http://www.studentdoctor.net/pandabearmd Navigating Medical School, Residency, and the Goat Rodeo that is American Medicine Mon, 12 Oct 2009 23:25:56 +0000 http://backend.userland.com/rss092 en Struggling for Rationality "This patient," I said to myself, "is going home."  I know.  She's 85 with the dreaded complaint of "Altered Mental Status" described by the family as a brief period of "staring."  No generalized seizure activity, you understand, and no syncope (fainting), slurring of speech, facial droop, drooling, weakness, confusion, ... http://www.studentdoctor.net/pandabearmd/2009/10/12/state-of-fear/ (More questions from real readers. -PB) What's the Emergency Department Really Like? The American College of Emergency Physicians and their bogus statistics notwithstanding, the majority of cases we see are not emergencies.   As I have mentioned before, most of the cases we see probably don't need to be seen at all by anybody in ... http://www.studentdoctor.net/pandabearmd/2009/09/05/yer-stinking-tax-dollars-at-work/ (Just a few random questions from real readers-PB) What is your job really like? As you know, I am an Emergency Physician working in a medium-sized community Emergency Department in a medium-sized hospital in a medium-sized city in a medium-sized state.   A "community" Emergency Department is not a major trauma center and ... http://www.studentdoctor.net/pandabearmd/2009/08/30/life-or-something-sorta-like-it/ Quick Learner So I had a drug seeker come in the other day with her usual back pain.  Lately I have been very stingy with narcotics and after refusing to give her a shot of anything stronger than Toradol I explained that I only give narcotics for patients with fractures or obvious acute injuries ... http://www.studentdoctor.net/pandabearmd/2009/08/15/pandamorama/ Michael Jackson is Dead and I Don't Care Michael Jackson is dead and, God forgive me, I don't care. I wasn't a fan and I didn't like his music. Sure, I listened to it; it would have been impossible not to but I never bought an album, stopped turning ... http://www.studentdoctor.net/pandabearmd/2009/07/13/poker-and-other-things/ Customer Disservice There are days when I explain to the family of a 98-year-old customer, in terror of the the inevitable end, that today is not that day and while the odds of their mother living another month are close to zero, she's alert, reasonably comfortable, and they have some time ... http://www.studentdoctor.net/pandabearmd/2009/06/14/bread-and-circuses-water-and-sewage/ Marching Up Country (With Apologies to Xenophon) The campaign draws to a close and will end like many such expeditions do; in a victory of sorts for I have certainly marched into and through the Empire of Medicine with my fellow mercenaries, outwitting the enemy on many occasions, laying waste to his ... http://www.studentdoctor.net/pandabearmd/2009/06/02/anabasis/ Perspective While driving through the downtown of our small but not insignificant Midwestern city (there are corn fields five miles from the city center but we do have the state capital and a handful of miniature skyscrapers) I noticed a fat brown squirrel scampering down a tree and bounding across the street in ... http://www.studentdoctor.net/pandabearmd/2009/05/22/edumucation-and-other-things/ "I got the Swine" I'm hoarse from explaining influenza to my patients, the numbers of whom showed a small but significant increase over the last two weeks as Swine Flu hysteria grew, peaked, and then receded.  Everybody wanted a pill for "The Swine" for which, unfortunately, there is none except an ... http://www.studentdoctor.net/pandabearmd/2009/05/09/panda-emic/ Actual Patient Conversation: "Man, that Dilaudid didn't even touch my pain." "Uh, Okay.  Your CT was negative so you're fine to go home.  I'll ask your nurse to come discharge you.  Come back if you get light headed or start to vomit but otherwise, just take Motrin for your headache and you ... http://www.studentdoctor.net/pandabearmd/2009/04/23/cant-touch-this/