Preparation isn’t panic

April 29, 2009 at 1:44 pm | Posted in Uncategorized | Leave a comment

Here’s my obligatory post on “swine” flu.

1. There are currently 90 or so confirmed cases in the U.S. and one death as of this morning.
2. There are probably many more cases of the regular seasonal flu out there right this minute, with numerically far more deaths occurring from that cause.
3. At the current rate of transmission, it will be at least another 10 days, and probably longer, before swine flu becomes a widespread public health issue.
4. Very likely the rate of transmission will drop off, due to the currently recommended public health measures such as staying home with a single caregiver if you’re ill, environmental decontamination, canceling school and school events in the event of a cluster of cases, and diligent handwashing.
5. Three isolated cases of swine flu had been identified earlier in this year’s flu season, in Iowa, Texas and North Dakota, with no documented human-to-human transmission.
6. The normal death rate from flu is 0.1%.
7. The death rate among confirmed cases of swine flu is 4% worldwide, 1% in the U.S.
8. The one U.S. death was a toddler with underlying health issues brought here from Mexico.

So while there’s certainly cause to be prepared for a pandemic, it has certainly not become one thus far, and with the public health measures noted above, may never do so. And those public health measures are things everyone can do.

Ad absurdum

April 28, 2009 at 7:45 am | Posted in Uncategorized | Leave a comment

Followed a link this morning, and found a whole host of new blogs and interesting topics. Chief among them, this one, with a post about nepotism. This is a topic near and dear to me, not least because 4 out of 5 of my summer/after school jobs throughout high school and early college were a direct result of it. Continue Reading Ad absurdum…

Everyone and their dog

April 27, 2009 at 6:43 am | Posted in pharmacy | Leave a comment

I strongly suspect that the store I worked at over the weekend has been unwittingly but routinely diverting narcotics. Continue Reading Everyone and their dog…

Hilarious!

April 23, 2009 at 6:14 pm | Posted in Uncategorized | Leave a comment

I get to post this, because I’m from Texas.

Oooooo, does that make me a douchebag? I hope so. I’ve got a long list of people I’d love to give a piece of my mind.

Regrets

April 22, 2009 at 10:49 pm | Posted in Uncategorized | Leave a comment

Well, I have an interesting problem on my hands at the moment. My training license application asks if my medical education or training was extended for any reason. I could truthfully answer no, except that the piece of fiction that is my MSPE says that it was. And my transcript says I repeated OB/GYN.

But neither of those things are true. And I’d just as soon tell the truth, since that’s easier to remember from one telling to the next and, conveniently, is also internally consistent, even-handed in its portrayal of the major players, and believable with respect to what we all know of human nature. As the truth tends to be.

But the committee never heard the whole story, because the Dean cut me off in the middle of it, at a point where I knew there were still too many unanswered questions for them to make the right decision.

I hate that I’m in this position now. Seriously, if I had it do over again, I would have refused to let myself be pressured into what I knew, even then, was an expedient but wrong and unjust solution. And quit medical school rather than accept anything less than a decision fully endorsing my explanation of events.

I’d certainly be no worse off at this point.

Doppelgänger

April 22, 2009 at 10:17 am | Posted in pharmacy | Leave a comment

A recent conversation at work in one of the tiny peninsula towns:

Customer: I know we’ve met somewhere before.

Me: I promise you, we haven’t. I just look remarkably like every other Nordic person you’ve met around here.

As a matter of fact, I worked with a tech out there who could have been me, ten years ago. Then I gave her my credit card to go pay for take out (I can’t legally leave the pharmacy without closing it, and I must have skipped class the day they taught us how not to need food, water and bathroom breaks). When she came back, she remarked that I had the same last name as her grandfather, which weirded me out even further.

— Jill

Gee, sounds like you need to see a doctor

April 22, 2009 at 1:36 am | Posted in pharmacy | Leave a comment

I’ve noticed something lately about the way I practice pharmacy these days: I’m a lot more likely to tell people to go see their doctor than I was before.

