One Story, Two Endings. Clearly I'm not a doctor yet.

The doctor looked at the patient's chief complaint on the chart. "Palpitations, SOBOE." He looked up at the nurse and made a joke out of it. "SOBOE - Shortness of breath on exertion... even I get that. Who doesn't get short of breath when they exercise?" The nurse laughed.

The doc grabbed the patient's ECG, which the nurses had already done and clipped to the patient's chart. One quick glance told him that it was a textbook example of normal sinus rhythm with the odd premature ventricular beat (PVC) - when the ventricles contract before they receive a signal from the sinoatrial node - something that happens in normal, healthy adults and is absolutely nothing to worry about.

"Hi, I'm Dr. Vitum Medicinus," said the doctor, scrawling his initials on the ECG sheet to show he'd read it, while walking into the patient's room. Dr. Medicinus took a quick history, and the patient described the thump in his chest that was consistent with a PVC. "We'll take a few blood tests and see how they turn out," said Dr. Medicinus, as he scrawled "MI Protocol" in the orders section of the chart. He was just covering his ass. He knew that the patient didn't really have a heart attack.

Sure enough, the blood tests for a heart attack were normal. "Nothing to worry about - PVCs are entirely normal if they're as infrequent as yours. You'll be just fine," said Dr. Medicinus as he walked back into the room. "If it gets worse, come on back in, but you're good to go now."

-----

The medical student looked at the patient's chief complaint on the chart. "Palpitations, SOBOE." He looked up at the doctor he was shadowing and made a joke out of it. "SOBOE - Shortness of breath on exertion... even I get that. Who doesn't get short of breath when they exercise?" The doctor laughed.

The doctor picked up the patient's ECG, which the nurses had already done and clipped to the patient's chart. One quick glance told the doctor that it was a textbook example of normal sinus rhythm with the odd PVC. Even the med student picked up on this.

"Hi, I'm Dr. Alex O'Brien," said the doctor, walking into the patient's room, "and this is Mr. Vitum Medicinus, a medical student working with me today; is it okay if he watches?" The patient nodded. Dr. O'Brien took a quick history, and the patient described the thump in his chest that was consistent with a PVC. "We'll take a few blood tests and see how they turn out," said Dr. O'Brien, as he scrawled "MI Protocol" in the orders section of the chart. Vitum thought to himself, "There's no way this patient is having a heart attack."

Vitum was right. Sure enough, the blood tests were normal. However, the doctor's years of experience told him to be cautious, and keep his mind open to other possible diagnoses. "I'm going to order one other test," he said.

Dr. O'Brien told Vitum that because the patient had just had his appendix out a few weeks ago, and was complaining of shortness of breath, he should check the patient's D-dimers - a blood test to measure if the body is breaking down a blood clot - as the patient was at risk for a pulmonary embolus - a clot in his lungs.

Vitum kicked himself. He remembered quickly dismissing the patient's complaint of shortness of breath. Actually, worse than that - Vitum had made a joke out of it.

Sure enough, the D-dimers came back slightly elevated - not too high, but enough that the doctor wanted to get a CT to make sure. An hour later the CT came back positive for a pulmonary embolus - a blood clot in the patient's lung.

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In our pulmonary pathology lecture a few months ago, the lecturer described a pulmonary embolus as one of the worst ways to die. "I've seen somebody die from it once," the lecturer said. "The guy just gasping for air like a guppy, breathing as hard and fast as he could. The air was getting in alright, but the blood wasn't, and he suffocated to death with lungs full of air."

If I was the doctor, I would've sent that patient home. Maybe killed him. Just as described above.

Apparently it's a good thing that I'm not actually responsible for any patients yet. I'm glad thing medical school is four years, not one... I've still got a heck of a lot to learn.

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What doctors REALLY think... and preliminary thoughts on interdisciplinary health

"Research is a real problem. Doctors just make up the data. They don’t report negative side effects, no question about it."

