Wednesday, July 26, 2006

Funny Story 1

So a colleague and I just had a great time swapping some silly experiences in clinic. Since it's late, I'll jot down one of mine, but sometime in the future I have to write down hers too, because it was hilarious!

So as you know, we see patients in clinic. Many of them. There's a general patient pool for each clinic that is shared amongst several residents. Since there are A LOT of patients scheduled, and you don't want to be the slow resident that isn't pulling his/her own weight, there isn't time to do much else - you don't have time to write the official note for the visit, you don't have time for lunch, heck, you barely have time to go use the restroom. Which means that you see a patient, present to the attending, finalize the plan for that patient, discuss it with them and send them on their way, then hurry to see the next patient.

There isn't much time to think between patients, which works for this time of year, because if you gave me ten minutes per patient to think things through at this point in my training, I likely would not be any closer to the correct diagnosis. The other fact that I've come to grips with is that I don't know dermatology medications. In internal medicine, where I knew most of the names of medications, or at least if I came across a name that was unfamiliar, I could figure out the general category it fell under and have a broad understanding of how that medication worked and what it was for. And if I didn't even know that, I'd pull out the handy PDA and find the medication in ePocrates. Since starting Dermatology (now going on three weeks - woohoo!) it's been completely different. I've never heard of 90% of medications that people rattle off, so as they do some I'm usually subtly trying to scribble down the name to try and look it up and learn about it later.

As some of you may know, patients don't necessarily know the meds they're taking. Usually its the "little green triangular pill" or the "half black half white one" which means nothing to those of us who don't count pills for a living. And if they do happen to know their pills, they may mispronounce or say the name incorrectly. Usually when this happens, the savvy health care provider knows what the patient is trying to say. As in, if someone is taking a "water pill" and it starts with "hydro-something" you know it's likely hydrochlorothiazide.

Anyways, so I see this patient in clinic who has had psoriasis for the last several decades. He's a pretty put together guy, seems to know his disease well and know what medications work and don't work for him. As an example, corticosteroids and often used in psoriasis, and long-term use of steroids is associated with a phenomenon known as tachyphylaxis, which means that after prolonged use, the skin doesn't respond as well to the agent anymore, so you need a stronger med to get the same effect. He was able to describe this effect and explained that he cycled his medications to get around it. So I'm thinking, that's good, he's pretty sophisticated in his med use, knows what he's doing. I proceed to get his actual medication regimen from him and I get a list of several agents (that I've never heard of) and scribble these phonetically on a piece of paper. After finishing up, I leave the room, intending to try to look up some of these weird medications before talking to the attending so I have some semblance of knowing what is going on. Surprisingly, there is no line to present to the attending (there's usually a 15 to 20 minute wait) so I hurry to present the patient.

Attending: What's his med regimen?
Me: He's taking X in the morning, Y and Z at night, and switches to something called 'A' every several months. (am very grateful that I didn't forget to ask this of the patient and happy that I could say the medications without looking at the sheet)
Attending: He does X but switches to A when X doesn't work?
Me: Yep
*slight pause*
Attending: (slowly) You do know, that, X is A?? He's mispronouncing it, but A is the brand name for X...
Me: Oh... (DOH!)

3 Comments:

Anonymous Moof said...

*LOL* No wonder it wasn't working!

Now, what I'd have to wonder is who set up with that regimen, and instructed him to alternate them! ;o)

11:31 AM  
Anonymous canoehead said...

Sometimes I wish we could send the patients that don't know their own meds back home. If you don't at least bring a list you have to do the walk of shame back to the bottom of the waiting list. I keep an imaginary bat behind the door for anyone who says "Dr X has a record, why can't you get it from him?"

11:35 AM  
Blogger always learning said...

canoehead:

:D

i like that idea. Seriously though, sometimes I wonder what goes through people's minds. If you can't tell me your med list, your past medical problems, or any details beyond "i dont feel good," where do i start?? oh wait, let me get the x-ray vision goggles I stash away just for this purpose... ;)

10:15 PM  

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