vitum medicinus --- a life of medicine vitum medicinus --- a life of medicine A Canadian medical student blogging about the funny, action-packed, and dramatic moments of his medical education.
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Listen, the patient is telling you the diagnosis
2007-11-16 08:08:00 There's an old saying attributed to Sir William Osler that you'll hear dozens of times even one year into medicine: Listen , the patient is telling you the diagnosis. We've also been told that if you've done an extensive list of investigations and still don't know what the patient has, re-taking the history can sometimes bring a diagnosis to light.Being able to spend time in clinic is great, but to be honest, we don't really know what questions to ask yet. Yeah, we know a few: does it hurt? how much? where? and for how long? But it takes a long time and a lot more training to learn all the important associated conditions - that I should ask the patient with Crohn's disease if their joints hurt, or the patient with chronic hypertension how their vision is. Some of these things come second nature for doctors who have been doing this for years, but when you're new at this, you feel like getting a diagnosis just by asking the patient a few questions can be pretty difficult.Gettin... More About: Diagnosis , Patient
Can't be too careful with physical exams...can I?
2007-11-06 07:52:00 "Well, given the problems you've mentioned, I'm going to need to do a quick physical exam."Now that I'm in second year, that's something that I've been able to do, and be confident doing: if a patient presents to me in clinic with an ear/nose/throat issue, a heart or lung problem, a musculoskeletal problem, or an abdominal problem, I'm able to do a focused physical exam before the doctor comes in."The doctor will come in and do an exam as well in a few minutes, but for now could you lay on your back and lift up your shirt so I can examine your abdomen please?"I turned my back to wash my hands as the patient, a friendly, effervescent girl my age, set her backpack down from her lap and hopped up onto the exam table. She had been explaining that she had been going #2 once every four or five days, and that was "normal" for her, and even though she had been that way for a while she constantly felt abdominal pain and fullness and bloating. So, after asking her a few more questions, ... More About: Physical , Exams , Careful
SurgeXperiences 107 Blog Carnival
2007-10-28 07:59:00 Welcome to SurgeXperiences 107!On the forefront: Robotic SurgeXperiences Aggravated Docsurg talks about what robotic surgery is all about.Once you've read that, another perspective can be found at surgeon's critique of robotic surgery.Patient and Provider eXperiencesBongi tells the story of a surgery hopeful who had an unfortunate experience in the OR. I'd recommend if you read this one, you don't miss the postscript.While it may be minor as far as surgical experiences go, JD had a thyroid nodule biopsy performed recently, and explains the process from the patient's perspective.Surgical eXperiences AbroadKathryn provides a description of surgery in less than optimal conditions in a less than first-world country: "...The residents even tried to do surgery with sterile drapes wrapped around them because there aren’t any gowns at the moment..."Going to a different country to get surgery or other medical procedures done can be intimidating, but the Medical Tourism Guide provides ... More About: Carnival , Blog , Blog Carnival , Erie , Urge
SurgeXperiences 107 Blog Carnival ::: Call for submissions
2007-10-19 00:37:00 Vitum Medicinus is proud to be hosting SurgeXperiences 107 on October 28, 2007.What is SurgeXperiences?SurgeXperiences is a bi-weekly blog carnival featuring posts on a variety of surgical experiences. Find out more...DeadlineThe deadline to submit blog posts is October 25, 2007 at midnight local time. Submission ProcedureSubmissions will be accepted via a Blog Carnival . Click here to submit your blog post. More About: Blog Carnival , Call , Erie
Education mirrors reality in a series of random coincidences
2007-10-08 19:56:00 I got a text message from a friend this morning:"Leafs forward Jason Blake diagnosed with CML (Chronic Mylegenous Leukemia) - More at TSN.ca."The guy who sent me this text message is a huge Ottawa Senators fan, and he knows how much I love the Leafs (I still owe him $5 because of a game that Toronto couldn't pull out of the hat last week). As often as he can, he tells me how much he thinks the Leafs suck, even though the Sens haven't won a Stanley Cup for way longer than the Leafs.So, combine that with the fact that our last week of class involved learning about all the types of leukemia, lymphoma and myelodysplastic syndromes, and it's obvious that I would interpret this text message as him reaching a new low in mocking my favourite sports team.But then I checked it out. He wasn't kidding. Odd coincidence? Yep. Virtually impossible? Okay, probably not even close... but still weird.It's not just with this story, though. This week's Extreme Makeover: Home Edition built a new ho... More About: Education , Reality , Series , Random , Duca
Studying Scared
2007-10-05 23:39:00 What does it take to get Vitum off his butt and into study mode?Good intention? A desire to do well?Try fear. Plain, simple fear of failure. That's all it takes.Unlike last year, when around this time I was enjoying how slack I thought medical school was, this year is different. Not just for me - I've noticed that a lot of people who took it easy early in the semester for the last two terms are turning up at the hospital & university study rooms on the weekends / evenings. And I've got three things that are giving me enough fear to get me studying scared this early into the semester.1. Life around finals time sucks.First of all, now that I've been through a year of medical school, I'm more aware of what it involves. I know how hard I had to work when last year's finals were approaching. I spent entire days and entire weeks studying with few breaks. Seeing few friends outside of med - and even friends in med - was not an option, and how the only thing that kept me going was... More About: Studying , Scared
Getting used to palliative patients might take some time.
