No thanks
Welcome to the first in a series of posts entitled "Specialties I Don't Want To Do."
Well, lets get right to it, I don't care for family practice. I have no aspirations of managing meds and talking to every patient about their depression and what we can do to change it. There is nothing wrong with that. We need primary care docs. I'm just not the candidate for that.
Next. I recently decided that I will have no part in becoming a critical care doc. For those of you unfamiliar with that position, let me explain a bit. A Critical Care physician is one who deals with and manages the patients in the Intensive Care Unit (any intensive care, PICU, NICU, SICU, MICU, CCU... you get the idea). Granted, there is a huge difference between what an internal medicine hospitalist does and a CC doc's duties. But, there is too much of a similarity. Put this into context you ask? Okay.
I was in our clinic (it's an orthopedic clinic) when my resident got a page about a patient in the CCU (Critical Care Unit). The nurse said something about him having a tib/fib and yada yada yada come take a look. (I'm assuming that was the jist of the conversation, since I didn't talk to the nurse right then. Anyways... we take a look at the patient's x-rays of his lower leg and see that he has a nice tib/fib fracture and he is in a long leg cast. No problem. So, my resident tells me to go up and see what the deal is.
Still with me? OK. So, I get up to CCU and find this patient. Find his nurse, who tells me she is concerned about his wrist and not his leg. (Good thing I looked at his wrist films... not so much). So I go into the room, which is about the size of your average airport Starbucks. (It's a big room by hospital standards.) This guy is the only patient in the room. He has tubes emerging from everywhere underneath his gown. Picture a tube in any hole you have. That is this guy. He's got a feeding tube, a foley, IVs, drains, you get the idea. He is not intubated though, so that's a step up for him. Anyways, to further complicate matters, this guy is about in a coma. He's one step out of a coma. So, he can't answer questions, can't point to where it hurts, can't walk, talk, feed himself, none of the above. So, I start evaluating his wrist and not his leg and find that it looks a bit swollen and that's about it. There are no other findings that indicate a fracture or really anything else wrong with this guy.
I mean, nothing wrong other than the fact that he was hit by a car and now he's pretty much a vegetable. A nice piece of celery in a bed with machines keeping him alive. He's breathing only because his brain stem's respiratory center has taken over. And people really want to do this for a living? I just value talking to the patient too much. Also, he wasn't a candidate for surgery, so that nixed that idea. He'll probably end up in a nursing home somewhere with no family visiting him while he's hooked up to machines for the rest of his life. The kicker is that he's only 70. He could live another 20 years like this theoretically. In reality, there is a huge 6 month mortality for people who become non-ambulatory (they stop walking around). Sad? Damn right. And something I don't want to deal with every day of my life at work.
Those are two of the several specialties which hold no appeal to me. More to come, but first a public service announcement.
Life is precious; treat your body as a sanctuary. For those of you wanting to harm your bodies with drugs, let me paint a little picture for you of what you can look forward to. You can be 46 years old, with no job, no house, and no future. You will be in the hospital for back pain. When people look at your CT they will see that all those IV drugs you did allowed bacteria in your blood stream. Now those bacteria have taken up residence in you spine. They have found a nice home in the vertebral body of your lumbar vertebrae. The unfortunate thing is that they have eaten the bone away and left a small shell of what used to be a weight bearing structure for your entire upper extremity. One day you got up to walk to the corner to buy steal something so you could buy more meth or heroin or whatever and your upper body's weight compressed and crushed your vertebrae. Now you are in excruciating pain and your back is broken. Hooray. But it gets better. During your stay at the hospital you can't drink for a couple days, so you go into withdrawal from the drugs as well as the alcohol. So now you are in fulminant delerium tremens as well as narcotic withdrawal. HOORAY!!!! Your short little jaunt to the corner turned into a 4 day hospital stay, which cost the taxpayers 1000 a night for just the room plus nursing and doctor expenses, and a lifetime of back pain because you have no viable spine now. Looks like you should have stuck to prostitution to feed your 3 kids and stayed away from being a crack whore.
More to follow on what not to do with your life.
Topics include: not jumping off the roof, not slicing your hand with a butcher knife, and my personal favorite not running from the police on your motorcycle.
