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Dr. Cranquis' Mumbled Gripes

I'm an American physician who works in an Urgent Care clinic. I see lots of stupid or funny things that people do with-and-to their health. I cope by mumbling under my breath (and then posting about it on this pseudonymous blog). Thought you might be interested.

(Disclaimer: Questions related to medical topics will be answered to the best of Dr. Cranquis' (and Google's) knowledge, but the internet-delivered wisdom on this blog CAN NOT AND SHOULD NOT SUBSTITUTE for your Real-Life Doctor's personal attention + examination, and your own common sense too! If you think you're having a medical emergency, hang up and go email 911. The author of this blog takes no responsibility for any medical, relationship, scholastic, financial, or other decisions you may make based on information found in this blog.)

And since people seem to be a bit confused about this: any "real-sounding" patients names are just horrible puns, and not HIPAA violations.

Blogs I Follow
Posts tagged "medicine"

thuc:

I’ve moved my site, Cool Health Infographics, back onto the tumblr community.  New template and no more advertisements.

Follow it for a daily dose of infographics pertaining to health.  Posts are queued to start tomorrow.

Cheers!

It’s back! Yippee!

brighid45:

My housemate wrote a great entry about reading and understanding prescriptions in our FMS newsletter this month. I’m copying it here for those of us who deal with meds on a daily basis. 

This is not to blame doctors and pharmacies—mistakes happen, that’s unavoidable. It’s just a good idea to double-check everything before you leave the office, and again at the pharmacy. If you have ANY doubts about your prescription, don’t be afraid to speak out. I would rather annoy the hell out of a doctor or pharmacist by asking questions, than go home with the wrong meds or an incorrect dosage, or a prescription that hasn’t been written properly. In my experience those mistakes are rare but they do turn up now and then.

For chronic disease patients with multiple prescriptions, knowing these basics is a necessity IMO. The more scrips you have to fill, the greater the possibility for error. If you’re not capable of remembering details, ask someone to handle this for you if possible or use an app or other software to help you keep track of things. Having an advocate, whether human or electronic, is a huge help and a great stress reliever. 

Learn How to Read & Understand Your Prescription

So you can check it for errors BEFORE you leave the doctor’s office…

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What follows is an incredibly detailed and useful primer on how to interpret all the “secret codes” used in writing medical prescriptions! Very handy for any patient, especially those with multiple conditions and multiple meds!

One comment: regarding the abbreviation “g or gm”, while yes that could mean “grain” (which is hardly used), it is more often used to mean “gram”.

2nd comment: Thankfully, the forced adoption of EHR/EMR systems and e-prescribing has helped eliminate many of the errors related to obscure abbreviations and stereotypically-rotten doctor handwriting.

mynotes4usmle:

Every med student on Tumblr needs to read this blog post.  It’s spot on, golden advice for your future work relationships ( ;

I remember my Internal Medicine rotation as the best I had! Not only bc is my favorite, but bc the team work was amazing.

We, interns and nurses were one, we helped each other, and our pts were alway our n°1 priority. Nurses are always gonna have your back, -I know so, cause i’ve been raised by one- and if you don’t listen to them my friend, you are screwed!

Everytime I’m gonna check a pt, my beautiful mom always reminds me certain things. For example, if my pt is with diarrhea, she always says “don’t forget to check if his/her pulse is consistent with his/her T°” (to rule out typhoid fever, since is very common here in Peru).

This post is amazing guys! (=  And every single word written here is TRUE. Nurses rock!!!

Dr. Grumpy (no relation) speaks true. Much boundary-appropriate love to all the nurses out there!

thenotquitedoctor:

Hi! First of all, I really enjoy reading your blog! Second, I’m a senior in undergrad who has been accepted to med school (YAY!!!), but is looking at the next year of my life with a healthy combination of fear and excitement. Not sure if you have done a post like this already, but could you offer some wisdom on surviving and thriving as an M1?

First off, congrats on getting into medical school.  That is an amazing accomplishment.  My first bit of advice is to really reflect on that and let it sink in.  You got in!

Now I have a disclaimer.  I am still in my first year of med school (three weeks from being done) so I may not be an authority.  But I feel like I have enough experience to offer some advice.  So take this for what ever you think it is worth.  Here are some tips (in no particular order) for the coming year:

Read More

TheNotQuiteDoctor asked me to “chime in” on this excellent reply. I agree with all of his tips! Here’s my own list of Med School Survival Tips (broken down by year). Good luck to all of you upcoming MS1 students! :)

md-admissions:

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Hi Anon!

