Anatomy lessons

I don't know how anatomy is taught in other countries, but in America it isn't taught at all outside of health profession schools. The average citizen doesn't know what a gallbladder does, much less where it lives. And this lack of fundamental knowledge of our own bodies makes us completely paranoid whenever we don't feel well. "Help! My lip is tingling! I think I'm having a stroke!" "Oh my god, I have back pain! I think my kidneys are failing!" That is actually one of my favorites. Everyone with back pain thinks it is kidney related. They also think that their kidneys reside just above the waist (which they don't). Ask them what their kidneys do and get a blank stare.

In any case, I picked up a chart to see a new patient and the chief complaint was "fatigue". In a 25 year old male without any medical history. I hate fatigue in young people. Guess what? I'm tired, too. And some days all I do is yawn and without coffee, I'm a danger on the road. But do I think it's a serious medical condition? No. I went to interview the patient, who was sitting up on the gurney talking animatedly to his girlfriend. When he spotted me, he flopped against the stretcher and moaned, "I don't feel good." Please. I tried to ask him some questions about his symptoms, but he would only give me one word answers. At that point, the girlfriend chimed in, "I want him tested for everything." "Everything?" I asked. "That's a lot. Can we narrow it down?" She rattled off the usual diabetes, high blood pressure, appendicitis (??) and then threw the big one at me. "I want him tested for cervical cancer." "Cervical cancer? I can't test him for that." "Why not?" she asked, angrily. "Because he doesn't have a cervix," I replied, trying to be polite. "How do you know he doesn't have one? You ain't even examined him yet!" She had me there.

Twisted

I feel pretty lame. One week into this blog and I've already skipped three days! Of course, I've been at the hospital, which, indirectly, is working on the blog.

I guess that's twisted logic, but it's one of the skills I've picked up from my patients. Often, I try to convince them that their bad habits are economically unsound, since the threats of lung cancer or cirrhosis of the liver don't seem to be deterrents. "Two packs a day? That's an expensive habit! Think of the money you could save by quitting! Ten bucks a day is $70 a week." I even do the math FOR them. But they one-up me and proudly show their financial wizardry. "It's ok, I save money by going out of state. It's not expensive at all!"

Then there was the young woman (26 years old, as I recall) who came in complaining of abdominal pain. When I told her that her pregnancy test was positive, she just groaned and said, "Again?!?" When asked how many times she had been pregnant, she said "at least twenty". I guess you start to lose track. She went on to say that she had two children and had aborted the rest, except for the "couple" of ectopics she'd had. I should have known better than to ask if she used any kind of birth control, but I asked. "No one will give me a tubal. I asked my doctor and he just won't do it." I just looked at her. "Have you tried not having sex?" The blank stare I received was answer enough.

Everyone's an expert

The patient in room 6 was a middle-aged male, a heavy smoker, who was complaining of chest pain and shortness of breath. We tend to take chest pain pretty seriously in the emergency department, as there is a zero tolerance policy for missing MIs (myocardial infarctions or heart attacks). Still, about 3% of people with an MI will be sent home from the ED. His EKG was ok, but his story was convincing. I had him on oxygen at 2L/min, but his oxygen saturation was still low. I turned it up to 4L/min. He looked at the regulator and told me that he was receiving too much oxygen. I explained that 4L was not an unusual amount of oxygen and that he needed it. He guffawed (really) and laid his hand on my arm, "No offense, ma'am, but I deliver medical equipment and I think I know how much oxygen is too much." How could I argue with those credentials?

TV star

Another humiliating experience last week. A patient's sister referred to me as Doogie Howser every time I entered the room. I just laughed at first, then toned it down to a smile, and finally told her that I was 40 years old, not 15 (in fact, I am neither 40 nor 15). "Well, you look like a little girl! Are you really a doctor?" It took all my strength not to say that I was a doctor who was prone to intubating and chemically paralyzing people who tease me.

As a resident, many years ago, I was suturing up a large laceration on the arm of a patient who was in police custody. He had sustained the injury when he attempted to climb a barbed-wire fence to avoid arrest. (Note to self- only climb smooth fences when running from the cops.) The patient's other arm was handcuffed to the stretcher, so the officer felt comfortable walking in and out of the room. He kept peering at my work and finally said, "Do you know what you're doing?" I assured him that I did. He walked out for a few minutes, came back in and said, "Are you sure you're doing that right?" Again, I answered yes. Ten minutes later, "Does that look right to you?" I laid down my suture materials and calmly said, "Everyone in this room who has graduated from medical school, raise your hand. It looks like I'm the only one, so we'll continue to do it my way." He didn't bother me again and the patient/prisoner couldn't stop grinning.

Let me call you sweetheart...

My experiences as a female physician are completely different from those of my male colleagues. This blog won't be completely about what it's like to be a girl doc, but the first few postings will. I am repeatedly called "baby", "sweetie", and "honey" by male patients. I can easily forgive these slights from older patients. After all, they were raised in an era when that was acceptable. But people my own age!?! I try to let it slide, but one 30 year old patient called me "sweetheart" one too many times. I asked him not to keep calling me that, but that only encouraged him. As I pulled on my glove to do a rectal exam, he said, "I don't really need that, do I sweetheart?" I just smiled, saying, "Lower your pants, and that's DOCTOR sweetheart to you."

Hey nurse!

While sitting at the nursing station in my emergency department one morning, I heard the patient in room 10 bellow out, "Hey nurse!" Not being a nurse, I continued what I was doing and waited for the nurse to see the patient. No one was answering him despite several rounds of "Hey nurse!" I looked over at room 10 and saw a giant man in nothing but a hospital gown. Said gown was dangling precariously and drenched in urine. He looked at me and repeated, "Hey nurse!" "I'm not your nurse, sir, I'm your doctor. What do you need?" I asked. He looked at me, shrugged his shoulders, and started again, "Hey lady doctor!" I've been "lady doctor" to those nurses ever since.

My medical school in upstate New York graduated its first female physician in the mid-1950's. Since then, the number of women in medicine has exploded. In fact, many major medical school graduating classes are now more than 50% women. Despite this, the public's perception is that women are nurses and men are doctors. It is not unusual for one of my Emergency Department patients to tell the nurse who is discharging them that they are angry that they have not seen a doctor during the visit. This despite the fact that I introduce myself as a physician and wear scrubs, a lab coat and an ID that all say "MD".