Is that a good thing? I don’t know. I also don’t give medication doses for children under age 2, unless their pediatrician specifically said to ask me. To me, that’s practicing medicine. The way I see it, in my role as a pharmacist dealing with the public, I’m allowed to recommend OTC drugs at labeled doses for low acuity or self-limited diagnostically clear problems.

In other words, if my differential includes at least one probable diagnosis that isn’t easily excluded by a history or fully clothed inspection/light palpation, or requires a prescription or procedure to treat, and delay of treatment would significantly worsen its prognosis, my duty is to refrain from offering advice on self-treatment, and instead advise them to see their own doctor.

More knowledge = less advice to self-treat. I confess, though, sometimes I forget how much stuff is available OTC now. I used to be very creative at finding OTC ways to treat things. Now I mainly think of what tests I’d order and the ideal way to treat, which is usually by prescription or involves a procedure where I’d need sterile equipment, etc. But there may well be an adequate OTC option out there, that I just didn’t realize was available. This hands-off approach is probably best from a liability standpoint, since people can easily look up my name with the state’s department of health and see that I’m also a physician, and think that any self-treatment recommendation I make means they don’t need to see their own doctor. However, it makes my advice (or actually, lack thereof) very disappointing for pharmacy customers these days.

So my pharmacy degree has helped me somewhat to be a better physician. Maybe not a better surgeon, but certainly better at treating the random patient complaint. But my medical degree has certainly not made me a better pharmacist. At least, not in retail pharmacy.

Sun-atics

April 21, 2009 at 7:56 am | Posted in Uncategorized | Leave a comment

It’s been sunny here in Seattle, which means no one here is working, if they can at all avoid it. And those who can’t get out of work entirely are all scheming how to leave an hour or two early. Up at the hospital, there will be at least one team having an afternoon running-of-the-list out in the courtyard. Probably one of the surgical services, since all the medicine teams will probably have gotten the hell out of the hospital already.

Seriously, this town goes sun-crazy every spring. Everything comes second, on a sunny day here, to spending time outdoors. In the south, sunny days are also usually intolerably hot and humid, and people start wearing coats as soon as the temperature falls below 70. Sunlight is everywhere all year, and in summer, relief from the heat is the priority. So when I first moved here, in May of the year before I started med school, it seemed both bizarre and hilarious how frantically people would try to get their work done on a sunny day, just so they could leave an hour earlier. People would be talking about how hot it was outside, while I was still shivering in long sleeves.

A year later, it was a different story entirely. Over 45 degrees, I don’t need a coat. When it hit 55 degrees, I broke out the short sleeves. 65-75 was perfect, and at 85 I was uncomfortably hot.

Then I went to New Orleans, Houston’s batty but endearing old great-aunt with exactly the same weather genes. Back to the heat and humidity. Which wasn’t nearly the shock that its culture was, since I’d lived in Houston most of my life. Because of the humidity, the heat feels hotter, and the cold feels colder. August, September and October are unbearable, as are February and the first half of March. The rain comes in afternoon torrents, so heavy you can’t see the tail lights of a car more than a car-length or two ahead of you, and then is gone. Even so, New Orleans weather is actually more extreme than Houston’s.

So it was actually nice to move back to Seattle, where the rain is monotonous but not dangerous, and the city is well-maintained and the environment aesthetically pleasing. The snow this year was a bonus, not to mention that it was very entertaining–as long as you didn’t have to drive in it with all the Seattle snow n00bs (myself included).

Well, it’s a sunny day today, so I’ll have to wrap this up now and get outside while there are still some rays to worship.

Brief hiatus

April 12, 2009 at 4:58 pm | Posted in Uncategorized | 7 Comments

Please pardon the brief lack of posting. Things got interesting all of a sudden, and everything I write seems a bit unfit for posting right now. I promise to back at it regularly when I have something more definite to write about.

Let’s get this straight

April 12, 2009 at 2:03 pm | Posted in neurosurgery | Leave a comment

Someone recently made a comment to me that’s been rattling around in my head these last couple weeks. It’s sort of like when someone gives you a backhanded compliment out of the blue, and a moment later you’re thinking “wait….what exactly did you mean by that?” Except it wasn’t a compliment, just a random observation/piece of advice for which I can’t fathom the reason.

