Momwithastethoscope's Weblog

December 29, 2008

On Call Sampling

Filed under: Uncategorized — momwithastethoscope @ 4:23 pm

Just finishing up my 5 of 7 days on call to cover the Christmas holiday.  I hope I’ve paid my dues to my partners for at least a couple of years.  Here’s a random sampling of some of the patients I took care of during the weekend plus:

12/24 3:30 PM   cough

12/24 5:17 PM  cough and shortness of breath in 6 month old with bronchiolitis

12/25 7:45 AM discharged newborn from hospital

12/25 4:03 PM Out of town family needed antibiotic change that triage unable to call in because the family was out of state

12/26 8:25 AM Initial check on new baby

12/27 9:05 AM Follow-up check on baby and discharge to home

12/27 10:15 AM  Call from parent about 3 1/2 year old with chronic constipation

12/27 3:21 PM 5 year old bit into tongue in moon walk.  Need to know if they need to go to ED for stitches.  No active bleeding.  Patient turns out to be family friend.  Called to reassure that he could go without stitches.

12/27 5:24 PM 22 month old with bronchiolitis with cough.

12/28 10:30 AM Six year old with sore throat.  Seen at Urgent Care out of town.  Strep test negative.  Getting worse and wants medicine.  Called in Amoxicillin. (Bad doctor. Bad doctor.  Calling in antibiotics for probable viral illness.  Getting tired and resolve to uphold tenants of Ivory Tower medicine getting weak)

12/29 4:45 AM  Six month old teething and screaming for past hour.  Would like to go to ED. “OK?”, Nurse Triage asks.  “Sure.”

12/29 7:08 AM  Notification of new baby at hospital

Looking through the triage documentation, I’ve noticed Benadryl popping up in the advice section with frequency.  With all of the FDA’s warning and cautions about cold and cough preparations especially in the less than 6 year old set, I wonder what those of us on the front lines are left with to advise suffering patients and their parents during cough and cold season. What does Benadryl do for coughing, runny nosed kids except sedate them?  Is there any evidence to suggest it helps cold symptoms? (Funny, I thought antihistamines were for allergies.)

I’m feeling like my hands are tied this sick season – limited to raising heads, vaporizing air, rubbing Vicks on hands (and feet).  Have prescribed a few more nebulizers than past years and probably more antibiotics than were necessary to try to give my patients some relief while the FDA cats are sleeping it off with a healthy dose of Nyquil.  Can bet that none of them are parents of young children with colds.  May have to resort to some of my grandmother’s concoctions – hair of the dog with honey – to get us all through.  While I agree that there is no real scientific evidence that cold meds give symptomatic relief, I do believe there is some comfort to patients with viruses by getting some much needed zzz’s.

December 23, 2008

5 Ways I know I am Not My Mother at Christmas

Filed under: Food,More about Me,Parenthood,Uncategorized — momwithastethoscope @ 6:25 am
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dough-boy

1. Cookies: My mother made dozens of cookies when I grew up: pecan sandies coated in powdered sugar, gingerbread cutouts, spritz, bourbon balls, fruitcake cookies, “painted cookies” (sugar cookies with glossy egg wash in corresponding colors) just to name a few. What we did with all of these cookies, I really don’t remember. Maybe we gave some away. We ate some for dessert nightly. We left a few for Santa. While I enjoy cooking, and cooking with my sons can be a lot of fun, I just don’t do it much. My mom gave me an appreciation for homemade baked goods, and I love that holiday tradition. But the boys & I don’t need the temptation of baked butter and sugar close by – Pilsbury, Duncan Hines, or my own.
2. Carrying a pager on 12/25/08: I’m on call for my partners and myself this year. The upside is that only the sickest of the sick children’s parents call that day. I’ll make rounds in the morning, and my kids are understanding about my leaving for an hour or two.
3. Stuffing things in bags at the last minute: I believe I have perfected the wrap in tissue and shove in snowman bag much as a quarterback throws a perfect spiral. It’s all in the wrist. My mom’s method is to wrap and then add beautiful ribbons and bows and embellishments. It also requires sitting. My method can be done as I am striding to the car on the way to a recital or party.
4. Looking forward to mother-in-law’s Christmas day because I don’t have to cook (much): My mom is an amazing cook. My family tradition is an English Christmas dinner with roast beef, Yorkshire pudding, parsnips and potatoes, and gravy. It makes my mouth water just to type those words. We lived overseas when I was in grade school, and adopted this tradition. I’ve alluded to my ability to juggle cooking and call – just not able to do it. I’m very grateful to my in-laws that they host the family for a covered dish get together. My husband makes his popular meatballs (another Crockpot winner!)
5. The internet: I shop (thank you, Amazon). I keep up with life, and blog: Where would I be without the ability to find and ship gifts to multiple places? My mother spent hours going from store to store searching for the perfect gift, packing them, and hauling the box to the post office. I do some of that, but the internet has streamlined the process so that I can continue to work full-time (a Pediatrician’s busy season) through the months of November & December.
A year ago, I didn’t know what a blog was let alone had an idea I would be writing on one with such an amazing group of women. Thank you. Mothers in Medicine! Thanks, KC, for giving me a chance to voice my opinion. Happy Holidays to you and your families & I look forward to the New Year!

December 22, 2008

Five things

Filed under: Food,More about Me — momwithastethoscope @ 6:31 am
Tags: ,

Maybe you’ve seen these lists on other blogs.  This one came from Abel PharmBoy’s blog.  He didn’t tag me, but I thought they were interesting lists. So here goes:

5 things I was doing 10 years ago:

1)  Settled into new pediatric practice of all women in Husband’s hometown

2)  Watched new home take shape as drywall went up

3) Kept up with very mobile 17 month old son

4)  Spent night with in-laws after rental house ran out of oil in the first cold snap @ 11pm

5)  Planted pansies in container by front door to make rental seem homey.