2007-09-30 21:44:00 For our clinical skills classes, we spend most of our time on actors / standardized patients, who come into our clinical skills training rooms at the hospital and we learn how to do basic exams on them.However, the odd time we'll go onto an actual hospital ward and get the opportunity to examine symptomatic patients.Last semester we were at the hospital practicing our cardiac exams on a couple of hospitalized patients. My group was assigned a patient who was really friendly, and such a great sport - she didn't complain once about the four medical students percussing and auscultating her chest, tapping for a lung here, listening for a murmur there, asking her to sit up and lie down, even though it was obvious that due to her bad back the ordeal wasn't entirely pain-free for her.Over the twenty or so minutes we spent at her bedside, she told us more and more about her condition, but she also talked her life - her job, her family, and the things she enjoyed doing before she ended up... More About: Time , Patients , Some
New poll on VM: Nice Doctors (and Sicko poll results)
2007-09-28 05:16:00 For RSS readers of this blog who can't see the updates on Vitum Medicinus - Check out the newest poll at Vitum Medicinus, and provide your opinion on the question:Based on the doctors you've met, what is your impression of physicians?All doctors are nice to patients.Most doctors are nice to patients.It's about 50/50.Most doctors are mean to patients.All doctors are mean to patients.Find the poll in the right-hand column on any page in this blog, under the heading "Vitum Poll icus."Previous Poll Results :Vovici Online Survey Software More About: Doctors , Sicko , Nice
It had to happen eventually: "That sounds like something I read on a blog o
2007-09-27 14:13:00 When I'm hanging out with med friends, as much as we may try to avoid it, every conversation turns to school somehow... some gross thing we saw, some cool clinic case, or general hatred or love for certain professors. (The professor who approached me and told me he reads my blog fits into the latter category, of course). The other day I was at a classmate's house having some incredible steak, and for some unknown reason, the conversation turned to our cadavers. We were talking about the nature of our cadavers and how some of the ones with high BMIs are really hard to dissect... some of them you're cutting through the skin and you cut and there's fat, so you go deeper and there's more fat, and you go really deep and you're in the muscle, and so you go back and realize that there isn't any distinction really between the fat and the muscle like there is on the really nice cadavers; instead, on the more fatty ones it's more of a gradient and the fat and muscle is all mixed toget... More About: Sounds , Blog , Read , Ally , Some
"I'll show you, bitch!"
2007-09-23 19:48:00 The other day at the hospital, while I was shadowing in the emergency department, a physician called me over to the x-ray computer terminal. "Vitum, come take a look at this."He showed me an X-ray very similar to the one I've borrowed from Wikipedia thanks to the GNU Free Documentation License, photoshopped to match my story, and placed here. "What's wrong with this picture?" he asked."Well," I replied, "I haven't done my musculoskeletal study unit yet, so I could be way off... but aren't hands supposed to be attached to arms?""Right!" the doctor replied. "Trust me, the story is just as good as the X-ray. It even made the newspaper."Assuming that a story in the newspaper presents fewer issues of confidentiality, I'll share the exciting story with you here, with only a few altered details. Truth is indeed stranger.Apparently, this gentleman was involved in a fight with his girlfriend, and all hopped up on drugs. The fight got more and more heated to the point where our patient r... More About: Show , Bitch
One Story, Two Endings. Clearly I'm not a doctor yet.
