Monday, October 27, 2008

On Another Planet

I started my outpatient Dermatology rotation today. The details of the "other planet" are dizzying. I'm not talking about me being clueless regarding dermatologic disease, I'm talking about the way that a Derm office runs. I must say, it's pretty obscene.

Firstly, the doctor has appointments scheduled every 10 minutes, some (probably 1/4) are double-booked. AND THEY NEVER RUN BEHIND!!!

The nurse to doctor ratio is 3:1....let me repeat, the doctor has 3 nurses to herself, probably leading to why the first point above exists. Each nurse comes into the room with the doctor and performs the following duties:
  • Getting all of the Chief Complaint, History of Present Illness, and Past Medical History from the patient without the doctor repeating the questions
  • Writing prescriptions and if a patient needs refills, the nurse goes ahead and writes it
  • Ripping the carbon copy off of the prescription (as in, today, the nurse handed a prescription to the doctor with its carbon copy on the back and the doctor handed it back to the nurse--I think, for the only purpose of the nurse ripping them apart and handing it back to the doctor)
  • Numbing areas to biopsy
  • Being at the beck and call of the doctor to run and get samples, etc.
  • Doing all the teaching regarding wounds and dressing

My mind was boggled at what the doctor DIDN'T have to do...and how she billed for the visits.

One visit she called a "Level 4" (which, for those non-medical out there... pretty complicated but not the highest, Level 5) --the patient was on Accutane, she looked over his dry skin, suggested heavy mosturizer, asked him a few questions about mood, and looked at his lab work...that was it! Geeze, I'm sure in Family Medicine nobody would get away with calling at a Level 4.

And one last thing...all of the patients came in with an understanding that only their skin would be taken care of, that's it. It was so strange to not have them bringing up multiple, unrelated complaints...and very boring.

Lesson Learned: I'd be bored to tears and unable to sleep in peace at night if I did "medicine" this way.

What it's Worth: Seeing how "the other half" lives.

Tuesday, October 21, 2008


I've decided I love words. Last night as I was trying to go to sleep, I was thinking about how remarkable they are. A series of letters, put together to convey greater meaning, to share thoughts, and to connect the human experience. I was thinking of some of my favorite words--some are my favorites just because of the sounds they make coming off of the tongue, and some are my favorites because they are just perfect for what sentiment, what action, what thought is needed for any situation. So, here they no particular order:

1. Raucous--"disagreeably harsh or strident OR boisterously disorderly"

2. Serreptitious--"done, made, or acquired by stealth OR acting or doing something clandestinely"

3. Recalcitrant-- "obstinately defiant of authority or restraint OR difficult to manage or operate OR not responsive to treatment "

4. Glower--"to look or stare with sullen annoyance or anger"

5. Querulous--"habitually complaining, fretful, or whining"

6. Candid--"free from bias, prejudice, or malice OR marked by honest sincere expression"

Lesson Learned--none really from the statements above, but I will leave it with the following caution from the Bible:

"When words are many, sin is not absent, but he who holds his tongue is wise." Proverbs 10: 19

I'm still working on that one.

(also, many thanks to for their formal definitions.)

Wednesday, October 8, 2008

Personal Responsibility Anyone?

I think I may write a more coherent and collected blog about this later (maybe). I don't know if I'd be able to accomplish this without being, well, legalistic, unforgiving, judgemental, condemning... yadda yadda. If you've not seen the following articles online lately, I suggest you read below.,2933,409262,00.html



Basically, the genius lawmakers in Nebraska have made a law letting people "abandon/drop off/give a safe haven" to "children." They left it open to interpretation (seemingly intentionally) as to children up to 18 can be given over as wards of the state. I think that one of the fatal flaws in their thinking is that those people who actually TAKE THE INITIATIVE to drop off their children probably wouldn't have been horrible parents in the first place, because they care about how their children might turn out. Those who actually are playing an active role in abusing and neglecting their children--I wonder how many of them would use this law?

Now, I'm not implying that any child should be deprived of a safe, nurturing, supportive home. Where is the personal responsibility in all of this? As Americans, we've become devoid of any consequences, ready to have somebody bail us out, give us a quick fix, and take away any little thing that may cause stress. Promises seemingly mean nothing, nobody stops to think ahead.

Out of all the actions we can perform on this Earth... shouldn't the decision to have children be one that gives us the most pause?

Sunday, October 5, 2008


I had a great weekend .... except.... well, see below:

That would be a horse bite...and no, I really didn't do anything to the horse to make it bite me. And yes, it did hurt as badly as it might seem from the picture. The "eyes" of the bruise (the two lighter areas) were where her teeth actually made contact.

We ended up riding after that, but I wasn't on her. :)

We went camping on Friday, horseback riding Saturday. Lovely weather, lovely time. I love KY in the fall.

Lesson Learned: Never trust a horse, even if you've known it since it was a little one.

What It's Worth: Not having to explain that your husband doesn't, in fact, inflict bruises upon you, haha.