Well, lets get right to it, I don't care for family practice. I have no aspirations of managing meds and talking to every patient about their depression and what we can do to change it. There is nothing wrong with that. We need primary care docs. I'm just not the candidate for that.
Next. I recently decided that I will have no part in becoming a critical care doc. For those of you unfamiliar with that position, let me explain a bit. A Critical Care physician is one who deals with and manages the patients in the Intensive Care Unit (any intensive care, PICU, NICU, SICU, MICU, CCU... you get the idea). Granted, there is a huge difference between what an internal medicine hospitalist does and a CC doc's duties. But, there is too much of a similarity. Put this into context you ask? Okay.
I was in our clinic (it's an orthopedic clinic) when my resident got a page about a patient in the CCU (Critical Care Unit). The nurse said something about him having a tib/fib and yada yada yada come take a look. (I'm assuming that was the jist of the conversation, since I didn't talk to the nurse right then. Anyways... we take a look at the patient's x-rays of his lower leg and see that he has a nice tib/fib fracture and he is in a long leg cast. No problem. So, my resident tells me to go up and see what the deal is.
Still with me? OK. So, I get up to CCU and find this patient. Find his nurse, who tells me she is concerned about his wrist and not his leg. (Good thing I looked at his wrist films... not so much). So I go into the room, which is about the size of your average airport Starbucks. (It's a big room by hospital standards.) This guy is the only patient in the room. He has tubes emerging from everywhere underneath his gown. Picture a tube in any hole you have. That is this guy. He's got a feeding tube, a foley, IVs, drains, you get the idea. He is not intubated though, so that's a step up for him. Anyways, to further complicate matters, this guy is about in a coma. He's one step out of a coma. So, he can't answer questions, can't point to where it hurts, can't walk, talk, feed himself, none of the above. So, I start evaluating his wrist and not his leg and find that it looks a bit swollen and that's about it. There are no other findings that indicate a fracture or really anything else wrong with this guy.
I mean, nothing wrong other than the fact that he was hit by a car and now he's pretty much a vegetable. A nice piece of celery in a bed with machines keeping him alive. He's breathing only because his brain stem's respiratory center has taken over. And people really want to do this for a living? I just value talking to the patient too much. Also, he wasn't a candidate for surgery, so that nixed that idea. He'll probably end up in a nursing home somewhere with no family visiting him while he's hooked up to machines for the rest of his life. The kicker is that he's only 70. He could live another 20 years like this theoretically. In reality, there is a huge 6 month mortality for people who become non-ambulatory (they stop walking around). Sad? Damn right. And something I don't want to deal with every day of my life at work.
Those are two of the several specialties which hold no appeal to me. More to come, but first a public service announcement.
Life is precious; treat your body as a sanctuary. For those of you wanting to harm your bodies with drugs, let me paint a little picture for you of what you can look forward to. You can be 46 years old, with no job, no house, and no future. You will be in the hospital for back pain. When people look at your CT they will see that all those IV drugs you did allowed bacteria in your blood stream. Now those bacteria have taken up residence in you spine. They have found a nice home in the vertebral body of your lumbar vertebrae. The unfortunate thing is that they have eaten the bone away and left a small shell of what used to be a weight bearing structure for your entire upper extremity. One day you got up to walk to the corner to buy steal something so you could buy more meth or heroin or whatever and your upper body's weight compressed and crushed your vertebrae. Now you are in excruciating pain and your back is broken. Hooray. But it gets better. During your stay at the hospital you can't drink for a couple days, so you go into withdrawal from the drugs as well as the alcohol. So now you are in fulminant delerium tremens as well as narcotic withdrawal. HOORAY!!!! Your short little jaunt to the corner turned into a 4 day hospital stay, which cost the taxpayers 1000 a night for just the room plus nursing and doctor expenses, and a lifetime of back pain because you have no viable spine now. Looks like you should have stuck to prostitution to feed your 3 kids and stayed away from being a crack whore.
More to follow on what not to do with your life.
Topics include: not jumping off the roof, not slicing your hand with a butcher knife, and my personal favorite not running from the police on your motorcycle.
posted by runrMD08 at 5:18 AM
1 Comments:
Dr.,
thanks for the advice. have you considered dropping this Medical crap and just becoming a life coach??
in regards to your career coaching, do crack whores get benefits? what's the pension like?
keep up the hard work.
-DLMWS
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