2007-09-18 09:19:00 The doctor looked at the patient's chief complaint on the chart. "Palpitations, SOBOE." He looked up at the nurse and made a joke out of it. "SOBOE - Shortness of breath on exertion... even I get that. Who doesn't get short of breath when they exercise?" The nurse laughed.The doc grabbed the patient's ECG, which the nurses had already done and clipped to the patient's chart. One quick glance told him that it was a textbook example of normal sinus rhythm with the odd premature ventricular beat (PVC) - when the ventricles contract before they receive a signal from the sinoatrial node - something that happens in normal, healthy adults and is absolutely nothing to worry about."Hi, I'm Dr. Vitum Medicinus," said the doctor, scrawling his initials on the ECG sheet to show he'd read it, while walking into the patient's room. Dr. Medicinus took a quick history, and the patient described the thump in his chest that was consistent with a PVC. "We'll take a few blood tests and see how ... More About: Story , Endings , Doctor , Tory , Earl
Great Moments in Anatomy Lab
2007-09-12 07:36:00 Today in anatomy lab I was using the suction to clean the fluid out of the body bag. This fluid, scientifically known as DHBF (or Dead Human Body Fluid) is comprised of melted fat, extra embalming fluid, and random juices from the cadaver. Unfortunately, I had an accident. While I lifted up the body bag to try to get the DHBF to pool for easier suctioning, I accidentally inverted the corner, releasing a hidden pocket of DHBF which streamed directly for my leg.As I stood there, feeling somebody else's fat running down my leg, I thought to myself,"The worst part about this isn't the fact that I have DHBF running down my leg."It's that this is the second time I've done this to myself." More About: Anatomy , Great , Moments , Anatom
Summer Facelift - What's New at Vitum Medicinus
2007-08-23 18:58:00 Summer+ job supervisors kind enough to realize that this is my summer = free time to do some tune-ups at blog.vitummedicinus.com. You may not have noticed all the upgrades, especially if you're reading VM in a RSS reader. In order that you don't have to pore over the blog looking for them like a radiology resident scanning an x-ray film (I had to tie in that photo somehow), here's the improvements listed for you.New Blog Header PhotoI had to change it anyways since I grew a year older since I started this blog; but I figured I might as well change the photo to something that actually happened in medical school, rather than something I did during my pre-med years. This photo was taken in a hospital on my cell phone camera when a bunch of us were waiting around for a pediatric clinical skills session to start. My favourite part of it is the subtle tribute to Canadiana - there's a Tim Horton's coffee cup sitting on a table in the photo. Favourite and Most Popular Posts a.k.a. Vit... More About: Summer , Facelift , Medici
Top 10 List: Terrific Tips for Stupendous Suturing
2007-08-18 23:02:00 Today, while shadowing in the ER, I sutured real people for the first time. Twice.Clearly, this makes me one of the world's leading expert on skin sewing. Ask any doctor. This, and watching dozens of lacerations put together, and taking part in a suturing workshop with very realistic artificial materials designed to perfectly simulate human skin (those materials being made of box cardboard).Fortunately, it was the second patient - not the first - who asked, "Have you done this before?"I answered him truthfully. "Yes," I said.So, having learned so much from my great wealth of experience, I have decided to benefit you, the reader, with ten terrific tips for stupendous suturing of lacerations. If you're a medical student, like myself, use these ten tips and you will blow away your classmates.If you are a nurse or patient, read this list then verbally chastise any physician you see who does not follow these ten tips.If you are a doctor, verbally chastise yourself right now, out loud, ... More About: Tips , Top 10 List , List , Turin
The day the ER nurses ganged up on me
2007-08-16 06:11:00 I swear I was being good. Really, I was! Honest!But still, they hunted me down and cornered me, like an angry, bloodthirsty pack of shewolves avenging the death of their young. Or something like that.Tonight, during a ER shadowing shift, I was sitting unsuspectingly at a computer (I don't know how else to sit), looking up the difference between ringworm lesions and lyme disease target lesions. You know, minding my own business. I thought I heard some nurses off in the distance saying something like "student" or "medical student"... but I brushed it off and ignored it. I went back to my googling. And then it happened.I felt a massive shadow coming up behind me. I turned around... in time to see half the ER nursing staff approaching me in a pack akin (great word) to a pack of shewolves (yes that word is worth the repeated reference). I hadn't done anything wrong (other than written a certain blog post several weeks ago which shall remain unnamed here) but I figured I was screwed. I ... More About: The D , Nurses
