TiredMD

I'm trying to mislead people by telling you what I took in medical school? Amusing. Believe it or not, we do have a few prereqs we do before we go to med school. And the fact that a few courses have titles that sound similar to traditional undergraduate topics does not mean that these subjects are taught at a basic level, or that we haven't seen the basic material as undergraduates. I took biochemistry in med school, yet it still was a required pre-req. If you think new med students come in fresh, having never taken stats, ethics, etc, you're kind of deluding yourself. It's also funny that you take statements of my own experience as some kind of attack on the nursing profession. I sense a touch of insecurity about your degree program.

Thank you. There's a definite undertone here that anyone who doesn't buy into the new-age "everybody should just hug and be happy" mindset is either trolling or some kind of hideous person. The real kicker for me in this thread was the notion that you shouldn't even yell at your kids. After all, little Johnny might need a lifetime of therapy if you yell at him as he tries to run into the street . . . Anyway, I've said my piece, and have nothing left to add. It's a simple disagreement. Shame so many have to take it personally.

Don't do it too often, but off the top of my head: 1) Patient acutely decompensating, I asked for critical piece of equipment (pericardiocentesis needle, ET tube, etc) that is not in the room. The quality nurses and techs are busting their behinds to get done what needs to be done and can hardly drop it to run to the supply room. The 5 "lookie-loos" standing by the door just stand there staring and chatting. 2) Fellow physician begins performing OR procedure . . . incorrectly 3) Intern/medical student makes potentially dangerous error (I've been on both the giving and receiving end of this one) or, my favorite 4) Walk on to a neuro ward one night, and CNA is announcing in a loud voice at nurses station that he is "sick and tired of cleaning up these old people's " and that he wishes "someone would just take them out back and shoot them like dogs". The first 3 are patient safety issues requiring strong and rapid intervention. The last one was just cathartic.

Again, let me encourage you to take this cop mentality to the hospitals, and attempt to get one of your physicians arrested for raising their voice. You'd be famous in the hospital for years to come, even if your employment was short-lived . . .

I absolutely do.

Don't worry, bronchitis isn't real anyway.

Never even opened the stupid thing. When I need administration information, I use Davis' Drug Guide for Nurses. When I need info on adverse effects, dosing, and interactions, I prefer to use sources not published by the manufacturer. I really don't think you're missing out on much.

How can you tell the difference when everyone wears a long white coat and no one wears a nametag? But I digress . . . Under LCME, ethics training is mandatory for medical schools. The actual form and structure of the courseis left to the discretion of individual schools. Mine, and most of my colleagues I have discussed this with, was a stripped-down bare minimum "seminar" which basically outlined important topics like, "Don't have sex with your patients, even if they're attractive" and "Get a patient to sign a release form before you let them go AMA." In general, our curriculum is already packed to the gills with actual medical topics, so the goal of ethics education tends more towards a 'check the box' mentality than any real attempt to address the topic comprehensively. No, we didn't learn biostats and epidemiology. That's an undergraduate topic. It was discussed, but not formally taught, because the presumption was that you had already covered it as a component of your bachelors degree. Kind of like Newtonian physics and basic cell biology. All that is covered in the licensing exams, so if you are weak in it, it's a good idea to relearn it on your own. The business/financial/management side of health care is generally not addressed, because an MD is a clinical degree, not an administrative degree.

Actually, they're not. I had one seminar on ethics, once a week for four weeks. Everyone is presumed to have learned statistics as an undergraduate, along with the other basics like biochemistry, cellular biology, and basic writing. Management isn't even discussed.

Whoa, don't think I'm equating yelling with threatening. Threatening is clearly out of order and obviously criminal.

That's kind of interesting, and I meant to ask you about it. I would have thought it would be opposite; that men would get yelled more than women, given the sensitivity to sexual harassment lawsuits. FWIW, I work in an all-male environment, so there's no opportunity for gender preference when it comes to yelling . . .

Once the OP clarified that this physician was on-call, obviously the yelling was inappropriate. Hell, the anger at being called was inappropriate. But I continue to insist that not only is yelling not a particularly big deal, but it can also be incredibly effective if used infrequently and only when absolutely necessary. Seriously, if you haven't yelled at someone lately, give it a try. You might be shocked how well it works.

I love it!

Not too sure why so many of these narcs are available as stand-alone products. There is that "synergy" theory that NSAIDs/tylenol in combination with narcs complement each other to provide superior pain relief. And certainly, other than the overdose factor, acetaminophen is a far safer drug overall. The NSAIDs have the gastric problems, potential renal failure, potentially contribute to heart disease, and at least theoretically can exacerbate bleeding issues. But yeah, not a clue why no hydrocodone on it's own. If given the option, I would probably utilize that before oxycodone, given the addiction/abuse profiles.

I'm with you 100%. In fact, I'll go a step further and say that many, if not most, chronic back pain patients should see Pain before they get sent to a surgeon. We are doing so many questionable lumbar lamis and decompressions, and so many recent papers have suggested that the outcomes w/ & w/o surgery are very very close . . . we could probably save a lot of people a surgery that really won't make them better in the long run.

Sorry, next time I'll lie so that you feel better. Ultram is a wonderful drug! It works just like narcotics and I fully expect it to work every time I give it!! The mechanism of action is identical to morphine but you won't get addicted to it!

