Society has an obsession with age, and using the term "old" is controversial. Despite the almost universal fear of the aging process, there is no universal definition.
My own personal definition of "old" is: always 10 years from where you are now. A decade always seems like such a long time, and the great thing about this definition is that the cut point is moving with you. I can only assume my grandmother had a similar policy, as even at the age of 88 she absolutely refused to consider moving to a nursing home or assisted-living facility because "that's for OLD people."
This made me start thinking about how different medical specialties see "old."Most literature I've seen uses 65 as the definition for elderly.
Here are my impressions for what each specialty thinks of as old:
Medicine: When the patient develops an obsession with describing their bowel movements
Cardiology: 65 - when your age is enough to bump up your risk even without other medical conditions
GI: 50 - colonoscopy time!
OB/GYN: 35. the point at which you're automatically high risk in pregnancy due to age.
Anesthesia: 65, your age puts you at greater risk with sedation
Surgery: When you include the word elderly in your note
Pediatrics: 19. Time to find a new doctor.
Geriatrics: Is geriatrics consulted? If yes, patient is old.
Radiology: When any finding can be attributed to "age-related"
Thursday, August 8, 2013
Monday, July 22, 2013
GAAAAA!
As the intern, there are so many things I know that I don't know. Some things, however, just don't feel right. I'm used to double- or even triple-checking my work just to make sure nothing's slipped through the cracks, but sometimes things slip through. Sometimes, however, it's not me who's missing something.
After seeing a patient for a relatively simple consult. I called the primary team to give our recommendations. "okay", was the reply, "what about transfer to medicine?"
"Excuse me?," I said, "you didn't mention that when you called for the consult."
"Maybe I didn't communicate that clearly, but there's also a question about transfer to medicine" the surgical resident replied.
"Okay, but the patient has no active medical conditions," I said
"We're not going to do surgery, so we can't keep her and she can't stay in the observation unit past 24 hours"
"I know that, but she doesn't meet admission criteria for medicine"
"She has MULTIPLE medical problems!!!!!"
"That's true, but none of them are active. medicine can't accept the transfer."
At this point, sensing I wasn't getting anywhere, I told the resident I would talk to my senior and get back to them.
My senior resident agreed with my assessment but suggested I run it by the attending just to prevent too much pushback from the surgical team.
I went by the patient's room to check on his condition and to make sure I hadn't missed anything. I ran into the surgical resident and went another round as he insisted the patient needed admission to medicine and I explained that we couldn't do that, the patient did not meet criteria for admission, and that I had included recommendations for home medications and care in my note.
The resident clearly wasn't happy, but I did what I could and gave my senior resident the heads up. It was a good thing too, as she then got an extraordinarily angry call from the surgery chief resident about it.
This was one of two cases that day where surgery requested an inappropriate transfer that we turned down. My senior resident and my attending had my back, and it was a really good feeling when they told me I was correct and had done the right thing. I know I'll miss things and make plenty of mistakes, but it's nice to know I can do things right sometimes too.
After seeing a patient for a relatively simple consult. I called the primary team to give our recommendations. "okay", was the reply, "what about transfer to medicine?"
"Excuse me?," I said, "you didn't mention that when you called for the consult."
"Maybe I didn't communicate that clearly, but there's also a question about transfer to medicine" the surgical resident replied.
"Okay, but the patient has no active medical conditions," I said
"We're not going to do surgery, so we can't keep her and she can't stay in the observation unit past 24 hours"
"I know that, but she doesn't meet admission criteria for medicine"
"She has MULTIPLE medical problems!!!!!"
"That's true, but none of them are active. medicine can't accept the transfer."
At this point, sensing I wasn't getting anywhere, I told the resident I would talk to my senior and get back to them.
My senior resident agreed with my assessment but suggested I run it by the attending just to prevent too much pushback from the surgical team.
I went by the patient's room to check on his condition and to make sure I hadn't missed anything. I ran into the surgical resident and went another round as he insisted the patient needed admission to medicine and I explained that we couldn't do that, the patient did not meet criteria for admission, and that I had included recommendations for home medications and care in my note.
The resident clearly wasn't happy, but I did what I could and gave my senior resident the heads up. It was a good thing too, as she then got an extraordinarily angry call from the surgery chief resident about it.
This was one of two cases that day where surgery requested an inappropriate transfer that we turned down. My senior resident and my attending had my back, and it was a really good feeling when they told me I was correct and had done the right thing. I know I'll miss things and make plenty of mistakes, but it's nice to know I can do things right sometimes too.
Tuesday, July 16, 2013
Medicine Consult is an excuse for surgeons to not use their brains!
I'm currently on the medicine consult service. We manage medical issues in surgical patients, but I've found it to be primarily used by surgeons as a way of getting out of dealing with ANY non-surgical issues.
The frustrating thing is, most of our consults are from Orthopedics and Neurosurgery - these are very competitive fields, so I find it hard to believe people who got 280 on their USMLE Steps1 and 2 all of a sudden are completely clueless when it comes to medicine. Perhaps picking up a bonesaw kills brain cells?
Here are actual consults I've gotten
1) Diabetes management - in a patient that had well-controlled glucose at home. They didn't even consider putting him back on his home dose of insulin
2) Syncope, in a patient that had not, in fact, fainted. Don't know why it didn't occur to them to actually ask the patient this very important question before calling.
3) STD check. At least the neurosurgery resident was apologetic, saying "sorry for the consult but I wasn't sure what to order", but they couldn't be bothered to look it up on uptodate themselves?
We've gotten dozens of consults for simple problems with basic management, where it just seemed they just had no interest in dealing with the problem. If there's one thing I've gotten from this rotation, it's a loss of respect for the surgery profession in general.
The frustrating thing is, most of our consults are from Orthopedics and Neurosurgery - these are very competitive fields, so I find it hard to believe people who got 280 on their USMLE Steps1 and 2 all of a sudden are completely clueless when it comes to medicine. Perhaps picking up a bonesaw kills brain cells?
Here are actual consults I've gotten
1) Diabetes management - in a patient that had well-controlled glucose at home. They didn't even consider putting him back on his home dose of insulin
2) Syncope, in a patient that had not, in fact, fainted. Don't know why it didn't occur to them to actually ask the patient this very important question before calling.
3) STD check. At least the neurosurgery resident was apologetic, saying "sorry for the consult but I wasn't sure what to order", but they couldn't be bothered to look it up on uptodate themselves?
We've gotten dozens of consults for simple problems with basic management, where it just seemed they just had no interest in dealing with the problem. If there's one thing I've gotten from this rotation, it's a loss of respect for the surgery profession in general.
Saturday, July 6, 2013
Just the Beginning
Memorable moments of my first week of residency:
1) Repressing the urge to do a double take when addressed as doctor
2) Having to counsel a patient against cocaine use
3) Getting paged for the first time, only to have to repeat orders that were already perfectly clear in my note.
It's a surreal experience, to put on the long white coat, be called doctor, to be able to put in notes and orders. I'm not sure I'll ever get used to that. It still feels like I'm getting away with something.
1) Repressing the urge to do a double take when addressed as doctor
2) Having to counsel a patient against cocaine use
3) Getting paged for the first time, only to have to repeat orders that were already perfectly clear in my note.
It's a surreal experience, to put on the long white coat, be called doctor, to be able to put in notes and orders. I'm not sure I'll ever get used to that. It still feels like I'm getting away with something.
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