New to medical blogs? Vitum's Beginner's Guide to Reading Medical Blogs
2007-08-13 03:04:00 Over a year ago, I discovered the medical blogging community, and the amount I've learned from it has been incredible. I linked to my first blog through an online medical forum, found a series I enjoyed (the Don't Become a Doctor series on Incidental Finding's blog), and started reading every post in that series. I was captivated. I loved the humour, the point-blank honesty, and the impact the blog made on me.I wanted more. But I didn't really have a clue about where to begin reading more medical blogs. I somewhat stumbled through blogs for a while, here and there learning neat things about being a blog reader that I wish I'd known sooner. It would have been nice to know them right from the start - to read them in some sort of concise, brief overview guide. So, after a year of being involved in the medblog community and somewhat 'knowing the ropes' by now, I've decided to put a guide together myself. Here it is.WHAT IS THE MEDICAL BLOGGING COMMUNITY?If you're reading this, ... More About: Medical , Reading , Blogs , Guide , Guid
You found this blog how?! or, Fun with search engine analysis tools: Volume
2007-08-07 17:27:00 Thanks to the good folks at 103bees.com (leaving out the "www" is the latest thing now, you heard? It's supposedly redundant), I have been quite entertained over the past several weeks taking note of the ways people find Vitum Medicinus using search keywords.Every so often, I'll see that someone came here through a search term and I wish I could find out who it was so that I could say something to them. So, in hopes that any of these individuals who stumbled upon my blog (and obviously did so quite unintentionally) have subscribed to VM via e-mail or through a feed reader or check back regularly, and will therefore read this, here is what I have to say in response to your search engine phrases. (If this was actually you, I and everyone else here would be quite interested if you'd leave a comment explaining what was going through your mind when you searched that). And before you approach me asking "Did someone actually..." I will swear on my hamster's grave, I made none of these ... More About: Tools , Analysis , Search , Search Engine , Blog
Why Rural Docs have to leave town if they want a vacation
2007-08-03 05:36:00 I've written a few posts already about how medicine has started to take over my life. Apparently, it doesn't necessarily end once you've become a doctor.A doc at a rural conference I went to told me that in order for them to take a day off, they need to literally leave town.Why? They explained as follows.One day, early in their career in the town, the doctor was enjoying a vacation day with his family. The phone rang, and the doctor picked it up. "Doctor, I need your help please." The doctor explained, "Sorry, today is my day off," and made a mental note to not pick up the phone during his next day off.The next time he had a day off and the phone rang, he decided he'd let the machine get it, just in case it might have something to do with work. Sure enough, the message started out, "Doctor, I need your help..."Shortly after, the phone rang again. It was the same number. Another message was left:"Doctor, please pick up the phone, I know you're home, we can see your car in the dr... More About: Vacation , Leave , Town , Rural , Ural
Top 10 List: Pieces of advice for pre-med students
2007-07-30 21:44:00 Overheard during the interviewer lunch break at my med school's interview weekend: one old doctor to another - "The very first student we interviewed blew us away. She'd summited Mt. Kilimanjaro, competed in the Olympics, and was an honours student with incredible research experience and publications. You know, if applying to medical school was like this back when I applied, I don't think I'd be admitted."Getting in to medical school is tough. In Canada, less than 30% of students who apply each year are admitted to a school, and on an individual basis Canadian schools accept as little as 3% of the people who apply (that's more competitive than some Ivy League schools in the USA!) (source). That's not counting the thousands of students who wanted to be doctors when they started their undergrad degree, and had to face the realization that thanks to things like the MCAT and the competitiveness of the pre-med world, and perhaps the odd slack semester or difficult year, they would ... More About: Advice , Students , Top 10 List , List , Pieces
New Poll on VM: Sicko (and Grand Rounds Poll results)
2007-07-26 20:17:00 For RSS readers of this blog who can't see the updates on Vitum Medicinus - Check out the newest poll at Vitum Medicinus, and provide your opinion on the question:Did the movie Sicko change your outlook on American healthcare?Yes, made it betterYes, made it worseNo, it didn'tHaven't seen it yetWon't see itFind the poll in the right-hand column on any page in this blog, under the heading "Vitum Poll icus."Previous Poll Result s :Vovici Online Survey Software More About: Grand
Grey's Anatomy...Scrubs??
