Rules are Made to be Broken - Unfortunately

We in the world of academic medicine have a just a few simple rules that we hope to be followed.

1. When the weather is crap, so is clinic show-rate.  BROKEN today.

2. When a clinic is cancelled, I wish to be left alone to do whatever else I need to do, which may or may not be work related. BROKEN today.

3. If I am called while on call to come see you in the emergency room, I expect you to show up for your follow up appointment. BROKEN today.

4. Consults should be legitimate. Asking me to see your patient to evaluate for a condition which we already know the patient has does not count. BROKEN today.

I'm sure there are others, but these are the ones which stand out for the day.

What Ophthalmologists Hate About Lawyers

Had to sift through all the Jude Law pictures to find this.

Certainly not all lawyers are bad. There will be the day when I want to join a practice or contract with an academic program, and I will most certainly want my own lawer to help me iron out the finer details. But, as a physician, there is a certain breed of lawyers which annoys us more than any other.

We all know about the lawyers who dive deep into malpractice suits. We also know they don't do what they do to increase awareness about suboptimal healthcare, or to be advocates for an unfortunate patient population. After all, I firmly believe medical negligence is no more common now than one hundred years ago, except for the fact there is much more we can do for the human state nowadays and thus much more that can go wrong. True accidents, however, probably are more common only because of all the road blocks put in place from prior law suits and our so-called government.

They're in it for the money, and are there to further and to capitalize on the litigenous tendency of our society.

A particular type of malpractice lawyer is unique to ophthalmologists - ROP (retinopathy of prematurity) lawyers. There are actually folks who specialize in this. Now, tell me. Do you really think there are eye doctors out there being deliberately negligent when screening babies for ROP? Not likely. What happens is a baby is screened, the decision is made to observe rather than do laser therapy(and legitimately so based on pretty well-defined guidelines), and the poor child's disease progresses causing visual deficit. Did anyone do anything wrong here? No. It was a proper decision paired with a bad result.

And yet, we are still sued, and the bastard lawyers win on occasion. Do you really have to ask why healthcare is so expensive in our country?

Practicing Oral

 After the completion of residency, the final steps in becoming board certified include an expensive written test, followed by an even more expensive oral exam. It's obvious what the written test consists of, but let me tell you about the bazaar nature of the oral exam.

It's hosted in a hotel somewhere. A bunch of examining ophthalmologists are there, each in individual hotel rooms. As the examinee, you go into a room (past the bathrooms and beds to the little window-side work table) and sit down. The examiner begins asking questions, covering several cases over about 30 minutes. Then it's on to the next room.

Did you catch the bazaar part? How about the fact this is done in hotel rooms, the very ones the examiner stayed in the night before? This is supposed to be a very formal exam, but I think this is somewhat hampered by being in a hotel room. I hope at least the beds are made and there isn't a hooker scurrying out of the room on my way in. Do think anyone is still in pajamas?

So anyway, we (the junior residents) had a very brief practice session yesterday - one case in one room (not a hotel) that lasted 3-5 minutes at most. We were each video taped and we then conglomerated in the conference room to watch each other when the examining was done. I think we all did fairly well, but I didn't realize how soft spoken I was in this type of testing situation. Maybe next year I'll bring a megaphone.

Let's Not Make Things Difficult

Here's something you should now. If you are not feeling well, and someone happens to be examining you, please let them know when you are about to vomit.

A patient today in the ED gave me only just enough notice to this regard. And remember, as an eye doctor, I tend to examine you sitting very close, face to face with only inches separating us sometimes.

Now don't worry, I did not get spewed on today. But it was close. Close enough that I got to watch it happen, which is also not a pleasantry for me. Nor is the after effect on the breath when I have yet to finish the exam.

There Must be a Name for It

There have been many books published over time written by doctors who also happened to have a knack for writing. They have often come up with their own set of rules, sayings, constants, etc. pertaining to their experiences.

Here is one such constant. It's 4 o' clock, maybe 4:30, and in through the clinic door walks this patient as an add on/urgent care. Inevitably, the problem(s) plaguing this person is (are) not simple. Multiple people have to get involved, special tests need to be ran, and suddenly no one else is available to help.

If you've read any of the above mentioned literary pieces, perhaps you can tell me what this phenomenon has been named. If no name has been chosen, I am also open to any suggestions.

I Might Have a Chance

The Ozark Mountains - if only I could just study there.

It's funny this OKAP thing. It used to be the day would come and go. Some people studied hard for the test, some not at all. And if one did poorly on it, he or she maybe got a talking to, perhaps a gentle slap on the hand, and was told to do better next time. But then this phenomenon called "Faculty Retreat" would come around in the mid- to late-summer months, and certain faculty members would sit around and discuss how lazy or ill-prepared the residents were. Some of the most outspoken faculty members are minimally (if at all) involved with our training/education - but again, that's another discussion all together.  All the while, residents are present at the retreat but with little chance to voice a rebuttle.