Someone at New York magazine had a brilliant idea a few weeks ago.

"If I ask a bunch of doctors a bunch of questions," they pondered, "but promise them anonymity, just think all the great dirt I'll be able to print! They'll be so straightforward and honest, I'll be one of the few people on earth to know what doctors really think."

Someone at New York magazine seems to have forgotten about the medical blogosphere.

Every day, countless doctors rant anonymously about the dirt that goes on in hospitals. They just happen to do so in the form of blogging.

But someone at New York Magazine ended up doing the interview, writing the article, and hey, it got published. How Comrade found this article in the New York magazine online four full days ahead of print, I'll never know, but thank him, since you'll probably find it quite interesting.

Selected highights, my smartass comments in italics:

• Why you have to wait so long in a doctor's waiting room.
  It's because you are not the doctor's only patient.

• Doctors make up research data.
  Did you know that 86% of statistics you hear are made up on the spot?

• The way we train doctors now is worse than it used to be, because the residents who do surgery on patients are now allowed to do surgeries after they have had time to sleep.
  Yeah, you'll have trouble convincing me of that one. Say it with me: "Old-Boy's-Club."

• Patients have to wait for 45 minutes after they press the call button, not because nurses are standing around chatting, but because there's a nursing shortage.
  Hmm, so it's not just in Canada, eh?

• Doctors think that "By virtue of our training and knowledge, we can get away with... treating patients like shit."
  Strange, it took me only one year's worth of med school finals to get that feeling. At this point, I call it self-respect. Three more years of this and you'll probably call it me being an asshole.

• A doctor admitted to dropping a baby once.
  You think that's a big deal? Read the next one.

• Doctors feel powerful when they've killed somebody.
  I told you you need to read this article. Here's the link again.

After reading that article, I'm surprised that even at my early stage in the game, a lot of it I could have told you. A good chunk of it is, in fact, common sense. Think about it. Doctors like seeing patients that don't yell at them. Surprise. You have to wait in the waiting room for a long time because, well, doctors are seeing other patients. Surprise again.

But there's one thing that I'm surprised they didn't mention. It's...wait a minute, what? you want my opinion?

Sorry, but apparently in training for making a living by, well, mostly giving my professional opinion, it's been made abundantly clear that I am not to provide medical opinions of any sort. Not even to a friend who asks about their cold. Or growth. Or whatever.

Of course, I'll give you my opinion anyways. That's what this blog is all about. But here, I'm protected by my fancy disclaimer at the bottom of this page. Yeah, it probably provides little more protection than did those fancy flying-squirrel-like jumpsuits that early would-be aviators donned before jumping to their deaths, but at least it's something.

So here's what I think. I'm surprised the article didn't ask any of the doctors their take on the "interdisciplinary health team" that everybody is talking about.

I was talking about this interdisciplinary health thing with a nurse friend of mine the other day. I was going with that old joke that I find so funny (that no nurses see any humour in at all), telling her, "I can't wait until I've graduated med school so I can boss around nurses." (That is NOT how I will approach nurses on the wards...trust me, I know better.) But after we got back on speaking terms, we got into this talk about interdisciplinary health care - a concept that is very interesting, considering how little of it I've heard in my med school curriculum.

Medicine these days is supposed to involve all "health professionals" on an "equal playing field" - doctors, nurse practicioners, nurses, licenced professional nurses slash registered practical nurses (depending on your geographical location), respiratory therapists, physiotherapists, occupational therapists, chiropractors, naturopaths, quack cure-all syrup salesmen... (uh, in no, particular order...I swear...), all working together in perfect harmony like oompa-loompas churning out everlasting gobstoppers. If that's the case, though, and if it's the new wave, how come I haven't been taught that yet in medical school?

But that's another story for another day - I have a rant on that waiting in the wings...to be continued.

Click here to read the continuation of this post.

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