warriorsavant: (Chimerae)
DuckDuckGo. Does anyone else use this? It's an alternative search engine to The Borg. Their claim to fame is that they don't keep track of you/don't create a profile that follows you around. So far, their searches seem to give reasonable results, but I haven't done a head-to-head comparison with other search engines.

Office & Staff. Evil Secretary was actually out sick for almost 2 days. She takes sick days about once every 7-8 years. I came in Monday and she looked green, told me she'd just thown up, and needed to go home. Fortunately we have T on board now. Even though she's here as a nurse, she has secondary duties of filling in when ES isn't here. Also fortunately, it was a little slow, so she jumped in and did just fine. Yeah, lots of small things weren't perfect, but so what, this isn't her primary job and she's only been here a month. ES had initially told me she thought she'd need to come in for 1 day to clean up whatever mess was left, but there wasn't any. Good. Not having reliable back up of ES has always been a slightly worrisome issue for me, but this is another instance of T seeming to work out well.

RAMQ, fighting with. That's the government medical insurance bureaucracy in Quebec. Despite all our complaining (both as patients and providers), they generally get things done with a minimum of fuss. Had a couple of issues that I had to fight with them about yesterday, which is to say had to get on the phone with someone. Doesn't happen often (as best I can tell, most doctors in US spend more time fighting with gov't and/or insurance companies than actually seeing patients), and at least I got to speak to a human being.
     The Good. A patient who was falling between the cracks. He has horrible psoriasis, was put on one of the new biological medications with great results when he lived in Ontario. He moved back here, and the requirements are a little different, and I've been trying for > 6 months to get him approved. Discussed with them for 10 minutes, and today got the approval. They generally figure that if a doctor is willing to take the time to call them directly, it must be important.*
     The Bad. Only "medically necessary" acts are insured, which is reasonable. (Some of the backstory is not reasonable, but irrelevant here.) For example, a cyst that is not inflamed, infected, or physically troublesome is not covered for removal, so the patient has to pay. They may not like the cyst (or other benign growth), but the world is full of things one doesn't like, and that doesn't mean someone else has to pay for it. Anyhow, removed a cyst from a patient this past summer, duly warned him he'd have to pay for it, which he seemed to accept, duly charged him… and then he complained to RAMQ asking for reimbursement. Last fall they sent me a nastygram, asking for my notes on the patient and my justification. I sent that back, including a direct quote from their manual. They just sent me a letter saying basically, "illegal charge, we're collecting it back from you with a penalty." I spoke to someone who took the info, "and will get back to me." This is seriously annoying, but I am going to smack them down. If I let it go, besides the money immediately involved, it sets a really bad precedent. I've gotten the Assoc. Derm. Quebec involved, and they will help me for the same reasons. We'll win, but annoying.

*More on fighting for patients. It's part of the job. I'd hate to have to do it for every patient. Frankly, wouldn't have time to earn a living if I had to do that, but every 2-3-4 weeks, something comes up and I need to do it. It comes with the turf. Sometimes it really shouldn't be my job on a particular patient, but if he/she has been bounced around enough times, and is sitting in my office, I figure that morally it has defaulted to being my job, and I'll at least take the time for find out who should really be the one to see him/her, and make sure it happens.
warriorsavant: (Dr. Injecto)
Patient today was looking at my med school diploma, and said, "Wow, you graduated before I was born!" (Just had a haircut yesterday - my hair is now back its proper 1/2-mm length - and during said bloodletting haircutting was noting my salt-pepper-and-more-salt hair on the floor of the barbershop.)

"Okay, you just went from near top of the 'favorite patient' list to the bottom."

"No, I mean I thought you were in your 40's."

"Wow. Okay you're back near the top - in fact at the very top - of the list."

Maybe she's just a poor judge of ages, being a mere slip of a 30-something, but I'll take it.

Cameras

Jan. 22nd, 2019 11:45 am
warriorsavant: (Time)
Just read some silly meme about Gen Z making Millennials feel old, by not recognizing xxx. Most was extremely stupid pop culture stuff, like "they didn't know my fav band from when I was in college," and a lot of the rest was other pop culture stuff. A few were clever like "why do you say 'hang up' on a phone call?"