So now the stakes are higher. If one does poorly, he or she must do some sort of remediation. Well no one wants to see any of us have to remediate; or at least no one wants to have to take time out of their schedule to remediate us. So now we spend a lot of time having review sessions leading up to the test (hey, anything to get out of grand rounds!).

What it has become, though, is somewhat of a pissing contest. Each facutly who is largely responsible for a particular topic, say cornea or optics or whatever, wants the residents to do the best on that section. I think there have been more review sessions this year than in past years. With all of them to attend, I might have a chance to average out okay in the end.

I need to do well. Firstly, to rub it in the faces of the above mentioned facutly. (Don't get me wrong, I like 99% of the faculty, but there are always those couple. . .) Secondly, wanting to go into oculoplastics, I need to do well. No, wait. I need to do fucking awesome.

Not Sure if I Could Do It

My day of work is done. I have gone for my jog and eaten dinner. The little one has gotten her story and has been tucked in for the night. So now it's time to sit down and study for that OKAP. I've mentioned it before, and you best be prepared to hear it mentioned in the future.

If you know me at all, you know I'm interested in oculoplastics. This would entail a two-year fellowship after the completion of residency. How that whole process works is an entirely different discussion. Suffice it to say, I have to be prepared with a backup plan. I've always thought that if the oculoplastics thing didn't work out, I would seriously consider doing a cornea fellowship. I have experience with the tissue bank and I think I would enjoy being a corneal surgeon.

Which brings me to the point. I'm focusing this week on cornea and anterior segment diseases in studying for the OKAP. And then I sit back and wonder, having to learn all this stuff, could I really become a competent corneal specialist?

I just don't know.

What's With This Test?

With lots of things to discuss, let me just start today with that which is most pressing - the OKAP. This is supposed to be an "assessment tool" in regards to our current progress with learning the required material.

All of this material, that is. The desk where I make my best attempts at studying.

This all occurs on April 16th - a Saturday. Two hundred questions about things I may have learned. Or not. This of course to be followed by a [drunken] post-OKAP celebration.

Who cares? After all, the Academy states that this test is an assessment tool for resident progress only, and should not be used in the evaluation of fellowship candidates (very nearly their exact words). The fact is, fellowships ask questions - lots of them. They're going to want to know if I bombed the plastics section of the test.

So back to it.

Although, I do need an oil change and a haircut. Hmmm. . .

The Return

After a nineteen-month (or so) hiatus from this, and after much forethought, I have decided to revive this blog. I mean, things have changed immensely since then. At the writing of the last entry, I was barely starting my dreaded intern year. Now, I am nearly finished with my first year of ophthalmology.

Things are different now. My goals are the same, but their immediacy and importance have changed. Mia, who was then a small baby, is now a dominating toddler. Rachel is far more advanced and engrossed in her blogging hobby than she was then - which I think is pretty cool. I have since remodeled (nearly) our master bathroom and kitchen.

My goals with this blog are also different. I intend to write more frequently (duh), but perhaps with more actual focus on my career. There are many things to discuss; some things are very behind-the-scenes and others not so much. The fellowship deal is just around the corner, and I know within a few blinks of an eye, residency will be over. Why not comment on its progression in the meantime?

Hey, it's better than playing computer games all the time as an excuse to take "breaks." And aren't the changes pretty cool? I thought so.

A New Academic Year

I have returned to blog. I know you've heard it before, but allow me to apologize for the blogging drought. Been busy you know.

Since my last blog, let's see now. Graduation - it was fun, a big shebang and caboodle about a bunch of peoples' life achievement known as medical school. I have always felt that much of the ceremonial stuff is a bit antiquated, especially if we go to socialized medicine where doctors have no autonomy and can't practice the art of medicine as they were trained (another discussion all together), but I'm sure it is nice for the family and friends to come see it all. Many of them see the whole process and think, "Gosh, I could never do that!" Truth is, most of them probably could. Anyone who spends that many years training to become a member of a profession is gonna know his stuff. Much like a long-time plumber knows his shit. OK, that was a bad one, but here I am sitting in an endocrinology work room bored as hell. Anyways, what else?

Then there was vacation. It was a great reprieve from this year's opening events - you know, the whole Mia situation. Though she is doing great, we needed a break after all. It started with a graduation party at my parents' house. My sister was graduating from high school, my brother from college, and I from medical school. Party worthy? I think so. Then we were off to a cabin hidden away outside of Eureka Springs, AR. It was a 5Bed/3Bath cabin on top of a hill with a great view of the White River, on which I fished a few times. Only one very minor emergency room visit, which could have easily been avoided with a tube of lube. Before you get any ideas, Mia's G-button came out - an extremely common complication with such a device. But a little lube goes a long way in getting one back in, and of all things, that is the one thing we forgot. Got a massage, did a little shopping around, jet skied, and most importantly, relaxed. For when we came back, the move.