5 things on my to-do list today:

1)  Research bipolar disorder from a family perspective for a book character

2)  See half a dozen “just want a quick check before we leave for Christmas vacation” patients

3)  Meet with three different drug reps who drop in to check samples

4)  Sift through 143 e-mails that I “need” to read

5)  Find time to exercise – especially after eating wicked chocolate cake that grateful parent brought to office for the holiday

5 snacks I love:

1)  Popcorn – movie version, microwave version – just regular with no cheese, ranch or kettle seasoning

2)  Chips and salsa from a mexican restaurant – just not the same at home

3)  Pepparkakor Swedish Gingersnaps – can eat them like potato chips

4)  Chocolate covered pretzels

5)  A gin & tonic- what?  Nobody said I had to chew my snack

5 things I would do if I were a millionaire:

1)   Pay off school loans – boring but true

2)  Take a month off to travel in Italy

3)  Take a month off to write

4)  Hire a personal trainer for myself and my kids

5)  Take sister on surfing vacation for her 40th birthday in Mexico

5 places I’ve lived

1)  In Illchester, England with King’ Arthur’s playground in view

2)  Third floor walk-up close to medical school

3)  On Pensacola Beach

4)  In the land of Nicholas Sparks

5)  NASCAR country

5 jobs i’ve had:

1)  New Classic Coke sampler

2)  MS researcher with rats

3)  College TV film crew for football games

4)  Moonlighter in residency to attend deliveries of babies

5)  Expert witness in malpractice case

December 20, 2008

Medicalese

Filed under: Office,Uncategorized — momwithastethoscope @ 4:09 pm
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I really thought I was doing something when I took medical Spanish for gringos. My ego deserved a pat on the back for learning a new language. In high school, I enrolled in the romantic French class. My intention for attempting another language were good, however, since our Hispanic population continues to boom in our area. Our area is quite diverse – a melting pot, and in all fairness I would also need to learn Chinese, Japanese, Arabic, Portuguese, and Nigerian to name a few of the many languages I’ve encountered. The majority of my patients and their parents make very gracious efforts to help me bridge the communication gap.

There are several other languages that I wish I had been taught in my medical training. Languages in the midst of all the microbiology, pharmacology, pathology and ethics?

The first of these is what I refer to as code speak. Have you noticed that the way physicians document diseases and the insurance coding are legions apart? For instance, a nine month old with wheezing without upper respiratory symptoms. I like the term reactive airway disease because the parents can comprehend it somewhat. There is no ICD-9/ICD-10 code for RAD. In fact, there is no code for mild intermittent asthma or moderate persistent asthma. I really hesitate to assign asthma with haste. Parents really balk at the diagnosis because it’s not usually based on the kind of objective data like lab results or a chest X-ray. In the spirit of evidence based medicine – I have truly tried to incorporate objective data to make that diagnosis. It would be helpful on occasion if there existed a wishy washy code like RAD instead of obstructive pulmonary disease NOS.

Code speak is not limited to pulmonary disease. I have struggles with coding seizures as epilepsy, yeast diaper rash, and newborn codes. There seem to be a million obstetric codes, but a paucity of newborn codes. A code for granulating umbilical stump hanging by a thread would be helpful. A code for overriding sutures would also be helpful since that is a frequent question from parents of my patients.

I suspect that like many of my patients, my coding is still in its infancy. Recently I attempted to educate this infant to find that what coders tell us to code in our offices are still miles apart from what insurance companies will pay for. At the conference I attended, a very knowledgeable coder attempted to navigate us through codes for emergency visits, cerumen extraction, and the combination of sick and well visits at the same time. I am a pretty passionate person about my profession, and I am willing to advocate for better codes and insurance payments. Some days, it just doesn’t seem worth the fight to be paid the $15 for cerumen extraction with bilateral otitis media and nothing else after my nurse and I was wrestled an eighteen month old like the late Steve Irwin handled crocodiles.

Another language that I failed to learn in my training is TV reporter speak. My curiosity is always heightened by the mention that someone is in critical or stable condition. My mind flies to speculate that the woman in critical condition after being spun out on the interstate is ventilated and on a dobutamine drip. Is she being rushed to CT or had heavy output from her chest tube? Is there a published breakdown of what these categories mean? Then again, maybe my medical speculation game during the nightly news is just another way of escaping the realities of the world around us.

Parent speak is another language that seems to have multiple dialects. There are classic examples from residency that include “vomicking” and “thrash”. As the parent of two boys, I felt pretty fluent in parent, but I am still surprised by how filtered my thoughts are by my medical training. Case in point was when friends brought their toddler son to see me in the office. Being a former preemie, he has been susceptible to his fair share of respiratory viruses this past winter. On this particular occasion – I felt he had a right lower lobe pneumonia with crackles at the base. When I mentioned this to his father, Dad’s eyes got wide with anxiety. I cannot tell my wife that he has pneumonia – he tells me. She won’t be able to handle it. With all that they had been through with their former 35 weeker, our agreement was that we would tell mom her son had a “chest infection” leaving the diagnosis as a murky albeit less anxiety provoking than the “p word” That lasted about 5 minutes 15 sec. when mom, a social worker in a nursing home, called to ask me did I mean that her son had pneumonia?

Some days I’m not sure I am even fluent in my native language. How is it that I can tell a parent that their child has x and it comes back that the child has z? Where did I miss the boat? Did I uses too many medical terms, or did I oversimplify?

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