That, and some discussions here about taking pictures of the eclipse the other night made me think about photographic apparatus (apparatuses? apparati? thingies to take pix) in general. When I was young, daguerreotypes were just coming into vogue, but they were very combersome... Okay, more seriously, when I was a kid, my father was a bit of a Popular Science / Popular Mechanics / gadget guy. I suppose getting the latest camera was the equivalent of being a tech-gizmo-nerd. Polaroids were a big thing! Before that, we had a Kodak Brownie camera. (Dang, those items would be worth a lot of money as antiques now.)

I'm actually very good at composing shots. (Photos, I mean, although very good with a side arm also.) Partly that is my artistic eye, which I inherited from my mother, partly because with film, every shot you took cost money. Dermatology is very visual, so as Residents (early 1990s) we were encouraged to get a good camera, with a macro lens and ring flash. (That I still have somewhere.) It took really good 35-mm slides, and I had quite a collection. In 2005, I was mobilized to Walter Reed Army Hospital, and was asked to give a talk. I asked the Residents if they had a slide projector anywhere. They nearly died laughing, and claimed they'd have to borrow one from the Smithsonian. A little while after that, I decided to digitalize my whole collection. Even that is barely worth it now, as so much high-quality stuff on-line, but if giving a talk it is cool to have MY picture up there (with copyright notice).

Patients often insist on showing me pictures of their skin conditions. *Sigh.*
First, you are sitting right there in the flesh and full-sized, why would I want to see a tiny image of you?
Second, you stink as a photographer, especially a medical photographer, and the image on your phone is terrible. All that having been said, although I do have a small digital camera in my office, like as not, when I want a picture, I use my phone. (But remember that thing about knowing how to compose shots? It really matters.)

I don't take many pix of generic skin disease, but am getting better about documenting before- and after- for the small amount of cosmetics I do, also we're trying to build up a file for our Cutaneous Lymphoma clinic patients.
warriorsavant: (Time)
I've been working on being more patient. Succeeding to a fair extent, although really against my nature. Having been working on myself for a long time, with variable success. Having kids helps, both directly (having kids requires patience) and indirectly (I'm just a happier and more mellow person).

I realize, with some of my older patients, that they do require more patience (no pun happening here!). What is sad, with some of them, is that I've known them for 20+ years, and seen them go from "older but vigorous," to "elderly and decrepit and confused." I realize too that what sometimes seems just an annoying character trait is in fact their trying to cover for no longer being with it mentally. Not completely gone, but worse off than they seem at first glance.

One problem I noted today, is that some of them were frankly annoying when they were younger. Becoming elderly doesn't make you saintly. If you were a total pain when you were 25-35-45, if you haven't worked on yourself (whatever that could mean), then you are still a total pain at 65-75-85. Some people were just annoying for their whole lives, plus they pick up more annoying character traits to try to cover for their losing it. I'm training myself to see past the annoying to what really needs doing.
warriorsavant: (Dr. Injecto)
I was seeing a patient in Room 1, when I heard Evil Secretary yelling, "Doc, doc!" very loud and excited and anxious. Not like her. I thought someone was assaulting her. I ran out. There was a dementor hovering over the patient who had just come out of Room 2. I pulled out my wand and exclaimed, "expecto patronum!" driving it away. (From Harry Potter Does Dermatology, the about to be released 8th book in the series.)

Uh, yeah, okay, not quite. I'll get my fantasy life in check. What actually happened was that I had seen a patient in Room 2, and removed a small growth. We usually can tell when a patient is feeling faint or dizzy, and get them lying or sitting down quickly (such as the next patient who was in Room 2). This makes only twice in, uh, never mind how many years, that someone slipped past our guards. Anyhow, he seemed fine, said thank you & goodbye, and went to the front desk while I went into Room 1. Apparently he suddenly went from 'fine' to starting to fall over. Evil Secretary grabbed him, but she was on the other side of the reception desk. When I came out in response to her shout, she was leaning across the desk, holding him under the arms. Couldn't let go or he'd fall, but had no way to get around the desk either. I got him under the arms, and laid him down with something soft under his head and a stool to raise his feet. Turned out he hadn't eaten all day. Those are always the ones who get dizzy, combination of low blood sugar and anxiety. Frankly, if I don't have a nibble mid-morning, I get light-headed by the end of the morning (just the blood sugar, no anxiety), and this was the early afternoon when the gentlemen saw me and had his episode. We got him some juice (we keep some juice boxes in the fridge), and half of E.S.'s granola bar. After a while, he felt better, sat in a chair for a while, and when felt even better, took a taxi home. I think we're going to lay in a supply of not-very-good chocolate (because if it's good chocolate, well, I have no will power and would eat it all). Raises the blood sugar, and besides, everyone knows that's what you need after a dementor attack.
warriorsavant: (Composite)
These all involving excisions. All did well in the end.