The answer is complex.

To me, you can never give enough or be good enough for medicine. It wants all of you. There is a strong “Keeping Up with the Jones’” attitude that pervades many medical attitudes and minds. You can let that drive you crazy or find a way to be okay with…

WOW. This reply is a burst of lyrical encouragement!

I have learned to see medicine as not a symbol of perfected self, but as a calling.

YES!!

numberneededtotreat:

YouTube | The History of EHRs

Excellent, short description of one reason why electronic medical records are terrible—the original development has not been driven by creating a clinical tool for doctors, but more of an administrative tool for others in healthcare (i.e.—administrators and payers)

Agree, agree, agree. My particular thoughts on this video:

  1. “Meaningful Use” — HAHAHA! What a waste of time. Do you know that my EHR now REQUIRES me to enter a blood pressure on any patient AS YOUNG AS 2 YEARS OLD before I can actually “see” the patient? Even though no study shows that measuring BP in all kids under 12 provides any useful data to improve their health? “But it’s required, for meaningful use” whine the EHR people. FACE-SLAPS ALL AROUND.
  2. Yay Epocrates!
  3. Have you ever tried to read an old visit note in an EHR? Think about how much scrolling and scrolling and scrolling you did before you finally found the one tiny sentence or phrase which actually gave you any clinically-useful information. The rest of that crap? Coding and Billing fluff.
  4. @ 2:05, I love the woman who is just standing there staring at the white board in the background. That would be me if I was ever trapped in one of these types of meetings. Maybe doodling a tiny Cranquis curb-stomping a tiny laptop, Office Space style.
  5. Dr. Dombrowski’s idea of “getting all the governmental agencies… on the same page” about EHR is nice and all — but unless doctors/nurses/PEOPLE WHO ACTUALLY SEE PATIENTS are in charge of those much-needed revisions, things will never ever improve with EHR.


cranquis
:

I’ve said it before, and I will say it again, Urgent Care patients:

If you’re complaining about a “horrible unbearable miserable worst-ever can’t-stand-it” cold symptom (cough, sore throat, ear ache, runny nose, stuffy nose, body aches, fever)…

…and when I ask you, “What have you tried doing about it,” you reply with:

  • “Nothing”*
  • “I came here”
  • “I knew nothing would help, so I didn’t bother”

I will feel very little pity for you.

*(Note: The reply, “I didn’t know what I could do” is slightly better, but honestly, don’t you have an internet connection? Or a grandmother?)

So this happened again today, for the bajillionth time. Today’s variant answer was “How should *I* know what to try? YOU’RE the doctor.”

(via bajamandy)

jayparkinsonmd:

…[Skyscape] wanted to make an awesome app that people would love and use.

And I knew I could nail this one. So I said yes and we set off to design the next game-changing tool for doctors. It’s called Omnio.

As a doctor, I know what it’s like to integrate technology into a busy day seeing patients. I also know that doctors do the same thing over and over. They need access to familiar, helpful references on a regular basis and they don’t want to hunt for it every time. They also prescribe the same 20 drugs over and over because that’s what they know and trust. We doctors are creatures of habit. Inspired by my old-fashioned doctor bag that had 95% of everything you’d ever need as a physician right there in the bag, I came up with this concept, “a digital doctor’s bag that provides quick access to the most important things to your everyday practice.”

 


Skyscape has thousands of medical textbooks, medical calculators, drug indexes, and any other sort of digital reference you’d need as a physician. The problem is hunting through all that when you need quick access. So a user can favorite anything in the entire Skyscape library and “put it in their bag.” However, “in their bag” means adding a shortcut to the thing on the main screen of the Omnio app.

But I am my own unique doctor. I’ve got a different “bag” than my colleagues. But I know I have awesome stuff in there that my colleagues don’t have. And I’m super curious to know what they have in theirs that makes them an awesome doctor. So we made our bags “shareable.” You can steal from my bag and I can steal from yours. The point is, let’s help each other find the best tools and share them with our colleagues. And I’m also interested in seeing what the American Academy of Pediatrics or JAMA has in their bag. So you can find and follow people and trusted institutions to see what awesome things are going in and out of their “bags.” There’s plenty of other useful features, but the centerpiece is your digital doctor bag.

