Thursday, November 06, 2003

So I'm loving internal medicine. Well, okay, I at least love the hours of the clerkship in medicine. I feel like I'm actually being taught and learning useful information. And with the exception of one of the interns, I like my team. While I was trying to do an H&P on one of my new patients, he kept interrupting me to ask me what labs to order and so I told him the labs I personally wanted and knew what was needed to rule out a heart attack. It wouldn't have bothered me if he used a pimping tone but it was a tone of genuine uncertainty! What the hell! I'm supposed to learn these things from him not the other way around!!! I could have ordered a rectal probe and he would have written it down! I may try that next time he's the admitting intern (the other intern was night float) just for shits and giggles. Then he asks me what meds she needs again with that uncertain tone in his voice so I told him what was common for people that may have had an MI and with her history of diabetes, she needed an ace inhibitor so I just rattled off the classes of drugs she would need and then he goes one by one asking me what beta blocker to use and then what dose. Now, I'm trying to finish writing up my H&P and because he kept interrupting me, I had to squeeze in something into the HPI that I forgot due to his questions. I could have written the damn order sheet up myself instead of having to dictate to him what drugs are usually used. He asked me what was the formulary ace inhibitor (again with the uncertain tone) and so I said I didn't know but captopril would be fine because it's cheap but then he kept harping on formulary and so I said, "captopril is cheap, HMOs and the govt are cheap, just go with captopril." Later, after he had rewritten the orders, he asks to look over it to make sure there were no mistakes! Wha?!? So I looked at it and he didn't write dosages on 2 of the medications! Wha?!? He has book knowledge but he doesn't seem to try to think about what he's doing. Oh and then I asked him if he went to Tulane med school (hoping that he didn't come here) and he says no like I'm insulting him by trying to associate him with the med school! I think he'll eventually get used to internal medicine (he's med/psych and started the year on psych rotations and Jess tells me he wasn't that great in that realm either but that he was nice).
Oh and I don't know what it is about the charity ER nurses but they seem to direct their bitterness and hostility towards me on a routine basis even though I'm perfectly pleasant and polite towards them! The first nurse refused to tell me which patient was mine (i forgot the name but knew other details that only pertained to 1 patient in the OB/GYN cube of the MER) and then after I had paged my resident and got the name, I walk back into the cube and he tells me immediately before I even tell him the name, he tells me which patient is mine. Meanwhile I wasted 15 minutes finding this info out. Sure I could have written the name down but that's besides the point. And then tuesday night, I was looking through my patient's ER chart for vitals and when I asked the next bitter *itchy nurse I interacted with where they were recorded, she grabs the chart from me and says bitterly and sharply "this is nursing documentation. you can't see this!" So I tell her I'm writing my H&P and need to see her vitals and she snaps at me that it's on the monitor." SO I humor her and go check the monitor knowing full well all the info isn't on it but I write down what I can and come back and tell her I need to see the temp and she makes up some random temp (it was NEVER recorded on her chart that she ever had the temp she gave me). Then I tell her I still need to see the chart so I can see the trends since she's been sitting in the ER since we need to know trends for blood pressure and pulse and O2 sat and she again snaps at me that "this is nursing documentation and you can't have it." And then the idiot files it under the other folders as if I didn't see her do it?!? And then slams her hand on the folder and proceeds to stand there while I'm standing there writing my stuff up (this was before the intern arrived to annoy me). Eventually she has to do other stuff and I have access to the info (and I realized that she made up the temp - which I figured as much). So freaking annoying and at the very end I became a little short with her but I was nice until she treated me like crap. This is why nurses get treated like crap by some doctors, because their coworkers treated us like crap when we're med students and we get fed up with bitter nurses who exert their power trip over the only people they feel they can. Before this, I had no issues with nurses - some didn't do things as quickly as I would have wished but they didn't treat me like crap for no unprovoked reason and so I didn't treat them like crap. And why the hell do they document crap if we can't see it?!? If I were really motivated, I could write up an incident report against her for witholding patient information but it wouldn't really matter anyway - damn unions! I hope she gets that rod out of her butt soon. Other than that, things have been fine and dandy on medicine so far.
~me~ at 4:14 PM