1. A gentlemen who informed me right up front that he didn't like needles, wanted me to proceed, but said he thought he'd better lie down. Since either he'd suddenly turned albino, or else was about to faint, I thought that was a good idea. He apologized profusely. I told him not to, I was just appreciative that he had the good sense to lie down first, as I don't pick up people over the age of 5.

2. Another excision that I'd planned to take 15 minutes, took three times that long. When Evil Secretary mentioned that to me later, I pointed out that that wasn't bad for something I'd never done before. It was a nail surgery, building on what I'd learned when we brought in the world's top nail expert. Much of stretching one's self involves taking skills one already has, adding in new knowledge, then doing something just slightly different. Do that enough times, and one ends up with a vastly expanded skill set. It just takes a while, keeping calm, and thinking through problems when they aren't going the way one planned.

3. A very elderly lady with a melanoma on her back, who was mostly oriented (but not completely). She chatted almost non-stop during the procedure. Usually that's annoying, but for someone with my interest in history, it was fascinating to hear some of it, such as her father's having fought at Vimy Ridge (in WWI - look it up). Then, knowing that I'd been in the military, she asked me "which war did you fight in, doctor, the 1914 one or the 1939 one?"
warriorsavant: (Renovations)
First a literal one. The fire alarm went off in my office building. Understand that it is a condo building, with offices/businesses on the ground floor, and 6 stories of residential units above that. Fortunately very nice weather, so we all congregated outside. The building is along the Canal, surrounded by what is a rather long, thin, Federal Park, plus the office across from mine is a bike shop cum café and they have a terrace. Actually did a consultation on one or two of my waiting patients, who didn't have to undress; we just stepped "into my office" (ie several steps away from anyone else). In the end, it was a false alarm caused by dust from renovations getting into one of the detectors. (They are supposed to cover the detectors during the workday and uncover them when they leave. I know, having just done 2 sets of renovations.) I asked one of the fireman if false alerts happened frequently at this building, and he just nodded with a disgusted look on his face.


Second a metaphorical one. Had a message to call lawyer xxx at firm yyy. Calls from lawyers rarely good. Especially when I googled firm yyy and noted they were "
Un cabinet au service des usagers du système de santé du Québec" This is French for "Ambulance chasers." Turned out they were looking for someone to do Medical Expertise for Dermatology. Sorry, folks, but keep looking. One could argue that they are in the service of justice and I should help them, but "service of justice" sometimes is the same as "hired gun," depending which side of the table (courtroom) one is sitting on. It's rather like Satan asking the Preacher Man for help harvesting souls, "because they're sinners and they deserve it." We have an adversarial legal system, and they're the adversaries. Come to think of it, I believe the literal translation from the Old Hebrew of Satanactually does mean "Adversary." It is actually Ha Satan, "The Adversary." From my admittedly limited readings of the Old Testament, Satan is not the adversary of God, but of Man, more of what we would call today (un-ironically), a "Devil's Advocate."


Validation

Mar. 22nd, 2018 02:54 pm
warriorsavant: (Dr. Injecto)
My first patient of the afternoon was a little girl of 5. Her mom told Evil Secretary that she adored me; I'm the only doctor she's not scared of. I guess not being afraid to bite patients' toes works. ☺
warriorsavant: (Signpost Ft. Benning)
I suppose the title should be more, "local geography and it's impact on a dermatology practice," or maybe even, "look sucker, it's only 10 minutes away, stop whining."

When I was a resident, one of my teachers said, "my patients are so loyal they'd stay with me no matter what… unless someone else opened up 10 feet closer to them." Sort of how I'm feeling right now. I've moved all of 10 minutes away from my old office, and some of the patients are whining that it is too far, or just started looking around for someone else. This is counter-balanced emotionally by those who find it much easier to get to and are happy, but they were already coming, so it's a net loss of patients. Evil Secretary is filling in as much as possible with new patients, but winter is always the slow season for us.

