no. 13, sub-section b, paragraphs 2-6:

i apologize for the silliness of my prior posting; i was so filled with regret that i decided that i had to rectify the situation. rather than deleting the aforementioned abomination, which would be the humane thing to do, i have opted to leave it visible as a reminder to myself of what jackassery i am capable. (of note, none of the preceding statements apply to the chewy picture, which, of course, is awesome.)

so to make up for it, i will quickly describe my current work assignment: i have spent the last 2 days on inpatient medicine (herein "medicine"). exactly what this entails is sometimes difficult to understand for those not in the medical field. it is basically what most people think of when then hear "my mom is in the hospital." if you have a run-of-the-mill illness, you go to a basic medicine floor--think pneumonia, chest pain, urinary tract infections, asthma flairs. what it is NOT: surgical patients, intensive care unit work, etc. the patients are too sick to be at home, but they probably aren't about to die either. often patients are admitted not because the are really sick (ie, near death) but rather because the treatment is not something they can get as an outpatient (ie, at home) such as IV antibiotics, IV pain medications, continuous nursing care. people will also frequently get admitted to "rule out" something gnarly, such as a heart attack.

in the coming month there will doubtless be numerous rants about the difficulties i encounter for no other reason than "that's the way it always been," but today i will start with something that riles me quite severely: the amount of time i am forced to be in the hospital compared to the amount of work there is to be done.

right now i have 5 patients under my care. i got to work at 7am and went home at 4p; not too bad, right? it isn't so bad until you consider that, given the amount of work i had to do i could have left by noon, probably sooner. even if you tack-on a few hours for pure learning, i could have been home by 1pm. what is most enraging is that one might spend 15 minutes on three unique occasions discussion the same issue, and still not arrive at a decision. multiply this by 12 patients and you can see where the time goes (i say 12 because while i have 5 patients, the other intern on my team has 7).

as i said, i walked through the hospital doors at 7am; by 1030am, i hadn't done a single bit of actual work. i had talked about doing work, but had not actually accomplished anything. if i had been in the ED for the same time period, i would have seen and been in the process of working up approximately 5 patients. this number is not arbitrary, it is based on historical data from the ED in which i work. interns see approximately 1.4 patients per hour. granted, i think the ED is overcrowded/understaffed, but still, it is an example of what one can do in a given time period.

let's do some more calculating, shall we? i work 18 12 hour shifts per month in the ED, so if i see an average of 1.4/hr, then i'll see about 17 patients per shift, and 300 new patients per month1 now let's see what my medicine brethren are doing in the same 28 day period: interns are on call every 4th night, so in a 28 day block that is 7 call days. you can admit a maximum of 6 patients per call day, and you only admit on these days. that's a total of 42 patients in 28 days, roughly 14% of the patient load in the same number of days. there's more: i work about 214 hours (12hrs x18 days) per month in the ED; medicine residents work closer to 320, or about 1/3 more hours. granted there are significant differences in what one does to inpatients versus those being seen in the ED, and as i said, the ED shifts are non-stop work (which i don't think is ideal), but this still highlights the striking difference in what can be done in a given amount of time. neither is ideal, but even if we split the difference in hours (106/2) that is 53 fewer hours that i could be working! that's more than the average person works in a week; it would be like getting an extra week of vacation.

sigh...only 26 more days to go.

up next: what is "pre-rounding" and how do i make it require less time?