2007-07-24 17:41:00 Wow, people must really have a thing about wearing what they see people wear on TV.Some company decided to market a new line of scrubs. Not just any scrubs . . . Grey's Anatom y scrubs, as worn by the actors on the show models that resemble the actors on the show. As seen on Grey's Anatomy!**As seen in Grey's Anatomy Magazine. Not to be confused with the popular TV show.(Hmm, I suppose if they really want to resemble the actors on the show they need to get rid of the Dr. Burke lookalike in their catalogue. Oooooh. Burn.)Actually, this is great! I'll admit it - Grey's Anatomy is the real reason I wanted to become a doctor, so now I can look and live the overdramatized soap-opera disguised as medicine that I rarely watch!(I actually don't watch Grey's...to be honest, I had to look up the name of the black actor on The Angry Medic's blog).Too bad the tv show Scrubs can't make their own set of scrubs. Who would buy "Scrubs scrubs"?Then again, I'll stop making fun of these now t...
Stolen moment, shattered life
2007-07-24 06:47:00 "Before you interview this next patient, Vitum, there's something you should know.""Sure, what is it?"The doctor closed the door to his office, and handed me the patient's chart."This patient came to me a couple of years ago. He's a very successful architect, he lives downtown, and he's overall quite healthy. But before you go in there, I just wanted to give you the heads up - he was sexually assaulted when he was a young boy. Just, you know, so if anything along those lines comes up in your interview you can be sensitive to that."Ha, I thought. Warning me so that I don't put my foot in my mouth. Again. I guess he knows me better than I thought.I appreciated the warning, even though the patient was there for something entirely unrelated and that issue never came up in the interview. The guy was obviously very successful, clean-cut, and seemed quite confident and professional. He took good care of himself and seemed to have a really good head on his shoulders. I wrapped up with ... More About: Life , Stolen , Moment
Top 10 List: Foods that Med School has ruined
2007-07-20 12:07:00 Not for the faint of heart...I've written more than once about medical school taking over my life, but now, I'm about to demonstrate another, entirely new and different, way that being a medical student is invading every aspect of my daily existence. In the words of the evil resident, pathologists love food anologies. Thanks to pathologists who drew the analogies, and who provided photos that in many cases didn't need an analogy to be verbalized in order to cause irreprable harm, I now have trouble eating some foods. Without further ado, here is the list of foods that are hard to eat now, and why, thanks to medical school. Actually, there will be further ado, a warning that certain individuals may find the following quite disturbing. If you fall into that camp, I don't mind you choosing to not read this post, so long as you shower me with empathy anyways.(You're lucky I provided a warning, by the way. I didn't give my sister a warning before I took her on a tour of my school'... More About: School , Top 10 List , List , Med school , Foods
Patient Billed $49 million - This is news? Okay, maybe it is.
2007-07-17 17:28:00 I may have appeared to sympathize with the San Francisco hospital that billed a patient $12,000 supposedly "for a broken rib," (Patient "billed $12k for broken rib" - this is news? [7/14])...... but I'm not sure than any amount of explanation will make anybody believe that a $49,000,000.00 hospital bill is reasonable.Glad I live in Canada. More About: News , Million
The Official Grand Rounds, Volume 3, Number 43
2007-07-17 08:00:00 Welcome to Grand Rounds , Volume 3.43, hosted for the first time ever at VitumMedicinus.com. Having used Grand Rounds as a springboard into the world of medical blogging when I first started reading medblogs, it is truly an honour to be hosting Grand Rounds. The template for this Grand Rounds is as follows:Description: In his quest to bring you Grand Rounds, Vitum Medicinus went from excitement to panic to enjoyment. Excitement = signing up for Grand Rounds months ago. Panic = when 22 submissions had arrived in my inbox by Friday morning. Enjoyment = putting GR together. Once I got started, it was actually nothing to be panicked about.Why you should read it: There are some stellar posts in this edition, and for every post I’ve spelled out why it’s worth your time. As well, for the bloggers observant enough to notice that I requested they submit their favourite food along with their blog post, you’ll notice their dish of choice represented pictorially beside their entry. Just on... More About: Official , The O
Patient Billed $12k for Broken Rib - This is news? Give me a break.