Montreal area is interesting in that people can be very parochial about their little municipality. In the US, people are far less concerned about driving somewhere, including to see their doctor. Frankly, I loathe communiting, and prefer everything within a short walk, whether or not I actually walk. That's the urbanite in me. Also, I logically consider transportation time to be dead time. I'm neither at work, nor at home, nor getting things done. Montreal goes beyond that. Like many cities, it was agglomerated out of smaller municipalities. Some wanted to join up, some were shotgun marriages by the province. (Too much history to blog about here.) Even saying "Montreal" is not precise, because it could refer to Montreal City proper, or the Island of Montreal (which has an over-government/counsel for certain functions). And yes, Montreal actually is an island in the middle of the St. Lawrence River, the largest of a number of grouped islands, which I suppose technically makes it an archipelago, but I digress.

So, anyhow, some of the municipalities actually are separate cities, and some are "arondissments" in Montreal City, and some are former cities which emotionally keep their identities. Maybe it's the Canadian conferation-ist mentality, but people often are resistent to going to "another municipality," even if it's only 10 minutes travel time. I think overall that feeling is less than when I first got here, but it's still there. Years back, the big divide was St. Lawrence Blvd, which officially divided East and West on the island and city. (That is, civic numbers on the longer east-west streets were something like 1234 Avenue ABC East/West, like 5th Avenue divides Manhattan in NYC.) Overall more English west, and French east, with maps in each langauge showing blank space labelled "here be monsters" (or "voici des monstres"). A secondary divide was the Decarie Expressway dividing out the WestIsland from DownTown (for a West Islander, crossing the Decarie really did imply a risk of being eaten by monsters).

When I'd moved to my old office from where I'd worked for/with another Derm, a percent of the patients didn't follow me because it was "so far away." Which is to say, 10 minutes by car, maybe 20 by metro. Now, same thing has happened. I mean I don't claim to be much, but I think I'm worth an extra 10-minute drive. I'm not really annoyed (although Evil Secretary is), more faintly amused by the whole thing. I'm not suffering from lack of patients, and we'll see how fast they can get an appointment with another Derm.
warriorsavant: (Warriordaddy)
Friday was my 2nd day at the new office. (Thursday I was at St. Anne's which was fairly light. Just as well as I wasn't in the mood.) Patients overwhelmingly like the décor, which is very, very gratifying.

Several "firsts" at the new office (nothing earthshaking, but firsts for there).
First student. I like having students. At the hospital, since it's a teaching institution, the patient is basically stuck putting up with students and residents. I rarely have students in my private office, but sometimes, and the patient certain has the option to say "no," although few do. I had a student, which in this case was Evil Secretary's daughter. She had to do a project for High School, some part of which required shadowing someone at an interesting job. I almost calling her a medical student then catching myself just in time. "Mr/Mrs Patient, do you mind if our med… uh student joins us." I think Daughter of ES got something out of it.
First biopsy. Since skin is very accessible, skin bx are no big deal, unlike, say, a brain bx, or any other of those fiddly little internal organs. Reminds me of when I was a resident, and one of our patients needed a liver bx (was on methotrexate, and still did a lot of liver bx in those days for patients on MTX). Paged the Surgery resident to do it, and when he arrived, I asked if I could do it with his coaching me through it. He scoffed openly. A mere derm resident thinking he could do such a thing. That required the skilled hands of a Surgeon! Stand back, mortal, I shall do this wondrous thing!! Yeah. Then the bx came back as "normal lung tissue." Mr. "I'm a Surgeon" managed to miss the largest internal organ in the body. I still don't actually do liver bx (especially in my office, but I'm far less impressed by those who do.
First cosmetics. Got a peel, a botox (actually 2), and a filler. For me, the trifecta of cosmetic procedures. I have no intention of being a glorified cosmetician, but I do want to have all of Friday afternoons be my cosmetics time. I'm slowly working toward that. I hope having 4 procedures in one day is a harbinger of getting there, but probably just stacked up from my being away.
First toes. The advantages of now having my own kids, I'm better at dealing the kids-as-patients. This one, as so many, didn't like, and was frightened of, doctors. Which is often because the parents are frightened, and the kid picks up on it. Regardless, there are some tricks that help: take off the white coat, get down to their eye level, make faces. And, when all else fails, bite their toes. My Peds Derm colleagues scolded me today for having done that, but really, it worked. I was transformed from Frightening Monster to New Best Playmate.
warriorsavant: (Cafe)
First day at the new office.
It is gorgeous. Everyone from Evil Secretary to my grumpier patients to my cheerier patients commented. ES had seen it in past week while we were unpacking and contractors still working on last details, so it was beautiful in her eyes to see it as the patients see it. Still a few details have to be finished, plus things needing to be sorted out and put away, plus inevitable changes later. All that having been said, I love it. Probably cost me a month's worth of patients to give it that elegant and slightly magical look (pix eventually), but worth it to me to not be working in what looks like a 2nd hand bus terminal, which is what half the doctors' offices around here look like. Although not as full-on magical-looking as I'd like, there is still an air of Hogwarts School of Dermatology and Witchcraft.
Of course, couldn't start off entirely smoothly, what with the ice storm yesterday and the walkway not properly salted. No one broke anything, which is a good thing. Booked fairly lightly until we get the hang of things. It's all the little things that feel wrong: where did I put this? Why is this 2 steps further away than I'm used to? (Doesn't sound like much, but 20+ years of muscle-memory makes things like that fell just slightly off.)