The move went without a hitch. A very smooth process. We got back and that very day, we were surprised to find out the previous owners would be gone by that afternoon. So we rented a UHaul and began moving that evening. Within 24 hrs, the rental truck was back at its home base, and 48 hours after that, we were done with the rental house. It was sad in some ways to leave that house - out in woods, total privacy, all the firewood one could possibly want with space to actually burn in outside, great "neighbors," and a very helpful and understanding land lord. But the time was right to buy. We got into a house with essentially no money down with money earned in our pockets. The $8,000 of government money paid the down payment and we still had $2,700 left to spend. Then the fun started.

The roof was in need of repair. To our luck, the insurance company decided to pay for it. But they would only do so if it was a complete tear off and re-shingle job. "OK," we said, "That's even better!" It's what our roof really needed, I would've been surprised if a simple lay-over job lasted 10 years with the condition of that old roof. The guys who came to start the job started on a morning when an obviously ominous-looking cloud was rapidly approaching. And what do ya know, it started raining. Heavily. They already had much of the back side of the roof stripped clean off when it started. But they were too dumb to have A) put new felt paper down over the decking, and/or B) have enough tarp to cover the bare decking in the case of rain. Their solution? Go stand by the car and smoke until the rain stops. WTF?!? Naturally, my wife called me 8:30 in the AM to tell me it was raining on her head - in bed. All three bedrooms, the only carpeted rooms in the house, had rain leaking into them. And plenty of it. I had to call the head roofer (even though he was supposed to be on site at 0530!) to get his ass out to the house with more tarp and a solution to the problem. Then the carpet restoration guys had to dry everything out and clean the carpets. Then the painters had to come and fix the ceilings which thankfully didn't have to be frankly replaced. And the whole time it was nothing but excuses for what happened. Everything was finally completed yesterday, 3 weeks after it all started. Bastards.

Other than that, the house is coming along great. The baby's room was first, followed by the hall bath, then the master bath and bedroom, followed by the living room/entryway/hall. I'm finishing the trim in the hall now. Got a plumber to come fix our obscenely high water pressure and water heater issues. Next we will do the office/future guest bedroom. The kitchen, well that will happen in November if we are very lucky, or next May at the earliest. That's a much bigger, more expensive project to tackle, and I need a stretch of time off to do it since I will be doing the work. No more contractors, thank you. The roofer was one too many. I won't even go into all the yard work I am either doing now or want to do. I refer you to a couple blogs ago for pictures of the house before we changed everything. As much as I would love to post pictures, I am having a difficult time uploading them at this time. Maybe later.

Oh, and my intern year. Yeah, that started too. July 1, 2009. I really don't have a work excuse for not blogging; it's been easy so far. I started in the ER at the VA (except for the first few days and weekend of the month when I got pulled to work on the ward to cover for a foreigner who was not in the least bit prepared to start his internship since he literally got off the plane the day before orientation. I have issues with the sheer number of foreign medical trainees in this country when so many of our own American students didn't match this year. But that's a whole different subject and question of how that even happened). In the ER, I worked 8-5, M-F. No weekends. No call. No overnights. Easy for an intern, right? Other than I had no idea what the hell to do in most situations for at least the first week. Now I am on a consult service. Again, 8-5 (or 4 or 3), M-F, no weekends, no call, no overnights. Again, easy, right? Sure, but here's the problem. We get four "easy" months for the year, 3 of which we can take a week of vacation. I am getting two right off the bat. Any takers on what that means for the future? My September through next June schedule sucks, especially after January. Oh well, I can ease into things only to get smacked around a bit later. I have a week of vacation this month, one in November, one in December/January for one of the holidays, and one in May. That's four weeks in my first year of employment - so I can't complain too much. AND I'M GETTING PAID! Hmm, that's different.

So what about Mia? She is doing great. She continues to see one of her NICU docs on an outpatient basis. He's a great, very nice doctor, but seems a bit hesitant to change certain things. On the other hand, much of what needs to change with her, particularly in terms of her feeding, is dependant on her response to therapy. No one can drive that change but her. (Does that sound too Obamaish?) She has been doing oral and physical therapy for a few weeks now and is making reasonable progress. She starts at a therapy-based daycare on Wednesday, which will be wonderful for her, but perhaps more difficult for her mom. Rachel has enjoyed much well-deserved time off with Mia since April 23rd. That all changes on Wednesday. Back to work, as they say. In the long run, the extra money is much needed for all the improvements we still want to do to the house, and she needs a new car. We'll see how the first month back goes. Pictures below:

TTFN

Signed: Bradley A. Thuro, M.D. Sorry, I had to. I'm really not cocky, rather modest actually. You won't see that every time, I promise