28 May 2012

Family medicine in the 'burbs

My family medicine rotation is in Baytown, which I'm not terribly enthused about. I show up in the morning, round on the hospital patients in the morning (3 or less), then go to the clinic. Outpatient medicine can be interesting or as boring as you make it out to be.

I've probably had more appreciation in the last week than I have in the last year.

The attending also introduces me as Dr. Dash, which I'm not sure how to take. It always starts off as "Here is my medical student [doing fine..], Dr. Dash [ohgodwhy.jpg], and he'll be asking you a few questions." I don't think I ever want to be called that actually. I'd rather use it in case I need to throw down the hammer.*

What you don't see out there (directly) is death and destruction and that's a nice change of pace. It's nice to not hear that some patient isn't coming to clinic because they threw a large pulmonary embolism and fell face first into a bathtub or developed DIC a week ago and bleed out from every orifice.

I read this piece a few days ago : http://www.nytimes.com/2012/05/27/opinion/sunday/when-doctors-grieve.html

It's true. More importantly, I remember when I was on ICU, where a good 30-40% of my patients died within days of admission, I developed this furrowed browed look whenever I was down about my patients. It could have been interpreted multiple ways.

Are you furrowed because:

1) you realize you could have done more or
2) you're here too late and you don't want to deal with this, or
3) you're actually distressed by this patient dying or
4) some other miscellaneous cause.

Other people on my team had more unambiguous reactions. On top of that, after the "viewing" of the body and before the body would be transported down to the morgue, the family would leave the room, some would shake my hand and say "Thank you, doctor"

First of all, doctor?
Second, thank you? For what, exactly.

Baytown is a nice break.

*: Recall the short coat hammer from a few posts ago. 

27 May 2012

Getting things done

I may have figured this out. There are two keys to making life simpler & better.

1. Automation - Automate everything. Bill pay? Automate. How often do you need to look at your bill and dispute charges? (Look at it anyway). Rent? automate. Dividend reinvestment? Automate. Morning routine? Automate. Become that robot so everything goes smoothly. Make a checklist and follow it religiously.

2. Tolerate (and be good) at things you don't want to do but have to do - This is crucial. I'd rather be reading about family medicine or gliomatosis cerebri or something, but I have to do these evaluations. Or clean my place. Or cook for tomorrow. Or think of a schedule for later today. No thanks. Maybe one day I can automate all of that too.

I just finished reading Better by Atul Gawande. It's a good book. Reflects that quote 10,000 hours to mastery? I believe that.

A few years ago, I was roaming around my dad's office, looking at posters, pilfering sodas and coffee creamer and I came across a poster, most of which's details I don't remember, but I remember there was a huge picture of an aircraft carrier and it was advertising "carrier class" reliability (with respect to server uptime).

I looked it up a few days ago, and here we are (wiki):

In telecommunication, a "carrier grade" or "carrier class" refers to a system, or a hardware or software component that is extremely reliable, well tested and proven in its capabilities. Carrier grade systems are tested and engineered to meet or exceed "five nines" high availability standards, and provide very fast fault recovery through redundancy (normally less than 50 milliseconds).

 99.999%. That's a goal worth shooting for.