First day back at the hospital in a bit. Have been on-and-off between the Christmas Holidays and the move, but ramped up full time. First patient was easy: rectal melanoma. You read that correctly. What is usually a skin cancer, highly correlated to UV exposure, manifesting inside someone's rectum. Super rare. Had already been diagnosed and half-worked up, but she landed on my doorstep because she'd been shuffled around, didn't really know who to trust, or where to go. I told her frankly that I was not the person who would be able to treat her condition, but I would take charge of getting her to the best place and quickly.
A couple of other patients had odd cases of "who has been treating your case of xxx as yyy for how long?" Not grossly wrong, but the sort of thing that sometimes gets passed down as diagnosis xxx from one doctor to another, made sense initially, but nobody rechecked the facts when it didn't seem to be behaving as it should. Sometimes all I do is get people routed to the correct place. That can be a big thing by itself.


Came home, salted the walkway in front of the house, then had kids climb all over me (that's what is referred to as rearing children). Very tired, but life is good.

Tidbits

Dec. 9th, 2017 04:22 pm
warriorsavant: (Signpost Ft. Benning)
➢ Are sending out letters to patients telling them the new address. Should be moving the office in just over a month. For a few that I keep thinking, "maybe I won't send this one a letter…" Can't really do that, but for some people, I have to hold onto my professionalism with both hands.
➢ The weather teased us with a few nice days, now back to winter. Why don't I set up shop in the southern hemisphere for 6 months out of the year.
➢ In between those two is the fact that hard to determine if a lesion is hot to the touch if this is your first patient of the day, and you've just come in from outside. Gloves or no, hands are too cold to be sensitive. Had to tell her to wait until I saw anoth
➢ Dang it, stop wishing me "Happy Holidays," when (a) the phrase is "Merry Christmas" (even for we non-Christians), and (b) it's still November*. Gonna boil someone in their own plum pudding and bury them with a stake of holly through the heart.
➢ My accountant has his annual scotch tasting. Even bigger this year, with food. For him, it's a company-sponsored event (good will for employees and clients) which gives him a chance to hold court and drink scotch. He's quite sociable and great to talk with. For the invitees, it's a chance to… socialize (even I manage) and drink scotch.
➢ I'm secretly Sheldon Cooper. Well, Nom is. Well over a year ago, she ordered the kid's shower curtain. It displays the Periodic Table of the Elements (in lovely shades of brown, so even goes with the décor. Finally got it hung; it looks great. However, if I ever did shower in their, Tom Lehrer's Periodic Table of Elements would be running through my head**, not to mention C.J. & the PhD's Periodic Table of Elements.***



*Clearly jotted this one down a coupla weeks ago. I think I can start wishing people Merry Christmas by the middle of next week.
**Our neice was very proud of having memorized that, and was astounded that I'd heard of it.
***Not likely you'd heard of them. Probably all wanted to be Tom Lehrer when they grew up. I knew them in Virginia back when I was an Intern. They had originally formed the band as graduate student, singing humorous & satirical songs for beer money on the weekends (eg Nuke the Whales). By the time I heard them, they were only doing this for old time's sake, having all graduated and gone onto real jobs - well, except for one guy who had a little too much "fun" in the '60s and didn't have the brain power left.
warriorsavant: (Time)
An elderly female patient who I was treating for her 3rd skin cancer plus some precancerous growths. She also has antecedents of an internal cancer and lymphoma. She's survived all this and still going strong. I apologized for the discomfort (okay, pain) during the local treatment. She gave me a tolerant look. Her daughter laughed, "at 15, she was in the uprising in the Warshaw Ghetto; this is nothing."

