Thursday, November 27, 2008

On-call Liveblogging: Thanksgiving edition

And here it is, Thanksgiving evening heading into night. Managed to send holiday wishes to only a few friends & family -- apologies for not being better in touch with everyone.

Kind of a crazy day today. A lot of labs and offices were closed or slow, which put some pressure on the clinical side. Not sure how tonight will go, but there'll be some cleanup to do tomorrow.

The hospital gave us meal tickets for turkey in the cafeteria, so I managed to get a Thanksgiving dinner with only the pie interrupted by a page. Rumor has it that there's some pumpkin pie in the resident room, so I'm strongly motivated to head over and, um, write a clinical note. Or something....

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Saturday, November 22, 2008

Where no Ben-Bob has gone before

The other day while in Radiology with a patient getting a CT scan I was having some trouble with the phone system. The helpful radiology techs were trying to explain it to me, but it still wasn't happening. Noticing the Spock and McCoy desktop wallpaper on a nearby monitor I said "Dammit Jim, I'm a doctor, not an engineer," which cracked them up -- because it was true!

Sure, it took over a decade and cost more than a house, but at least the MD is good for some yuks....

Wednesday, November 19, 2008

Who is the president?

During the course of cognitive decline patients will tend to maintain their interpersonal functioning until the very end; it's famously said of dementia that the social graces are the last to go. In fact, it's surprising how often a patient will be able to converse fluently and pleasantly, but when asked directly is entirely unable to say what the month or even the year is.

Of course, to provide appropriate treatment it's important to accurately assess the extent of cognitive deficits. A question traditionally asked by psychiatrists and neurologists as a quick bedside test of the patient's awareness of current events is "who is the president?" If you can't answer that, it's a pretty good sign that you're not well engaged, for one reason or another.

However, this question has become more and more difficult to use over the past few years. Asking it would often provoke strong but non-medical opinions. This was particularly true during rotations at Veteran Administration hospitals; vets would frequently become quite agitated at the topic. I remember that early in my training, say in 2004, this was a routine question during neuro and psych histories, whereas now I hear it used infrequently and rarely ask it myself.

However, from time to time doctors fall into the old habit. The question slips out, and there's a moment when the rounding team holds its collective breath: are we going to have to take several minutes out of a rushed rounding schedule to head off a patient's (or clinician's) political polemic? But that seems to have changed this month. Evidently the election made quite an impression on a wide range of people. Several times I've seen patients who were minimally conversant, but when the recent election is mentioned will become more alert and are able to recall names and details.

Maybe I'll start asking my patients a question that seems to be both diagnostic and therapeutic: "who is the president-elect?"


Saturday, November 15, 2008

The return of On-call Liveblogging

I'm on call this weekend (a so-called "black weekend") and have the resident room all to myself at the moment, so I thought I'd revive an old category of blog posts.

These days it's Neurology: strokes, dizziness, seizures, and extra-big reflex hammers to elicit extra-big reflexes. (If you think I'm exaggerating and you ever have the chance to check out a neurologist in the hospital, eyeball the hammer -- they're big, heavy weights swung around on long handles. Much more effective than the little rubber triangles we're used to seeing.)

Hmmm, I can hear a commotion in the hall, so I'd better sign off for now. More later, perhaps....


Tuesday, November 11, 2008

Anal wink redux

On the neurology consult service at the moment, and today I performed a physical examination maneuver to assess a finding that's been discussed on this humble blog before. Yes, it's the return of anal wink!

Saturday, November 1, 2008

The thirteenth hour

I'm on again overnight in the ED for Peds tonight after a colorful but relatively non-disastrous Halloween last night. (One of the nurses was wearing an enormous bouffant wig with a flower in it, and it actually looked pretty good on him.) However, earlier Lady M reminded me that we go off Daylight Savings Time tonight, which means that the 12-hour shift turns into a 13-hour one. Usually the time change means an extra hour of sleep, but whaddya gonna do?