Wayfaring: I really think if you are able to get a good night’s sleep, you wouldn’t be so tired during the day.
Patient: I think some Ambien would be great to help me sleep.
Wayfaring: I see. So you would like Ambien to help you sleep and Nuvigil to wake you up?
Wayfaring: Too bad.
Doc: Do you take blood pressure medicine?
Patient: Only when my sister is in town visiting.
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.
New intern. Lord help us all.
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!
Toddler: ****SCREAMS BLOODY MURDER****
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!
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.
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?
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.