“Doctor, Doctor, Give Me the News…”

5280: If you had to describe doctors in general in just three words, what would those three words be?
Dr. Internal Medicine: Intelligent—you have to be to get your doctorate—but don’t confuse that with wise. I know many intelligent people who are idiots, and most of them are doctors. Motivated—they tend to stay the extra 30 minutes to find something out and don’t need someone to prompt them to do so. And jaded. Having to reason with the unreasonable and care for people who don’t care for themselves makes us begin to lose hope and question our influence in the grand scheme of things.
Dr. Anesthesia 1: Dorky. Intense. I would think most people would say arrogant, but that’s not what comes to my mind right away. My third adjective: apathetic.
Dr. Anesthesia 2: Motivated. Fatigued. Frustrated.
Dr. Psychiatry: Compulsive. Cordial. And I’d like to think empathetic.
Dr. Ob-gyn: Overworked, compulsive, and human.

Does the hospital where a doctor works influence what you think of that doctor?
Dr. Internal Medicine: Without a doubt. When is the last time you heard someone say, “I went to Mayo Clinic and it was nice but my doctor was an asshole”? Good example: People think all VA docs are horrible, but some of the nicest and most compassionate docs I have met work at the VA.
Dr. Anesthesia 2: I’ve worked at four hospitals, and there are good doctors and bad doctors at all of them.

What’s your take on having a resident (student doctor) work on you or on your child?
Dr. Internal Medicine: I would tolerate it on myself, but on my child? Never. The average adult takes about 72 hours to die, but a kid can die in 24 hours and that makes me nervous.
Dr. Anesthesia 1: I would, but it depends on exactly what it is. Do I think, in a hospital setting, that your care benefits from residents? Yes, because they are the ones that are there all the time. At a teaching hospital, if something were to happen, the wheels could start turning more quickly. If something happens in the middle of the night at a private hospital and the doctor is at home sleeping, the care might not be as good. On the flip side, if I need to have some sort of delicate surgery—neurosurgery—I might feel better with a seasoned surgeon as opposed to someone who is just learning how to do it.
Dr. Anesthesia 2: I’ve supervised residents and I’ve been in private practice without residents. I generally think the best person to take care of you is someone who has been in practice 10 years.
Dr. Ob-gyn: Because I’m a doctor and I know too much, I would not let a resident take care of my child or me. That being said, in general, residents provide excellent care.

How do you choose your own doctors?
Dr. Internal Medicine: I have a Magic 8 Ball. No, I usually go by word of mouth, and if I don’t have a reference I just take a chance. I have the luxury of being in medicine so I usually have a general idea when someone doesn’t know what he or she is doing.
Dr. Anesthesia 2: Word of mouth is 90 percent for me. And for specific specialties, I have certain requirements. For obstetricians, I feel strongly that I want to weigh their surgical skills over other aspects of their doctoring. My underlying suspicion is that even though we’re doctors, we’re not that much more informed about the docs we choose than the lay public.
Dr. Psychiatry: Personality is huge. Bedside manner. Rapport. A doctor that knows what they’re talking about only goes so far. There is an art to doctoring.

What does a patient have to do or say to get your undivided attention?
Dr. Internal Medicine: Most of the things that get my attention are nonverbal, or the patient is not aware of them. Loud people who get quiet, complainers who suddenly don’t want to talk, or normally sharp, little old ladies who can’t remember where they are all get my attention pretty quickly.
Dr. Anesthesia 1: On an individual patient basis, it’s the patient that is the most honest with me.
Dr. Anesthesia 2: For me, it’s basically if someone is in cardiopulmonary arrest, or if that person has disease processes that could lead to cardiopulmonary arrest. That’s extreme and specific to anesthesiology. Also, if someone is really nervous, I offer a little extra TLC. As an anesthesiologist, that’s my role.
Dr. Psychiatry: The best thing for a patient to do to get a doctor’s attention is to be organized. Tell me the top three things that you need to talk about today. Talk about your most important thing first.
Dr. Ob-gyn: If a patient is very honest with me about one specific problem, then I will do everything in my power to get that resolved. When a patient has a number of problems, it normally means that no one thing is really a problem.

