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Kind of your job

Fri, 14 Nov 2008 16:22:22 -0500

I've been away from the blog for a while, working on fellowship applications and riding the wave of the ICU. Thank you for your patience, as ever.

As you might remember from my days as an intern, I used to love the ICU. That love is no longer: doing procedures to people whose fate is inevitable isn't as much fun as it used to be, and I feel powerless in the face of a culture that doesn't exactly embrace the avoidance of unnecessary intervention.

This most recent time in the ICU, I worked with an intern who seemed to me less eager than some to take on the burden of her responsibility. About three days into the rotation, she--let's call her Dawanna--remarked to me with some irritation that "all I ever do is put in orders."

"Yes," I replied. "That's kind of your job."

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Smart kids

Thu, 02 Oct 2008 08:30:15 -0500

It's October 1st (well it was yesterday, anyway), and I'm pretty excited, because this means it's the start of another DonorsChoose challenge. For those of you who weren't around at this time last year, DonorsChoose is an organization that pairs up your ka$hmoney with educational projects in public schools. You get to choose the project your money goes to fund from an enormous range of schools, subjects, and students. It's sort of like what tax dollars are supposed to do, only it actually works.

Last year, I set what I thought was an ambitious fundraising goal for Signout's readership, and you guys absolutely blew it out of the water. This year, there are more of you--and with you all being so fabulously wealthy (and devastatingly attractive), I figure we can aim even higher. Watch the graphic to your left to see how we're doing.

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About them

Wed, 24 Sep 2008 07:51:29 -0500

Courtesy of the excellent bioephemera's Jess Palmer comes this item of news, which concerns photographs of patients taken at the University of New Mexico Hospital and posted to a website. The photographs were reportedly close-ups of injuries being treated--no faces or patient-identifying features were shown. The employees who took and posted the photos have been fired, and several others have been disciplined as a result of these events.

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Unpack the madness

Fri, 12 Sep 2008 10:00:40 -0500

From the Department of the Maximally Self-Righteous comes this delightful little piece of scholarship, a letter to the Journal of the American Medical Association (JAMA) that describes a survey of internal medicine interns on the subject of professionalism. In it, participants were asked to rate their participation in and perception of "unprofessional behaviors" related to residency. The survey* was created based on the input of third-year medical students, residents, and faculty, and was administered in the first three months of the subjects' intern years.

Among behaviors rated as most unprofessional by the participating interns were: discussing patient information in public spaces (yeah, that's a no-brainer); falsification of patient records (illegal, and bad medicine); reporting patient information as normal when uncertain of true results (dumb); not alerting the patient that the individual [made] an error (not always helpful, especially if it didn't result in harm, but certainly ethically reasonable); making fun of patients to colleagues (poor form, indee--wait, what?).

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Please to enjoy

Thu, 11 Sep 2008 10:59:38 -0500

While I slowly scrape together some original Signout blather on one of my favorite subjects, please to enjoy this terrific post by Dr. Rob about why much of the crap patients go through is not the fault of their providers. When you're done, read PalMD's interesting piece that follows up his first answer to "Would you do it all over again?" (See also the comments section in Orac's pointer.) Then, as a snack, go here for some outstanding fashion photography. After which you may enjoy this week's Change of Shift.

Also, my heart goes out to those memorializing loved ones lost on this day in 2001.

I promise, content is coming. Ayyy, it is so hard to write in complete sentences when I am working the night shift!

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Go read

Tue, 09 Sep 2008 10:45:20 -0500

There was a very nice piece in the New York Times yesterday about an oncology nurse's first code. Go read!

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Flurry

Tue, 02 Sep 2008 09:50:44 -0500

Anyone wishing to consume some tasty medical writing around the theme of "education" should have a peek at this week's Grand Rounds at A Chronic Dose. Laurie has kindly included not one, but two of Signout's snowflakes in her recent flurry of activity.

Speaking of which, this daily-plus blogging thing is exhausting. I need a vacation.

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Reasonable for us to judge

Mon, 01 Sep 2008 17:16:38 -0500

You heard it here first: John McCain got Sarah Palin's daughter pregnant.

You think I'm kidding?

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What makes it OK

Mon, 01 Sep 2008 08:42:00 -0500

Every now and then, I get email from pre-med types who are having a lot of trouble deciding whether to go to medical school.

Dear Dr. Signout*,
I was supposed to start medical school last week, but [I've deferred for a year to figure things out.]

I guess the thing is, I like living so much, and medicine seems both incredibly in line and at odds with that--you give up everything you've ever been passionate about to live, to the extreme, one particular passion.

I know that what-ifs are horrible exercises of futility, and that denial and self-rationalization are crucial elements of happiness, but I was wondering anyway: would you do it over again knowing what you know now?

*This email has been edited to preserve the writer's anonymity and enforce the use of Standard English.

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The luxury of time

Tue, 26 Aug 2008 09:15:54 -0500

One night last week, with not a whole lot going on, I strolled into the MICU to say hello to my friend Tom, who was working overnight.

"Wanna go for coffee?" I asked.

"Can't," he said, leaning against the nurse's station. "Probably gonna code the lady in room five sometime in the next half hour."

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Whipping up hype

Fri, 22 Aug 2008 08:37:00 -0500

It's been an exciting week here at Signout. Now that I am back from my unannounced sabblogtical (yeah, I made that up), I've tended to some much-needed housekeeping. To wit, the blogroll has been pruned of defunct and outdated links. Now you may futz around all up in the sidebar without fear. Futz, I say!

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To my face

Tue, 19 Aug 2008 09:34:30 -0500

Last week, I got invited into my program director's office for a little chat. My previous week's attending had emailed him about a complaint made by a family with regard to the way I'd handled an event on the general pediatrics wards.

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Throw some change

Sat, 16 Aug 2008 13:03:27 -0500

Yesterday, when I was on overnight call, something truly astounding happened: the hospital ran out of coffee. By which I mean, there was no coffee available all day, nor all night.

To quote one of my favorite ScienceBloggers, what the fucking fuck?! Seriously, what kind of hospital runs out of coffee? Doesn't that violate some kind of accreditation requirement?*

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Stand up straight

Wed, 13 Aug 2008 08:22:26 -0500

You know how, when you squint at a colorful tree, the borders disappear, and all the leaves merge together into one big mass of green? Turn that inside out, and you have my relationship with The Hospital. At times--especially difficult times--all the departments and interests and people in that place start to merge. Their demands and rules start to become one entity's demands and rules, and their borders disappear. I have to squint hard to separate the strands that come together to form the rope around my neck.

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Hallelujah!

Tue, 03 Jun 2008 22:15:14 -0500

Praise be, and hallelujah!

That is all.

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