2007-07-14 15:03:00 From page C-1 of the San Francisco Chronicle a little while back:Uninsured patient billed more than $12,000 for broken ribSynopsis: Some gentleman was in a motorcycle accident. The paramedics who arrived on scene were concerned that he might have some internal injuries, so they sent him to a hospital. A few X-rays, a few CTs, and eight hours later, they give him the good news: You had a broken rib, and nothing else. Sounds like he got off lucky, eh? I mean, a motorcycle accident! Could've broken every bone in his body and he gets to walk away. Lucky guy.But no, all of a sudden some reporter looks for something to complain about... and apparently makes a headline twisted enough to make the front page of section three.$12,000? for a broken rib? How could this be? This is horrible. Surely, this is news.This is something that Vitum will find on Reddit.com when he is killing time, with plenty of points because lots of readers think it's an atrocity. Well, first of all, surprise. This g... More About: News , Break , Give , Broken , Patient
Paramedics have great stories
2007-07-12 03:08:00 Hanging out with paramedics is always fun, because they all seem to never run out of great stories. From scrotal lacerations to decapitations, they’ve seen it all. Here's another story I picked up when I shadowed paramedics.There was a patient who had a cardiac arrest during intercourse. The paramedics picked him up, and revived him on the way to the hospital. When the doctor phoned his wife to tell her that her husband was going to be OK, she said, “What? My husband’s in the hospital?”Think about it... then you'll get it. More About: Stories , Great
Grand Rounds v3.43 ::: Call for Submissions
2007-07-09 21:25:00 Vitum Medicinus is proud to be hosting Grand Rounds , Volume 3 Number 43, on July 17, 2007.The opportunity to submit posts is now closed. Thank you for your submissions! Check back for Grand Rounds here on July 17.Receive an e-mail notification when Grand Rounds v3.44 is published What is Grand Rounds?Grand Rounds, originated and still overseen by Dr. Nicholas Genes, is a medical blog carnival, or a collection of the best healthcare-related posts of the week.Anyone can submit a blog post; the post being submitted is to be healthcare-related but can come from blogs of patients / healthcare workers / students / writers / anybody.Past editions of Grand Rounds can be found here.Submissions Due:The deadline has now passed. Thank you to those who submitted! Check back on July 17 for Grand Rounds at Vitum Medicinus.Late submissions will have to be pretty epic in order to be included. Send Submissions To:vitum{at}VitumMedicinus{dot}com; subject line "Grand Rounds"Vitum will send a confirmati... More About: Call , Missi
Geez, what a dumb nurse.
2007-07-05 11:02:00 Make sure you read this post to the end before you make any quick judgments!I was in the emergency department this week shadowing a doctor, and I was surprised when an older nurse came up to the doctor and said, "I don't usually have trouble putting in catheters, but I have no idea why putting one in this guy is so difficult. Could you help us out?" When I looked over at the patient she was pointing at, I gasped. How the heck could the nurse be that stupid? I had to interrupt. Looking her right in those dim-witted beady little eyes, I said, "Excuse me, but are you trying to be funny?"The patient was a 67-year-old male who had come in with a chief complaint of "I can't pee because my prostate is flaring up again." No kidding you're going to have a hard time putting a catheter in, and what do you mean you don't know why?! The guy's got BPH (Benign Prostatic Hyperplasia). When the prostate has swelled up to the size of an softball, seeing as how the urethra runs right through it, ... More About: Dumb , Nurse
Why do we need to know all this physiology?
More articles from this author:2007-07-05 06:10:00 We were told by a physician before an exam review session: Students sometimes ask me why they need to know all this respiratory physiology. I simply tell them, About 14 months from now you will be in third year. With that comes responsibility. For example, one day, you will get paged, and the nurse will tell you, "Mrs. S.'s oxygen saturation just dropped to 80% (life-threatening). The resident is in surgery, and the attending physician is in the ER resuscitating somebody.... ...what do we do?"That's what third year is like. That's why you need to know all this respiratory physiology.So, you might want to learn this. My class has never been that quiet. More About: Physiology , Ology 1, 2 |
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