Do you talk about your patients with your family and friends? Why?
Dr. Internal Medicine: I talk about my patients all the time. My spouse, father, and friends are all doctors, and no one understands like a doc.
Dr. Anesthesia 1: Absolutely. Of course, I believe in HIPAA laws and privacy. If I come home and tell my wife about a patient, she doesn’t know who it is, but yeah, I do say, “Geez, you won’t believe this patient I had today.”
Dr. Anesthesia 2: It’s a healthy form of venting for doctors. One night I had a patient that, for personal reasons, would not accept certain kinds of care. I had to watch this surgery unfold and could not help this patient. I thought the patient was going to die, and I was helpless.
Dr. Psychiatry: When you have profound experiences at work like doctors do, you have to get it out.
Dr. Ob-gyn: I do it all the time. I never use specifics, but I talk to my friends and family in medicine. Most of the time I’m trying to pick their brains about what else I can do to take care of that patient. We do a lot of learning by hearing about our colleagues’ patients.

Do you ever get embarrassed or grossed out by your patients?
Dr. Internal Medicine: I can’t remember ever being embarrassed by a patient. I have been embarrassed for a patient many times, usually when the family of a patient is telling me details about their son/father/granddad’s bowel habits while the patient sits there looking at me with an expression that says, “Every day I pray for death.”
Dr. Anesthesia 1: One word: maggots. What does that have to do with medicine? What it has to do with medicine is an old lady came in with a bandage on her foot. When we undid the bandage, maggots just fell out. Seeing those little guys wriggling around really grossed me out.
Dr. Anesthesia 2: I got grossed out on a regular basis in residency. Once I had a patient who was bleeding dark, black blood from her eyes. That was gross. These days, though, it’s when I go to intubate a person and you see a tooth you could just pick out because it’s so rotten.
Dr. Psychiatry: Excessive nicotine use. That grosses me out.
Dr. Ob-gyn: It is pretty hard to gross me out. I do think it’s nice when women shave their legs before an appointment, but they really don’t need to do it. And I don’t think patients understand, at the end of the day, I can’t remember what their private parts look like even under the threat of death.

Have you ever wanted to fire a patient?
Dr. Internal Medicine: Yes, I have fired many patients. I worked at a free clinic that had a three-month waiting list to be seen. We didn’t have time to waste on people who missed appointments or abused the system. In the hospital, however, I have never fired a patient because, unfortunately, you can’t.
Dr. Psychiatry: This is a good question for me. You can’t “abandon” a patient. But there are circumstances where it’s no longer therapeutic for you to work with a patient. You need to make sure that they have all aspects of their care covered. It kind of has to be a mutual firing. You can’t just say, “Hey, this isn’t working. See you later.”

What’s the most common mistake doctors make every day?
Dr. Internal Medicine: Overprescribing medication. Giving a high-powered antibiotic for a bladder infection is like killing a mosquito with a cannon. It works, but it’s very lazy and dangerous.
Dr. Anesthesia 1: Not listening to what their patients are telling them and instead relying on what tests and labs are telling them. The way health care is these days, you don’t get reimbursed for taking a long history. But you should.
Dr. Psychiatry: I 100 percent agree with Dr. Anesthesia 1. The patient’s history is the most powerful tool that you have.
Dr. Ob-gyn: We all try hard, but we probably don’t wash our hands before and after every patient encounter. No exaggeration: If I were batting a thousand, I would wash or sterilize my hands 60 times during one workday.