Some day I'll understand why my colleagues write for these idiotic Tylenol + Vicodin orders. A tab of Vicodin has 500mg acetaminophen, which is the same as an extra-strength Tylenol. You give 2 tabs of Vicodin and you just gave a gram of tylenol. So what ends up happening every time? The patient complains of pain, gets some Tylenol, still has pain, and can't get the narcs they need because they're already at the max dose of acetaminophen for the day. And of course this always happens right around 3am. Percocet + ibuprofen = good OxyIR + tylenol = better Vicodin + tylenol = dumb

If you really believe this, I encourage you to call the police the next time a physician yells at you. I imagine the laughter of the 911 operator will be the last thing you hear before you're fired.

I think you and I are reading this differently. I read it as the patient's primary care physician, who was not the admitting physician, was called at 11pm to answer a relatively insignificant question. Was he really on-call? I must have missed that part of the story. If so, then sure, he has an obligation. But if he's like most Primary Care docs these days, who do not admit their own patients, then he wasn't on-call for this patient, and it was a nuisance call. If that's the case, you really can't understand why someone might get hot under the collar? Personally, I disagree. It gives you every right to yell at them. Someone who wakes you up in the middle of the night for something that is not only unimportant, but also that you have no responsibility for, absolutely deserves to get yelled at. The fact that it is "hospital policy" does not trump the requirement to act with basic human courtesy. You do not wake up a person who is not on-call and not caring for a patient to ask some nonsense question. Anyone with half an ounce of common sense realizes this. Hiding behind hospital policy, or worse, making the physician responsible for changing an idiotic policy, is simply inappropriate. And I know you realize this, because you wouldn't have done it. There's a tendency on this board to equate yelling with some kind of hideous assault that leaves people emotionally scarred. I've never understood that, and personally I'm grateful I've never worked in a place where people shared that attitude. There are times when it is perfectly appropriate to raise your voice, and I have employed it (effectively) on numerous occassions. It's not illegal, it's not unprofessional when done at the correct time, and I see nothing wrong with it.

I've met people who swear by it, but as the above poster notes, it tends to be people who are highly medication-sensitive to begin with. For most patients, I don't find much use for the drug, and I am personally of the opinion that it is no more effective than ibuprofen, naproxen, or any other NSAID. That being said, I do prescribe it. Usually it's under two circumstances: 1) Patient has been on Percocet or Vicodin for a few weeks after an acute injury, and is really convinced they need more because they still hurt. I deliver my standard "Narcotics are not intended to be used indefinitely, and it's time to get you off them." Then I explain that I will give them Tramadol, which is believed to act similarly to narcotics but without the same dependence/addiction profile. 2) Patient is young, shows signs of developing chronic pain from a musculoskeletal condition (almost always low back pain or PFS), has cycled through all the NSAIDs and Tylenol, but I really don't want to send them down the narcotic pathway. Tramadol is offered as an "intermediate" solution. In truth, the only real benefit of Ultram is that people aren't all that familiar with it. If someone is sore, and you offer them Tylenol or Motrin, they think you're not taking them seriously, and don't expect it to work. But if you offer them Ultram, they assume it's a "real" pain medicine, and so it tends to work better.

Yeah, it binds to mu receptors just like opiates . . . just at 1/6000th the strength. Personally, I think it's a crap drug, a throw-away to pawn off on your chronic back pain patients in the hope that the weak anti-depressant effect will improve their overall pain scores (since they all absolutely refuse to believe they have any kind of depression and don't want to be labeled as "crazy"). But that's just me. For those who think it's okay to give a placebo (and I'm kind of amazed that it's taught in schools that it's an ethical thing to do), when you patient asks you what they're getting, what do you say?

Bingo. If this wasn't the admitting physician, there was no reason to call that late. It's just completely inappropriate. This isn't a case of a "rude doctor", it's a rude nurse. Would the OP have called a family member that late to ask the same question? And I wonder, if a telemarketer had called the OP that late, if maybe they wouldn't have done a little yelling too?

Ultram is my placebo of choice.

- You have the right to obtain a copy of your medical record; you do not have the right to take the original, nor do you have the right to get it on the spot - Many physicians are reluctant to release your records directly to you, because patients frequently don't understand medical terminology or misunderstand what they are reading. They prefer to send them directly to another physician so that there is always someone there to "translate" what is written. This is likely why they gave you the runaround the first time. Nonetheless, you do have a right to obtain your own copy, and you were right to press them on this point. - The physician's office has the right to charge you a reasonable fee for copying the record. If you have a large record, it may be more than you are expecting. No, you can't take it to Kinko's and copy it yourself cheaper. - Only an idiot would attempt to "sanitize" a record prior to turning it over. Altering a medical record will get your license pulled, which is the kiss of death for us. Malpractice suits are just the price of doing business these days, and are a minor inconvenience by comparison. - Physicians don't worry when other physicians scrutinize their medical records. We don't offer opinions on the care provided by other docs, and we certainly don't recommend suing our colleagues. I doubt your current physician is worried in the way you suggest.

Certain rules are somewhat set in stone. For example, a patient with a fresh arthroplasty, you don't want to place stress on the joint in such a way that it will cause a dislocation; hence no adduction past midline, flexion past 90, etc etc. But other rules are softer, not based on research but tradition and who you trained with. I once rotated with a Joint group where one surgeon insisted on an abduction pillow after all his hips while in bed for four days postop. The other only did it for one day. These kinds of minor clinical questions aren't normally addressed in large-scale clinical trials, and so you practice what your mentors practiced, unless research actually comes out contradicting you or you have a bad outcome with what you're doing. Much of what we do is not addressed by research, but contradicting a surgeon's preference on post-op management is never a good idea. Thus, if an Orthopod isn't clear about the activity or motion restrictions for a patient, you save yourself a butt chewing by asking up front. This is what I do as a resident, ditto for the smart nurses.