Omnio launched a few months ago and it’s got a 4 and half star rating

If I used Skyscape, I would definitely use this. But like many people, I was turned off by the atrocious Skyscape app design in the past few years. Hopefully, this new piggy-back app, fueled by Jay Parkinson’s ever-creative simply-simplifying ideas, will help turn all that around!

Always a little awkward: Performing a digital rectal exam.

Awkward multiplier: When the flustered patient says “Thank You” at the end.

Awkward cubed: When you reflexively reply with “No, Thank YOU.”

iMedicalApps is an independent online medical publication written by a team of physicians and medical students who provide commentary and reviews of mobile medical technology and applications. We receive over 400,000 views a month by the medical community. Reviews and commentary are based on our own experiences in the hospital and clinic setting and creative and content control are strictly managed by the medical professionals running the site.

Just stumbled across this website while checking out some “Headache Diary” apps for a patient with chronic migraines. VERY USEFUL RESOURCE for med students and beyond.

baffledinbrooklyn:

Stolen from Facebook. How to photobomb a chest x-ray.

I can just see the radiologist’s report now: “Possible cranium-shaped opacity in left chest of uncertain significance; clinical correlation recommended.”

baffledinbrooklyn:

Stolen from Facebook. How to photobomb a chest x-ray.

I can just see the radiologist’s report now: “Possible cranium-shaped opacity in left chest of uncertain significance; clinical correlation recommended.”

Norcoon. (nohr-koon). noun; slang.
1. A patient who keeps coming back to your clinic/ER/Urgent Care in the hopes of getting a refill on pain medication, even though you told him/her that there would be no more refills at the time of the initial prescription.
2. An apparently-calm patient with an apparently-innocent request for a pain med refill, who becomes suddenly vicious/rude/agressive when you say “No.”
Example: ‘If you keep feeding the norcoons, they’ll keep showing up on your back porch looking for more.’
Origin: Dr. Cranquis, after a long day of staving off rabid norcoons.
Synonyms: Vicopossum, Squirreltram.
Note: Probably not suitable for actual use in the patient’s medical record.
What do I want in a doctor? Perhaps more than anything else—a friend with special knowledge. If you had never dived and I were with you, it would be my purpose to instruct you in the depths and dangers, of the pleasant and the malign. I guess I mean the same thing somewhat. We are so made that rascally, unsubtle flares may cause a meaningless panic whereas a secret treason may be nibbling away, unannounced or even pleasant as in the rapture of the deep.

Part of an excellent letter written by John Steinbeck, in reply to the question “Any other data you think may be of importance?” on his new doctor’s medical-history form.

Read the rest of this letter at Letters of Note: What do I want in a doctor?

If a tooth is completely knocked out of the mouth:

  • This is a true “dental emergency” — see a dentist or an ER ASAP.
  • If the tooth is found, DO rinse it with saline or tap water — but DO NOT TOUCH THE ROOTS OR SCRUB THE TOOTH — before putting it back into the dental socket.
  • If you’re worried the patient would swallow the re-implanted tooth, DO put the tooth in saline or MILK for transport — Do NOT put the tooth in sports beverages or contact lens solution.
  • If the tooth has not been found, assume it has been inhaled or swallowed — get an xray to check the lungs and stomach.

(A post mainly written to help me remember what I’m learning from the article “Dental Emergencies” in Emergency Medicine journal, Sept 2010)

compoundfractur:

My phone scared the shit out of me. It was a little after 2 AM and it was my last night on call during my ob-gyn rotation. I always kept the volume on high because one of my peers once missed a page and, well, that ended badly for him. “Josh, I need you to meet me in Room 412423513452345324!” I…

Great story!

Twist ending! (not really, if you’ve ever been a med student, but funny ending nonetheless…)

The part which really irked me was this:

The nurses looked back and forth at each other baffled. “We don’t do blood draws in L&D, so none of us are comfortable with doing that.”

So who ends up doing it? The med student who hasn’t drawn blood in however-long (successfully, on a critical patient — up top for the high five!). In my (admittedly non-nurse opinion), nurses are going to be in phlebotomy-necessary situations way more often than doctors will, and should strive to be able to do those basic skills if called upon in an emergency. Not hatin’ on the L&D nurses (it’s a tough job which I do not envy at all!), just my opinion on this situation.