What’s the worst mistake you’ve ever made?
Dr. Internal Medicine: I don’t have a moment in time where I held my hands up and said, “God as my witness, this will never happen again!” I have given wrong meds, missed labs, and discharged patients who should have stayed. I will tell you that a large majority of my mistakes were when I was being pushed by a patient: things like, “The morphine isn’t working” or “I really have to be home today.”
Dr. Anesthesia 1: Physicians are human. Some patients are more difficult than others. On obstetrics, I don’t feel like I should ever wet-tap (which means that the needle has penetrated the dural sac, releasing cerebral spinal fluid, often causing a painful headache) somebody when I’m administering an epidural. But I’ve done that. I guess I think of a “mistake” as synonymous with negligence. The difference is that there are often bad outcomes without mistakes.
Dr. Anesthesia 2: Wait? Just one mistake? (Laughs.)
Dr. Psychiatry: When a bad outcome happens, the natural instinct is to say, “What did I do wrong?” I do a mental review of my care when something doesn’t go right. That’s helpful because it often shows you that you practiced within the standard of care.
Dr. Ob-gyn: I make mistakes every day, but there are layers of protection. Thank heaven for good nursing, ancillary staff, and pharmacists—they help us catch mistakes. Thankfully, I have never made a life-or-death mistake.

What’s the biggest mistake you’ve ever seen another doctor make?
Dr. Internal Medicine: A good friend of mine is a cardiologist and was performing a heart catheterization. He took an IV line from the nurse and hooked it up to the patient’s central line, then pushed the medicine in the IV. The problem was the tech hadn’t flushed the line to get the air out and my buddy didn’t check it, which realistically wasn’t his job. But the patient got a massive air embolism and died the next day. Was that my buddy’s mistake? I’m not sure, but I know he still doesn’t sleep well some nights.

What is the best—and worst—time to go into the hospital?
Dr. Internal Medicine: Going to the ER in the morning, after 7 a.m., is the best because you will see ER docs who are fresh. Going in early in the morning, 2 to 4 a.m., is a bad idea. Everyone is tired and the internist wants to be asleep, so he might convince himself to ignore findings that might be something but would require him to do more work. Avoid teaching hospitals in October. The interns who started in July know just enough to be dangerous and are confident enough to be reckless.
Dr. Anesthesia 1: The best time to go to the ER is during a Broncos game. If you’re going in for surgery, and you have the choice, take the earliest time slot. It’s like air travel—the longer the day goes on, the more likely delays are.
Dr. Anesthesia 2: For a nonteaching hospital, I’d avoid the holidays and weekends. If you’re going to be admitted for a workup, go in on Monday.
Dr. Psychiatry: Well, not July 1. That’s when the new residents first come out of medical school.

Do you work when you’re sick?
Dr. Anesthesia 1: Physicians don’t call in sick. Not to belittle any other job where work will pile up, but if you have 25 patients scheduled that day, how or when do you fit them in if you can’t go to work that day? I did go to work one day not feeling well. I had a stomach bug. I tried to fight through it, but I had to leave the room in the middle of giving a pregnant woman an epidural to puke in the hall.
Dr. Anesthesia 2: If I call in sick there are patients that don’t get their surgeries. It’s like, “Hey, sorry that you’ve been waiting three months for your hip replacement surgery, but I’m sick.” How do you do that to someone?

Do you worry about lawsuits?
Dr. Internal Medicine: Every day. It is such a part of your consciousness you don’t even realize you do things to avoid getting sued. You write things in your notes solely for the purpose of it being there if the note gets pulled up in court, like: “Discussed Coumadin with patient, and patient verbalized understanding of increased risk of bleeding.” In what world would you discuss Coumadin (a blood thinner) with a patient and not talk about bleeding risk? Yet we write it down because if it isn’t written down, it didn’t happen.
Dr. Anesthesia 1: I don’t worry about it all that much. I feel lucky that I have the job that I have. I get to make a difference in people’s lives every day. I would never ever trade those kinds of rewards that I get out of my job for not doing it out of fear that I’m going to get sued. The thing I think about is, when is it going to happen? It’s not if. It’s when. And that’s part of the business. If you can’t deal with that, maybe you shouldn’t be in this business. Unfortunately, our society is litigious. Everyone thinks everything is curable and that there should never be a bad outcome. I’m not saying there isn’t negligent care. There is. But I would say the majority of lawsuits are unfounded.
Dr. Anesthesia 2: I’ve known physicians who’ve been through lawsuits. It destroys them. They think they’re somebody who’s helping people and then they’re accused of malpractice. I’m petrified of that.
Dr. Psychiatry: These days you can be sued even when you’ve practiced within the standard of care. You can be dragged through the turmoil, headaches, and drama of a lawsuit even when you’ve done everything you were supposed to do.
Dr. Ob-gyn: All the time. I think ob-gyns get sued an average of three to four times in their careers. Even a lawsuit without merit can wreak havoc in a physician’s career. Most doctors care a lot about their patients and their outcomes, so to have someone angry enough to bring a lawsuit is very upsetting at a personal level. We didn’t go into medicine to ruin someone’s life, and it makes us doubt our abilities to be good doctors.

