Archive for March, 2009

I’ve started a Residency Horror Stories series. The point is not to get you nervous about your training or being on-call or anything like that… In fact, it’s quite the opposite.

Most people think they learn best through experience. That’s true, for the most part… but there’s another piece of “experience” that is even more important than the experience itself… and that’s “the story”. We remember things as stories. We further ingrain the memory by retelling that story. And each time we retell it, there’s an opportunity to extract new insights from it and an opportunity for the listener to benefit from your story.

Now some of the medical establishment (the Old Boys Network) may be a little upset with me for saying this, but… the dry, factual version we often present on rounds is not always optimal.

Which one are you going to remember?:

THIS?:

49 year-old obese female with a history of type 2 diabetes and smoking who presented to the ER with severe chest pain, hypotension, and diaphoresis. Her EKG demonstrated 3mm ST segment elevation inferiorly. Cardiology was consulted and she was emergently taken to the cath lab. After a brief Vtach arrest requiring 260 Joules for return to sinus rhythm, her right coronary artery was successfully stented with two Taxus stents with good angiographic results. She was transferred to the CCU in stable condition with an intra-aortic balloon pump, IV heparin, Plavix, and aspirin.

THIS?:

It was my first week as a second-year resident and I was on-call in the CCU. I was called stat to the ER for a CCU admission that was described as a “49 year-old obese female with a history of type 2 diabetes and smoking who presented to the ER with severe chest pain, shortness of breath, and diaphoresis.” I was told that cardiology was consulted via phone & they recommended transfer to CCU after a VQ scan.

I went to see the patient & there’s a morbily obese lady lying in Trendelenberg, IV fluids wide open, heart rate in the 40s, and huge “tomb stone” STs on the monitor. I introduced myself and told her that we would take good care of her. She looked up at me and said, “Son, I’m gonna die tonight if you don’t do somethin’.”

I went to the ER doc and said, “This lady’s clearly having a huge RCA MI! She’s bradycardic, hypotensive, complaining of chest pain, & her EKG… well, look at it! We can’t send her to the unit with a VQ scan.”

He responded, “Well, I talked to the cardiologist on-call.” And I asked, “Well, are sure he understood what we’re looking at here? I mean, no offense, but sometimes it’s all in how we say it. I think you should call him back.”

Well, he did… the ER doc called back the cardiologist on-call and got screamed at… loud enough for me to hear it through the phone from about 4 feet away. “I said!… Admit to CCU and get a VQ scan!”.

He hung up. There I am, a new second year, one of my first nights with any kind of real responsibility and I’m disagreeing with the ER attending and the subspecialist. What should I do?

Well, there was no question… that lady said to me, “Son, I’m gonna die tonight if you don’t do somethin’.” So I did… I firmly asked the ER doc, “I’m not comfortable with this! Are you comfortable with this?!” He said, “No… No, I’m not.” So, I asked, “Well, how about TPA?” He paused… so I snatched the EKG out of his hands and ran 3 floors up to the telemetry floor. There was a cardiologist (from a competing group) and I shoved the EKG in front of him and said, “49 year old lady in Room 8 in the ER, tons of risk factors, heart rate in the 40′s, telling me she’s going to die… no labs back yet.”

He said nothing to me. He picked up the phone and called the cath lab. Together he and I wheeled her into the lab. While we were lifting her to the table, she arrested….

So which one are you going to remember? Which one will give you strength to do the right thing when the time comes. Both of those versions are true. I lived through it. More importantly, so did the patient, but not before her night got much, much worse. I’ll tell you the full story and the lessons learned in the second video for “Residency Horror Stories”… the first video will be in the next few days.

Do you have a story we can all benefit from? Tell us. Here’s the link again:

OK. This might seem a little out of place. To some of you, it might even seem like one big load of crap. But it’s neither.

The early parts of your training (medical school, internship and residency especially) can feel very forced and directed at times. Go here. Do this. Get that. Well, you can actually take back control of your experience with this one touchy-feely brainstorm exercise.

