Sunday, September 20, 2015

Why don't patients remember your name?

It's simple: you don't look at them

A patient comes in, and you vaguely introduce yourself while sitting down to your computer (not looking at them), ask them what brings them (not looking at them), ask about their medications (not looking at them), ask about their pain (not looking at them). You turn around and look at them for the exam, but are you? You are looking at the aspect that you are inspecting / auscultating / palpating / precussing. You are not looking at them.

This is not a piece arguing against the use of computers during patient visits, it's a commentary about how the culture of medicine, particularly specialized medicine, is changing such that it is okay to not afford someone the basic respect of seeing them.

Why does this happen?

Part of the problem is that we function in a broken healthcare framework: a system that incentivizes piling up patients, double and triple booking them, to maximize profits because clinic visits don't pay as well as procedures. So providers can frequently be booked to see more than 30 patients in a day. For only 30 patients, in a normal eight hour day that's 16 minutes per patient encounter -- that's working straight, without a lunch break, time to write notes, or run to the restroom. This invariably leads to provider frustration, fatigue, and just "wanting to get the job done."It is an impossible system that needs to be fixed.

But part of it is a culture problem. Somewhere along the way, in large part because of the system we work in, we forget that most of us went into medicine for the love of the science and the people.

Looking at someone provides them agency and respect, and allows you to indicate that you are listening, allows you to convey empathy, concern, and interest in what they are saying. It is why we teach children to look someone in the eye when they speak. It is treating someone as an equal, another human being, and that in and of itself is healing. It is a subtle but real treatment we as providers can give every patient -- the opportunity to be seen, to be looked at, to have their words respected, and to perhaps leave with some relief that they were heard.

Maybe this is because I am coming off of my geriatrics rotation, but now when I see older patients coming into clinic I wonder if this is their only outing for the day. I wonder if they had a challenging time getting here with a walker, a cane, with diminished vision, and slower response times. I wonder how it must feel to have someone who is less than half your age speaking faster than you can hear, not looking at your when you speak, and pecking away at their computer for most of the 15 minute visit. I wonder at what point in my training will I stop wondering about that and just want to power through patient after patient?

I'm not suggesting anything radical. I'm simply saying that when you come into a room, look at the patient when you introduce yourself. Look at them when you ask a question, look at them when they give the answer. Type away in between, maybe explain that you're going to use the computer. These are simple things you can do in the 15 minute window you do have. Just, remember that looking at someone is part and parcel to making them feel better. Maybe then patients will remember our names.

Friday, September 18, 2015

And May The Odds Be Ever In Your Favor...

And they're in! Applications that is. Actually, they went in two days ago (9/15/15). Yep, I typed that whole date out. It's a date I'm going to remember. Four years. Remember this post when I started medical school? I do.

The details are fuzzy, I honestly don't remember the white coat ceremony well other than we had to wait in line and it was hot. But I remember getting my picture taken for my ID. I was so nervous--not because of having my picture taken, but that it was getting a medical school ID. After the worrying, and the applications, and the what not, I'd get a tangible piece of something saying I was a medical student.

Then I remember taking pictures in front of the school with my mom and Tyler and my dad in my white coat. I remember wondering what kind of doctor I'd be.

So now to wait for interviews, then eventually rank lists, then match day. This is the song that I keep playing in my head. Catchy.

Thursday, September 10, 2015

Camping and Camping Food

One of my goals for this summer is accomplished -- camping! We went to Otter River State Forest near Sterling, MA on a Friday. It was definitely the most "organized" camp site I've been on, with a lot of spots, pretty close if you're looking to "rough it" this is definitely not the spot to go. But they allow pets, the sites and reasonably sized (fit a four person tent, a car, a fire pit, and a picnic table), and there's swimming...though we didn't partake in that particular joy because it was a bit too crowded for my taste. I'd definitely recommend it for a weekend getaway for someone who is interested in camping/getting away but doesn't want to go somewhere too remote.  

Our tent
Circle of trees
That view
Either way, it was pretty fun. Friday we got there and made an awesome dinner with our camp stove of cilantro tofu with cheese and Arriabata sauce from TJs. We took our big dog with us and made our lives much easier by investing in a spiral pet stake, which we put in the ground first thing, hooked Rain up to it, and let her have "free" run of the site. Next day we got up early, made coffee with our aeropress, packed up our stuff, and hiked up Mt. Wachusetts. All in all a medium hike, definitely possible for beginning hikers.
of puppies and more puppies
I recently invested in hiking shoes, and they made a world of a difference in my hiking. My feet hurt less at the end of the day, my ankles didn't roll as much and as such hurt much less, and I was way more stable walking which is super important. Anyways, it was beautiful up at the top, and my favorite aspect was the windmill "farm." They have two windmills near the top of the mountain, and you can get pretty close to them. The quiet coupled with just the sound of the windmill is pretty awesome.
Then the piece de resistance, pizza. We made campfire pizza. Easy, peasy, lemon squeezy. Trader Joes pre-made pizza dough, arriabata sauce, some peppers, some pickles (we had leftover pickles so I thought, why not?!) and some cheese. Man alive was that pizza good. 

For the pizza dough, we floured it, and then cut it into four parts, so that our pizzas would be small and thin, and we rolled them out as thin as we could.
Trader Joes Pizza Dough

1/4 of the dough rolled out thin
We used our cast-iron skillet, coated in some oil, heated it over the campfire, and when it was hot, we put the pizza dough on it to cook and removed the cast iron from the heat (the residual heat will cook the pizza)
cast iron skillet heating on the fire
It's cooking
Flip it a few times
After the dough was mostly cooked, we topped it with pizza sauce, cheese, and toppings (light on the sauce so you don't get a super soggy pizza), and finished it on the stove top. You can definitely finish it on the fire if you want, you'll just have to watch it carefully to make sure it doesn't burn. 

Add caption

Finishing it on the fire

Puppy wanting food!
Finished product!
Bottom of the pizza!
Full and happy bellies!
Super fun, I'd definitely recommend it for your next trip, and if you don't have a cast iron pan, I'd recommend investing in one -- it's one of my few kitchen must-haves because it's so versatile! 

Summer Goal 2015: Camping at least once, ACCOMPLISHED!