bits, bobs, this, that, and the other.

chf: congestive heart failure. your heart is a pump. when it doesn't work so well, fluid backs up in the pipes behind the heart and you get fluid in your lungs or swelling in your legs, amongst other things.

there was an interesting/silly article in the nytimes a few days ago about facebook and the odd position one can get into when deleting friends. it made me wonder if i should defriend the 2 residents from my program who friended me basically so they could ask for favors. one guy wanted me to change vacation time with him, and the other wanted to swap my ccu and medicine floor month. neither worked out, or i should say, i didn't want to do either, but now i am left with these 2 "friends" who aren't really friends. i can't help but feel that they befriended me in a effort to make it harder for me to deny my request. they easily could have emailed me--my email address is firstname.lastnmae@_____.edu. they obviously have my name since they found me on facebook. it's easy to say no in a faceless email, but perhaps not so easy to deny a "friend." fortunately, i am impervious to such chicanery, and these folks are no longer my "friends."

a while ago i mentioned that i would reveal my method for faster pre-rounding, so here it is: i don't actually see all my patients. this isn't a big secret, since i am pretty sure many other interns do this, although i don't think many of them will admit it as openly as i do. rounding is when the medical team walks around and sees and discusses each patient and then informs him/her of the plan for the day. pre-rounding takes place before this and consists of the intern gather vital signs, lab results, and other information from overnight, and then physically seeing and examining the patient so that when it comes time for real rounds one has all the pertinent information.

this might seem like a lot of work, and it can be, depending on how sick the patient is and how much data there is; pre-rounding on icu patients is both necessary and time consuming as there is far more going on with them as they are actaully sick and have the potential to die quickly if ignored. the same is not true on many inpatient medicine patients. they might be ill, but generally they are not circling the drain like icu patients. you would be surprised at how frequently people get admitted who really have no need to be inpatients. even more surprising is the fact that many people, even if they had a legitimate reason for admission, often resist discharge once they are better. furthermore, there are often people who remain as inpatients to receive treatments that they cannot easily get as an outpatient--such as iv anitibiotics--or who are simply awaiting a bed at a rehab facility, nursing home, etc.

those last 4 groups of people are not generally actively ill, so i don't really feel that i need to see them at 6am. i do eventually go back and talk to them examine them, etc., but i don't do this in the early morning, before rounds (unless something happened overnight). right now i have 8 patients and 6 fall into one of those aforementioned categories. so when i get to work i just right down their vital signs and lab results which takes about 1-2 minutes per patient. i see and examine the other 2 which, takes up to 10 minutes. all together this take less than 30 min, but if i gave everyone the 10 minute treatment, it would take me an hour or more to pre-round. this would quickly lead to sleep deprivation, more medical errors, increased crankiness on my part, and generally bad outcomes for everyone.

it's a good thing i'm so pragmatic and forward thinking.