I titled my entry today based on the great song in the musical "Oklahoma!" It has to do with the conflict that existed on the open range between farmers building fences to keep their cattle in and the cowmen who pushed their cattle across the open spaces. Both are raising cattle, just in their own way. So too surgeons and medicine doctors, or internists, treat patients, but in their own way.
Which brings me to one of my favorite episodes of "Scrubs" where the main character and his best friend (a medicine intern and a surgical intern) play out the dichotomy between medicine and surgery ala "West Side Story."
Anyway, the reason I bring this up is because part of what is driving me crazy in the MICU is the way the medical interns approach patients. I know in part my prior training is affecting my perception, but seriously, I am suicidal most day on rounds. I just want to know: what is wrong, what are we going to be doing about it, and how soon will they be able to transfer out of the ICU? I don't think about their clinic visits, what their medications were six months ago and 3 hospitalizations earlier, or if they eat beets on Thursdays.
Facts, that's all I want to know. Now, medical people will say the most important part of the exam is the history. In fact, I had a professor in medical school that said that 80% of the time you could make the diagnosis based on history alone. I guess I have to work on my patience... and, dealing with some of the medicine residents, I am going to need a lot of it.
an alcoholic, diabetic admitted for leg ulcers who we admitted to the MICU for management of their alcohol withdrawal. They were intubated because we had to sedate them before they went into DT's.
a patient with knee pain who has been taking a LOT of Alleve over the last 2 weeks. So much that they gave themselves an ulcer. In fact, several since I saw the endoscopy while the GI doc did it. Ortho will be coming to see the offending knee tomorrow.
a patient who smoked for a long time, now has emphysema and came in with shortness of breath. They were having a CT scan to look for a pneumonia or possible mass when I was leaving. I wonder if they'll be off of the bipap mask tomorrow.
That's about it. I really don't have a lot going on. It seems like I pick up patients and send them out. I actually picked up a patient that was admitted overnight and discharged them to home this morning. Maybe things will pick up next weekend when I am on-call. Until then, I will be enjoying the attending we have now who also was a surgical resident before changing to anesthesia.... at least I have someone, along with the neurosurgery intern that I can roll my eyes with during rounds... the long, slow painful part of my day.