This is an exercise that a friend of mine who is into psychology and marketing sent to me. And after trying it myself, I initially thought, wow… let me share this with my blog readers and members. Then a little naysayer voice in my head conjured up thoughts of what everyone’s reactions would be. So, I sort of left it for a while. It’s touchy-feely, in a way. It deals with your wants and your fears.

Well, things have come up lately that required me to look back at the results of my previous exercise/brainstorm. And, wow… it’s right on target… providing clarity. So, I decided to share it with you after all. This is the type of thing that would be immensely beneficial if done early in training. But it has to be done sincerely and honestly.

If you know what you want, you can work on the right things. If you’re at all like me, when you’re in the thick of things, sometimes you get caught up in the task at hand and forget the “why”. At some point you stop and say, “Wait a minute. This just isn’t worth my time, my energy, my attention, and certainly not worth me worrying over it.” So you re-evaluate. Not necessarily in some formal sort of way, like this exercise, but you re-think it. Stopping and re-thinking is great… But what if you could “pre-think it”? That would be infinitely better.

Anyway, enough rambling. You’ll either thank me for this or just think I’m a tad weird.

It’s a little long (67 minute video), but if you do the steps, it’s well worth the time spent watching the video and doing the exercise. It takes a minute to load… Here it is:

You’ve been labeled. Even if you’re still a medical student, an intern or a resident… you are “one of them”, “one of those doctors who sleep on bags of money”. At least that’s what a lot of people think, anyway.

When you bring up your debt or how long your training is, it doesn’t matter. It’s irrelevant that everyone else enters the workforce 8-10 years before you. You’re still one of them. It says so right here, in such-and-such a magazine that your average salary is XYZ.

So guess what? You’re gonna pay more. Period.

Well, that’s how the Doctor Tax gets you. Now it’s time to change all of that. Check out this video. You’ll learn why you’re charged more and how to stop that from happening. I’m not saying you should be stingy… I’m just giving you the tools to have a little more control over your money. And the first step is to know the who, the why, and the how of the Doctor Tax.

First, my apologies…

I need to apologize for the brief blog post hiatus. My daughter’s basketball team is in local championship game, I’ve been ultra-busy opening a new unit at the hospital, and I’m planning a trip to San Diego… plus my wife is pretty far along (pregnant) with number 5. But, in the midst of all of that, I’ve been working on several awesome things for the site…

• The next video for Fiscal Therapy Rounds is about something I call, “The Doctor Tax”. Basically it covers why prices are inflated for doctors and how to resist it. I’ll try to post it in the next day or so.
• I recently finished an awesome interview with a co-author of the book Write Your Way to a Residency Match and I’m preparing a surprise for members before releasing the interview. It’s chock full of great information, so you won’t want to miss this. It applies to residency and fellowship applications. Awesome stuff. (RookieDoc Members: don’t buy this book yet. Trust me. The surprise I’m going to offer you with this book is worth the wait. I just need to get approval first.)
• Next week, I am conducting more interviews for you. The interview I am most excited about is actually with a VP from a malpractice company that is run by doctors. It’s one thing to learn how to do stuff right the first time… but when you hear how some people go wrong… you’ll never forget it.
• I’ve received a massive influx of questions in the Ask RookieDoc question section. Be patient with me as I try to get to them. I’ve already emailed a couple of you directly. But the other questions are going to be answered in one of two ways – (a) in the next FAQ call (more info coming soon), or (b) in upcoming videos. (see the next bullet)
• Residency Horror Stories. Although she may not know it, a RookieDoc member (Trish) answered a survey question about the Pager Module that sparked a whole new line of RookieDoc videos. They’re not just horror stories… they are real-life stories from med school, internship, and residency, that have important lessons for your training. Be on the lookout for these. They’re going to be priceless. Thanks Trish

Got any other ideas, questions or needs? Let me know. Post a comment below, or just ask.