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A bad tap or subarachnoid hemorrhage? This is the blood-tinged cerebrospinal fluid from a man presenting with fever, seizure and a confounding circumstance involving booze. Normal CSF is as clear as water. This pinkish fluid represents a diagnostic dilemma and the medical curiosity of the evening.

A bad tap or subarachnoid hemorrhage? This is the blood-tinged cerebrospinal fluid from a man presenting with fever, seizure and a confounding circumstance involving booze. Normal CSF is as clear as water. This pinkish fluid represents a diagnostic dilemma and the medical curiosity of the evening.

The boardwalk in Rockaway Beach, Queens, a few days after Hurricane Sandy. I was lucky to be among a group of doctors and nurses who set up a clinic for residents digging out after the storm. We treated a wide variety of common medical problems including diabetes, high blood pressure, respiratory infections and cardiac concerns. Vulnerable populations including the elderly and indigent were the most severely impacted. Psychiatric issues were also common, as were minor trauma cases such as lacerations, tetanus-prone puncture wounds and sprains. More about the clinic can be found on Gothamist and photos can be seen at www.rockawayqueens.tumblr.com.  

The boardwalk in Rockaway Beach, Queens, a few days after Hurricane Sandy. I was lucky to be among a group of doctors and nurses who set up a clinic for residents digging out after the storm. We treated a wide variety of common medical problems including diabetes, high blood pressure, respiratory infections and cardiac concerns. Vulnerable populations including the elderly and indigent were the most severely impacted. Psychiatric issues were also common, as were minor trauma cases such as lacerations, tetanus-prone puncture wounds and sprains. More about the clinic can be found on Gothamist and photos can be seen at www.rockawayqueens.tumblr.com.  

"Art is what you can get away with."

"Art is what you can get away with."

President Obama’s health care policies are not particularly exciting at face value but his legislation is a significant political step towards rational healthcare. This domino has fallen and others will follow. Nice work, Mr. President. 
Design by Chris Brand.

President Obama’s health care policies are not particularly exciting at face value but his legislation is a significant political step towards rational healthcare. This domino has fallen and others will follow. Nice work, Mr. President. 

Design by Chris Brand.

In the deserted operating rooms, colossal windows pointed to a time before electricity when surgeons were forced to rely on natural light. The walls curved where they met the floor, forming gutters to make it easier to mop up splattered blood. Here, a hallway in the hospital.

-an interesting New York Times slide show

pathology before electricity

image

Documented nicely here is hand-written evidence of passive aggression towards Press Ganey patient satisfaction survey results which were posted recently in our doctor’s lounge. This is slightly humorous, perhaps, for the casual physician observer—which is why I am posting it—as anyone who has been the subject of Press Ganey surveys understands the nuanced emotions created by them and can sympathize with the sarcasm penned across the bottom. Medicine is complicated business and surveys of patients treated, however well-intended, are a frustrating on some level due to their imprecision of measurement, especially in the context of treating patient populations with psychiatric illness and/or drug addiction. 

To illustrate the idea here is a simple example. A doctor patient relationship unfolds as such:

Patient: Doctor, I’m in pain. My [back, migraine, tooth, neuralgia, arthritis or fatigue] has been hurting for a long time [weeks, months, years] and I need some pain medication [percocet, vicodin, valium, or dilaudid] because my prescription ran out. I’m new in town and don’t have a doctor yet and I’m allergic to [list of non-narcotic pain medications] and my stomach can only handle [list of narcotic pain medications repeated and emphasized].

Doctor: [Recognizing obvious drug-seeking behavior.] Sir, I’m worried about your relationship to pain medication and believe it might not be in your best interest to give you a prescription for narcotics due to the potential of addiction. 

Patient: Leaves the Emergency Department upset.

Two weeks later a negative patient satisfaction survey arrives.

Once or twice a day such an occurrence is a fact of life for many types of physician as they treat the democratic spectrum of societal illnesses in emergency departments and medical offices. The characters involved are not always glaring, as illustrated, but the feeling is nonetheless unavoidable. In such cases the goals of patient satisfaction and good medicine are clearly mutually exclusive, and this then becomes the precise point where a rating system becomes irreconcilable. Yet it persists. Just imagine if parents were rated by misbehaving children when they tried to set them on a proper course by scolding them!

This is a challenging issue and these moments certainly stress one’s professionalism. Yet, when handled gracefully, they also define it. My advice to young doctors: meet this challenge and stay above the fray. See the forest for the trees. 

Here is a decent NY Times article on the subject: nyti.ms/IKnZZ5

Medical chart of the day: Maslow’s Heirarchy of Needs.

Medical chart of the day: Maslow’s Heirarchy of Needs.