The advice was not to concern myself so much with sucking up to my pharmacy colleagues, and to focus instead on making connections and impressing people within the neurosurgery field instead.

Now, part of this is entirely valid: I haven’t been doing enough networking in neurosurgery. I should be going to grand rounds, meeting the people who visit and getting to know them.

But my failure to do this is not at all an attempt to suck up to people in pharmacy. I am not trying to establish myself as part of the political scene in academic pharmacy. It might not be too difficult, given my credentials. But I’ve learned my lesson, and I’m very clear these days with my pharmacy colleagues that anything I do in pharmacy is either to meet basic needs for food, shelter and a good credit rating, or to pay for things that further my career in neurosurgery.

I did renew my board certification in pharmacotherapy. But that’s the kind of thing you don’t let slip away if you can at all avoid it, even if you leave the field entirely. It actually expired during internship, and the board contacted me to offer a one-year extension and an exception to their normal test registration deadline for recertification. So all I had to do was explain why I didn’t recertify when I was due (which was a very good excuse, you have to admit), pay some money, show up and pass.

So what was this comment about, really? The only thing that comes to mind is that people may think I’m avoiding a particular neurosurgeon because of a particular pharmacy colleague. It seems a bit far-fetched, but who knows? My behavior’s consistent with that, but the reason is very different.

To the extent that it’s even my business, what I know about the situation is third-hand at best, and I’ve seen enough of the world to know that it’s a story with at least two sides, probably three or four. I may nod and make sympathetic comments when my friends discuss it, but I’m also thinking to myself that there’s got to be more to the story, because it sounds to me like the typical way in which long distance relationships end. Or at least, the ones that were probably going to end at some point, anyway. But to say so out loud is just pouring salt in the wound.

I’d be willing to bet that some of my own relationship casualties are even more gruesome. The only difference is that mine were all among people I don’t have to deal with every day any more. So while I might be a little more guarded in getting to know the subject of this kind of gossip, it’s far from enough reason to avoid doing so. In other words, nice to meet you Kettle.

In reality, what I’m mainly concerned about is avoiding any special treatment, and avoiding any perception that I’m getting special treatment. My training depends on unvarnished feedback about my performance–being taken to task when my work is subpar, and praised when my work is good. This was the case on the November rotation, but in February I don’t think that was happening. So the real problem here is that while it’s best for me to avoid such a situation, I don’t actually want to discourage it, and in fact on some level would enjoy and appreciate it. It’s a situation that has no good solution, so I ignored it. I didn’t know what else to do. In fact, it may no longer even be an issue at this point.

Anyway, if that’s not what the remark was about, then I have absolutely no idea.

Edited 4/15/09

April 5, 2009 at 10:22 am | Posted in neurosurgery | Leave a comment

I forgot to mention in my previous post that the manner in which this opportunity came to me strongly suggests some behind the scenes phone calls. So whoever made them (as well as the ones that didn’t manifest in a job quite so fast), thank you.

Next

April 4, 2009 at 3:17 pm | Posted in neurosurgery | 8 Comments

Good news: I have a job in neurosurgery.
Bad news: I have to move.

Good news: cost of living is cheap there.
Bad news: there’s a reason for that.

Good news: there’s great skiing nearby.
Bad news: it’s not within the hospital, which means I’ll probably never see it.

Good news: it’s closer to my family.
Bad news: it’s still too far away for that to make any difference.

Good news: there’s nothing to keep me here.
Bad news: there’s nothing to keep me here.

That’s the sum of what I know right now. The rest is a big question mark. Since the answers wouldn’t matter, I didn’t ask. My goal is to work hard, learn as much as possible and make the most of whatever opportunities exist wherever I am. There may not be many, but I’ve certainly done more with less in other situations. So we’ll see how it goes.

99 cent fix

April 3, 2009 at 9:34 am | Posted in Uncategorized | Leave a comment

It truly sucks to work in 4 different pharmacies in one week. All of them requiring 30-90 minutes of travel time each way. There are some updates due, but you’ll have to stay tuned for this weekend.

On a side note, how in the world did I live for so long without an iPhone?

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