I pointed out my print of Roman Vishniac, who photo-documented the now-vanished inter-war life in the old Jewish Quarter in Warshaw. The mother thought she recognized the street.

People like that put "first world problem" whiners in perspective.
warriorsavant: (Sword & Microscope 1)

Most people cannot understand a conditional statement. I don't understand why they don't. In my case, part is that I've been scientifically trained, but part is that I am not a complete moron and can use my native language.

People need to be given instructions on how to use their medications, and other management of their condition. To me, that includes "if X happens, then do Y." Apparently that is beyond most people's comprehension, and they need instructions to the effect of "do X, then come back tomorrow for further instructions." Titrating a dose is wayyyyy to complicated for almost everyone. (Titrating - I don't use that term with patients - is basically, "raise how much you take every xxx days, until you get the effect you want, or you get side effects. Come back in yyy weeks/months and tell me what happened and how much medication you are taking.")

To me, it would be like being a driver's ed instructor telling someone, "if the light is red, stop your car."
"So you want me to stop my car?"
"Only if the light is red."
"What if the light isn't red?"
"Don't stop."
"How do I know if it's red?"
"Look at it."
"So when do I stop my car?"
"Only if the light is red."
Etc, etc, etc.

At least drivers ed cars have dual brakes.


warriorsavant: (Composite)
What is the purpose of a doctor wearing a lab coat, you ask? Three reasons: gives you pockets to hold useful stuff (pen, prescription pad, dermatoscope, hand grenade cream), keeps blood off of your shirt and tie (sometimes), and mostly as a badge of office/presenting yourself as a professional in the eyes of the patients.

In an article in a recent journal, patient were asked their preferences of how they would prefer their Dermatologist to be dressed in different situations (eg Medical vs Surgical Dermatology) with the options being business attire (eg suit and tie), professional (eg lab coat), surgical (eg scrub suit), or casual (eg casual). For all situations, patients preferred professional dress; yes, even in modern, increasingly casual America. I'm pleased to see that my beliefs are validated. I've always worn a lab coat with shirt and tie (and yes, pants and socks and shoes, for the smart alecks in the crowd). My idea of "casual" is maybe once/month ditching the tie.

I didn't always do that, although I learned early on in my career. When I started out in practice, I was in the Navy, and I wore my uniform. When I was an intern, I wore either a lab coat over my uniform, or scrubs, depending on what service I was rotating through. That's how all the house staff dressed. When I was in practice in the Fleet and with the Marines, I just wore my uniform (there was a medical crest on the collar). That's how we all dressed. When I first got out of the Navy and was working in walk-in clinics and ER's, I decided not to be one of those dorks who wore a white lab coat. My g.f. at the time was the daughter of a small town GP, and her father never wore a lab coat, and she too made fun of those dorks who did so. What wasn't figured into the equation was that he practiced in a small town, and everyone know he was ole' doc XX. He'd delivered half the town - and their mothers - and didn't need a badge of office ("Badges? I don't need no stinkin' badges."). One day saw a patient in the ER. I introduced myself, did the exam, wrote out the prescription. Then the nurse came in to discharge him, and he asked, "but when am I going to be seen by the doctor?" In his mind, no white coat, no doctor. Easy to make fun of him, but in fact, I was at fault having not presented the image he was expecting, the simple sign saying MD (Me Doctor). I learned (I don't usually learn that fast about social clues, I guess I was having a good day).

I've been preaching the wearing of the white lab coat to students and residents since. Nice to have some office data behind what I say.
warriorsavant: (Dr. Injecto)
I might be too successful at this botox biz. Saw someone today who I'd injected 4 years ago. She had just been laid off, and wanted to look and feel better going out to find a new position. It worked really well, she got an excellent new job which she is still enjoying (and no longer feels the need for more botox). It's great to get some positive feedback once in a while,
warriorsavant: (Lucky Hedgehog)
Had my Lymphoma Clinic at JGH today. I got there a little early, and was setting things out, and straightening things up a bit, in the teaching room, when I noticed there was something stuck inside one of the text books that were on the table. I flipped open the book; what was tucked inside was a porn magazine. Really?! Is someone in JHS, tucking their copy of Playboy inside their math book? (I asked one of the (male) Derm residents to get rid of it. Not sure if he has a g.f. (other than one named .jpg), or if it will end up with very sticky pages tonight, but that needed to get out of there.)