Do you practice defensive medicine?
Dr. Internal Medicine: You have to. The best piece of advice I got was from a physician I worked for at a Boy Scout camp. He told me to “practice with courage.” That doesn’t mean you are reckless; it means you do what you need to do to be thorough, but don’t order every possible test so you don’t miss a thing.
Dr. Ob-gyn: Absolutely. Most of my documentation and probably 25 percent of my lab orders are simply to cover my backside. I’m not proud of how much defensive medicine I practice, but I have spent more than 10 years and hundreds of thousands of dollars to become a physician, so if a $50 test will protect my career, you better believe I’m going to order it.

What do patients not understand about being a doctor?
Dr. Internal Medicine: Every minute you take from me, you are taking from someone else.
Dr. Anesthesia 1: How many hours we really put in.
Dr. Anesthesia 2: Hours, historically and currently. They don’t understand what we gave up in our younger years to get here.
Dr. Psychiatry: That I have other things going on. That I have a life. That I’m a working parent.
Dr. Ob-gyn: I only have 10 to 15 minutes to see you for your annual visit and 10 minutes or less to see you for your obstetrics appointment. I won’t be able to address all of your issues in one visit.

What do doctors forget about what it’s like to be a patient?
Dr. Internal Medicine: Patients have no idea what is going on 90 percent of the time. They talk to us once a day, and then for the other 23 hours and 30 minutes of the day, if they are lucky, they sit in their rooms scared or bored.
Dr. Anesthesia 1: That it’s scary.
Dr. Psychiatry: We take for granted the knowledge we have, and forget the patient doesn’t have that same knowledge.
Dr. Ob-gyn: Definitely how scary it is to be a patient. It’s a great reality check to be a patient every once in a while.

What advice do you give friends and family going into the hospital?
Dr. Internal Medicine: You and your doctor are on the same team. Extend trust until you have a reason not to trust.
Dr. Ob-gyn: Everyone responds to bribery. Bring candy or food to your nurses—they will love you for it.

In Medical Terms

Docs have a language all their own.

To Crump: to get a lot sicker or to die
Circling the Drain: when a patient is slowly declining and going to die
Seeker: someone who is seeking narcotics
Celestial Discharge: death
Self-Pay: an uninsured patient, which is never a good thing for hospitals and clinics, as the majority of “self-pays” will never “self pay”
Lapfatty: laparoscopic weight-reduction surgery done on an obese patient
Autoped: when an automobile hits a pedestrian
FLK: stands for funny-looking kid
Bumcicle: a homeless person who comes into the hospital because temperatures outside have dropped below freezing
Gomer: stands for Get Out of My Emergency Room; refers to a patient that “has lost—often through age—what goes into being a human being” (quote from Samuel Shem’s The House Of God); typically an old, demented, noncommunicative patient
Donorcycle: synonym for motorcycle; often motorcycle accidents create head trauma but don’t injure vital internal organs, which can be used for transplants
SOCMOB: acronym for Standing On Corner, Minding Own Business, which references assault victims who are lying about their injuries to avoid discussing their own illicit acts at the time of the attack