clinic · fellowship

Zero to Ten

Overheard in clinic:

MA: Do you have any pain?

Patient: Oh pain! Do I got pain? So much pain!

clinic · PGY-4 · residency

A one-act play

Staff message from clinic nurse: Mr. Scrooge called, he has some questions about his follow-up appointment. Can you give him a call?

** ring ring **

Timid Female Voice: Hello?

Me: Hi, this is the Scrivener calling from University Hospital. I’m returning a call from Mr. Scrooge?

** hang-up sound, then silence. Our new VoIP phones don’t have a dial tone, just soul-eating silence. Dial again….

** ring ring **

Hearty Man Voice: Hello?

Me: Mr. Scrooge? This is the Scrivener, returning your call.

Hearty Man: Oh yeah! It’s about my wife. She’s not your patient, but she has a follow up with The Ghost of Christmas Past next week, and she wanted to cancel it.

Me: Uh… You’ll have to call the Ghosts’ clinic and tell the receptionist. I can’t do that myself, they are a different department.

Mr. Scrooge: Oh, ok. Can you tell me their phone number?

Me: Well, according to Google, it’s 867-5309. Sure, I’ll hold while you find a pen. 8.67. 53. 09. No, nine, nine as in … as in cat o nine tails

** Co-resident gives me the side eye **

Me: Cat. Not at, there is no at sign on a phone. Nine. Oh, hold on, let me just transfer you.

** attempt to transfer the call on the new VoIP phone, accidentally drop the call **

Me: Mr. Scrooge? Are you still there? No? Well humbug to you too.


Merry Christmas, all!

books · clinic · PGY-4

Notes today, and some Twitter-style book reviews

“[Patient] arrived 53 minutes late for a 60 minute appointment, so evaluation was somewhat limited.”


Book #13: The Martian, by Andy Weir: [1 star]

Left for dead on Mars. But rebuilt the oxygen converter. YAY!

[I was a chemistry major. I enjoyed chemistry quite a bit. But let’s face it, narrative descriptions of the Wagner-Meerwein rearrangement does not make for compelling reading. For an action-adventure-scifi novel, this was a snoozefest.]

Book #14: Boy Snow Bird, by Helen Oyeyemi [3 stars]

Snow White Re-Told: The mirror reveals hidden secrets.

[More “inspired by” than “modern retelling,” to be honest. A meditation on race and identity and mimesis. The switch in narrators part way through, then switch back to the original voice, was jarring. The plot twist at the end felt gratuitous. But overall, an enjoyable read from a compelling writer. I’m interested in her other modern fables, too, like Mr. Fox, and the Icarus Girl.]

Book #15: Hundred Foot Journey, by Richard Morais [2 stars]

Edward Said rolls over in his grave.

Oh god. This book. It got super hyped cause of the movie (which I still haven’t seen) but it was extremely simplistic and more like a fairy tale than a book. And a Kiplingesque fairy tale at that. India is heavily Othered, throughout the book. The protagonist was dull and diffident — the real characters are Papa and Mme Mallory, and the second half of the book without them slogs. Avoid.

books · clinic · PGY-3

More on patient satisfaction

The patient satisfaction forms I mentioned in the last post? Are making it to the residency program now, courtesy of JCAHO (I think).

We were each given a packet of forms, printed on hideously green paper with black type (who made these, the Wicked Witch of the West?) to hand out to our patients.

JCAHO’s coming! Quick, gel your hands!

The statements themselves are in size 10 italic font (great for our elderly patients! so readable!) and range from “My doctor introduces himself or herself” to “My doctor is sincere, trustworthy, and doesn’t keep information from me.” Patients have to rate the resident on a scale of 1-5.

No mention of other things like “My doctor seems competent.” or “My doctor can answer my questions or direct me to more information.” Medical knowledge, it seems, is somewhat irrelevant in this brave new world.

In non medical news, I’m currently reading Wolf Hall, by Hilary Mantel. It won a bazillion prizes when it came out, and it’s being made into a movie in the spring. It’s a tad introspective, but I do like it. Also slogging through The Martian, by Andy Weir, my book club’s official selection, which … it’s like a survival guide to being on Mars. There’s lots of info on how to generate oxygen from hydrazine. There’s lots of “Yay! It worked!” or “Boooo! The generator failed!” which makes Our Hero (TM) sound more like a pre-teen girl than a 30-something mechanical engineer.

clinic · PGY-3

Can’t get no

The clinics here do patient satisfaction forms, and periodically we get aggregate feedback emailed out. For the most part, this is a good thing — helps us understand issues with workflow, ease of scheduling appointments, all those things that as a doc we don’t have direct access to, but surely affects patients’ perceptions of our clinic and our overall competence.

Then sometimes we get gems like this:

HONESTLY some of the questions I answered I had to guess. I did not know how to answer them. I did not have the all the knowledge needed to answer them.

I don’t … I can’t even …. In what world do you blame the clinic for your own stupidity? And if you don’t understand the question because of jargon or something, just SAY SO.

On a bigger scale these stats (% positive reviews) are almost certainly being including in some sort of pen-pusher quality metric. It’s part of larger moves in Health Policy. In the private world, I hear physicians’ pay is being directly linked to patient satisfaction ratings, which seems like a great way to produce a community of candy-men and sycophants. In academia, departments with more satisfaction probably get more perks, or something. They keep promising us that we’ll move out of the basement one day, but with reviews like this …..

clinic · ethics · MS-4 · narrative medicine · neuro

I spoke too soon. Last night’s class was the best yet; the debate was really intense, and even the really quiet ones had a lot to say. See, that’s the power of a really great story — it attacks you and forces you, sometimes against your will — to pay attention. Moments like that really make me love teaching.

Today, workwise, I was down on the Eastside practice with my preceptor, and then seeing patients on my own in the residents’ clinic.  It ran the gamut. The Eastside is private, very classy with paintings on the walls, patients who have done their homework, pleasant staff. The residents’ clinic is in the old, old part of the hospital, with cinderbrick walls and tiiiiny little exam rooms — I think the one I was in used to be a closet. Not even joking.

Of course, the quality of care is no different, because these are the same doctors, with the same brains. But I can’t help but wonder how much the ambiance affects the patient’s perception of the visit. It really disturbs me, the extent of the rich/poor dichotomy here. (Fun fact: our ED is in a different building from the hospital because the donors apparently did not want the uninsured rabble being too loud for the private patients. And don’t get me started on the Fancy Rich People’s Ward.)

I suppose that in the end, it doesn’t really matter, because the doctors are the same, the medicine is the same, even the computer system is the same. How much difference can a pretty painting make, when you’re sick? Both practices have access to Really Smart People, and both function very smoothly. But as a patient, I definitely know which one I would rather go to — even if that induces a fair amount of middle-class guilt.