Otherwise, the clinic was super-busy, and I was the only attending staff from most of it. It's a multi-disciplinary clinic, and we usually have 3-5 attending staff. I knew 2 were on vacation, but I thought there'd be at least 1-2 others there. In fact, I'm on vacation this week, but since this is the most academically & intellectually interesting part of my work (I mean besides the ocassional porno mag), I decided to come in. Good thing I did, or there would have been a bunch of very, very unhappy patients. I finally reached our Heme Pathologist, who had thought the clinic wasn't happening, and was able to come later in the morning, which was good b/c really needed her input on a few cases. It was triply good that I was there, as one patient had been bounced around different places, was getting worse, and felt like no one was taking care of him. I'm actually not best person for this problem (I routed him where he needed to be), but sometimes you just have to spend the time talking to a patient for a bit, and starting some sort of active treatment, because it needs doing and you're the one there at the time. I don't have patience for young, emo, drama-llamas taking up my time and energy, but an elderly patient with a serious problem, especially one who's slipped between the cracks, gets all the time and attention he/she needs.

This morning clinic finished at 2:30 in the afternoon. I am a bit annoyed in that some of the others keep adding patients, then aren't there, or leave early. Not 100% sure what I'm going to do about it. We do need to meet more often, but because these are rare conditions, it's not anyone's 1st priority, and therefore hard to get everyone together. 
warriorsavant: (Composite)
A lipoma is a benign collection of fat cells, much like a beauty mark (nevo-cellular nevus, or just nevus) is a benign collection of pigment cells. They appear clinically as soft, subcutaneous masses, generally painless, ranging in size from 1/2 cm - 6 cm. Some patients just want to know that they are harmless, some want them removed because they are unsightly or just prey on their minds.

Had a patient the other day who just wanted to make sure it was harmless, as he'd found a creative use for it. He was clearly into body building, and the lipoma was mid-upper back. Once he was reassured it was benign, he definitely wanted to keep it, as he found it useful for helping to steady the barbell when he was doing squats.
warriorsavant: (Sword & Microscope 1)
I know you spend a long time with each of my patients who comes to consult with you. They sit in your office, and the two of you have a long and very attentive dialog, and you tailor your recommendations and treatments to the specific needs of the individual patient. As such, I know I should take your advice very seriously when the patient comes to my office armed with that.

However, may I point out that if you recommend a medication only available in New Zealand, it won't do much good. I understand New Zealand is a lovely country, but it is quite a long trip from here, and my license isn't valid there.

Thank you for your understanding.

Warmest regards,
Dr. WS
warriorsavant: (Sword & Microscope 1)
Wednesday is usually a long day for me. My office in the morning, then my teaching clinic at JGH in the afternoon, then usually meeting with Residents after that. It's long, but usually fun.

Today had a patient with 4 lipomas. (Benign collections of fat cells, forming a lump, which is sometimes ugly, and sometimes (rarely) tender.) It's a minor office procedure to excise them. Basically, under local anesthesia, cut into them, work them out through the incision (sometimes like delivering a baby although smaller and less rewarding, but with fewer diaper changes at the end), suture closed.

The patient wanted them off. He probably figured we would make him come back at least once to do the surgery, if not 4 times. On the other hand, it was near the end of the clinic, I don't mind staying late, and I had 1 medical student and 3 junior Residents who needed to learn. Four lesions, four surgeons - perfect balance. Was hoping all 4 could work at once, but had to settle for 2 at a time. Still, all 6 of us had fun: he got to have his lumps removed all at once and enjoyed being the centre of attention; the student/Residents got to learn, or at least practice, their surgical skills, I got to supervise, kibbutz, and enjoy seeing them develop (a minor version of the satisfaction of seeing your child grow and develop). A good time was had by all.*



*Yeah, I know some ppl would consider it gross, but I do gross for a living. This is my idea of fun. I guess there's a reason I was never the popular kid. Bwahahahaha.

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