Happy 4th of July! PGY 39, Day 4
Yesterday brought worries to the surface of the interns. Let's see what today brings. So far, there are no panic calls. Yesterday, there was contained panic.
Dr. Mike
Today the newbies chilled out a bit, because they are getting familiar with our system. We have had some remarkably good outcomes with some remarkably sick patients over the last week. Good care works for all, and is generally appreciated by the patients and their loved ones. But, the barriers and burdens are growing like weeds in an untended garden, and the bottom line is that these factors are detracting from the joy that used to be and should be a normal part or the healing process. There was a sort of holiday barbecue in the house today. Folks brought some things in for lunch. I bought a couple jugs of coffee from Panera Bread and some listening gear ... ears. Morale is down. I asked, "why?" Answer: "Morale is always down." Others had something to say. Listening to them between patient care activities, as they expressed their disappointments, particulary with regard to the way things have changed for the worse. My conclusion is that most are unhappy with the factory atmosphere and pressures that interfere with their patient care time ... disregard of the human factors. We all feel it and find it discouraging that we spend more and more time with computers. All of this is unnecessary, because a proper interphase with the computer should make it easier to spend more time with the patients and less time with the computer. It is a fault of the computerized medical record vendors who fail to recognize and simplify this component of their systems. We talked a bit about some research that could be done to quantify these problems ... Patient care topics today included, among other things, 1. Pulmonary Emboli, Saddle Emboli, therapeutic options and prevention with inferior vena cava filters 2. Cerebral Salt Wasteing and SIADH 3. DI 4. Post Cardiac Arrest Syndrome (Circulation, October 23, 2008) 5. Traumatic Brain Injury 6. Blood Sugar Control 7. Euvolemia 8. MOSF and MODS 9, Acute Renal Failure 10. Alcoholism and Withdrawal: Treatment with Alcohol 11. Drug Administration: avoidance of complications due to simultaneous multiple drug administration 12.Treatment of Seizures and Status Epilepticus 13. Prevention Diagnosis and treatment of Pneumonia 14. Postural Drainage and Chest PT 15. Evaluation and Treatment of Abdominal surgical emergencies in patients with brain and spinal cord injury 16. Diagnosis and Treatment of Acalculous Cholecystitis. As I was rounding and wrapping things up with the night crew we had an emergency admission. This patient required emergency care for a catastrophic acute deterioration in clinical condition. We pulled the patient from the brink, a care plan was established and, once settled in ... for the moment, I left him in good hands. I am exhausted, but the night is not over till 8 AM ... Dr. Mike
Today the newbies chilled out a bit, because they are getting familiar with our system. We have had some remarkably good outcomes with some remarkably sick patients over the last week. Good care works for all, and is generally appreciated by the patients and their loved ones. But, the barriers and burdens are growing like weeds in an untended garden, and the bottom line is that these factors are detracting from the joy that used to be and should be a normal part or the healing process.
ReplyDeleteThere was a sort of holiday barbecue in the house today. Folks brought some things in for lunch. I bought a couple jugs of coffee from Panera Bread and some listening gear ... ears. Morale is down. I asked, "why?" Answer: "Morale is always down." Others had something to say. Listening to them between patient care activities, as they expressed their disappointments, particulary with regard to the way things have changed for the worse. My conclusion is that most are unhappy with the factory atmosphere and pressures that interfere with their patient care time ... disregard of the human factors. We all feel it and find it discouraging that we spend more and more time with computers. All of this is unnecessary, because a proper interphase with the computer should make it easier to spend more time with the patients and less time with the computer. It is a fault of the computerized medical record vendors who fail to recognize and simplify this component of their systems. We talked a bit about some research that could be done to quantify these problems ...
Patient care topics today included, among other things,
1. Pulmonary Emboli, Saddle Emboli, therapeutic options and prevention with inferior vena cava filters
2. Cerebral Salt Wasteing and SIADH
3. DI
4. Post Cardiac Arrest Syndrome (Circulation, October 23, 2008)
5. Traumatic Brain Injury
6. Blood Sugar Control
7. Euvolemia
8. MOSF and MODS
9, Acute Renal Failure
10. Alcoholism and Withdrawal: Treatment with Alcohol
11. Drug Administration: avoidance of complications due to simultaneous multiple drug administration
12.Treatment of Seizures and Status Epilepticus
13. Prevention Diagnosis and treatment of Pneumonia
14. Postural Drainage and Chest PT
15. Evaluation and Treatment of Abdominal surgical emergencies in patients with brain and spinal cord injury
16. Diagnosis and Treatment of Acalculous Cholecystitis.
As I was rounding and wrapping things up with the night crew we had an emergency admission. This patient required emergency care for a catastrophic acute deterioration in clinical condition. We pulled the patient from the brink, a care plan was established and, once settled in ... for the moment, I left him in good hands.
I am exhausted, but the night is not over till 8 AM ...
Dr. Mike