Reflections on a Consult Service

Since October I've been doing a first-year elective in Infectious Diseases. Mostly this entailed observing in the HIV clinic and on in-patient rounds in the QEII. Occasionally I'll get to listen to heart/lung/bowel sounds or help with history taking, though the latter typically only ever occurs in clinic. Initially, the plan had been to split my time equally between clinic and in-patient rounds, but the latter has ended up taking the lion's share of my time, something that I've liked.

Clinic is fairly non-threatening and low-key, and from the start I could appreciate the sorts of issues HIV patients face - side effects, compliance to meds, and all the psychosocial aspects unique to their situation. When I first went on in-patient rounds, I had to go meet the ID resident in Emerg where he was reviewing a consult. At this point, I could scarcely find my way around the hospital much less understand most of what I was hearing. As the afternoon progressed, I'd ask the odd question, but mostly I just listened, writing things down to look up later. I wrote down a lot.

As time went on, I met new residents coming onto the ID service more or less monthly. Everyone rotates through ID, and while most of the residents I've met have been in internal medicine, there have been others in physiatry, general surgery, neurosurgery, and ENT, along with a few actual ID fellows. I've really appreciated being able to meet so many people, to say nothing of the extremely varied patient exposure. I've been nearly everywhere at both sites of the QEII; ICUs, IMCU, Haem/Onc, CCU, MTU, Emerg, ENT, Ortho, Urology, various other clinics, and the dark, patient-less unit commonly known as Radiology. Even so, I still have only a vague sense of where many things are.

I'd say also that I've learned a lot about charts, how residents summarize patients for staff, and how a consult service works. I'm not sure whether I want necessarily to work on a service like ID in the end, but that's perhaps a topic for another post. In the end, I've enjoyed myself progressively more since January, both as I've learned more in class and as I've been lucky enough to end up with residents and staff who have been more open to teaching and having me listen and/or feel things for myself. This has really made all the difference. At this point, I can pretty much understand most of what the residents and staff are staying, and when I don't, I feel more confident and comfortable peppering them with questions. I know way more than I did in October, but the amount I don't know and have yet to learn always seems somewhat insurmountable.

I guess I'll get to that stuff eventually. My little assignment from today was to look up these:

Non-anion gap acidosis
Tumour lysis syndrome

BSG at the UN

Since BSG ends tonight (or, I should say, ended, as I've already watched it), I present Edward James Olmos and Mary MacDonnell at some sort of UN-hosted event on racism:



I can't really tell whether Olmos is in character or not.

Cells Are Awesome

As evidenced by the video below:

CaRMS is Scary

And kind of exciting. Yesterday was match day for Canadian med students graduating in 2009. That will be my match day in three years, and I'm realising that that time will go by quickly, and that on the day I'll have my future career determined to a great extent.

Best to focus on the present, though. I'm still trying to figure out what I want to do. Surgery is interesting, areas of internal could be good. What do I want in terms of lifestyle, practice, and location? What *can* I get? It's hard to say. Fortunately I have lots of opportunities to try things out. But that CaRMS match day, though seemingly far off, requires preparation and lots of thought. Maybe it's best not to think about it too much, but I still seem to be (it's a decent enough way to avoid studying at least!).

Update: Ahem. CaRMS = Canadian Resident Matching Service.

Google Lies

Well, probably not intentionally. But don't trust Google Maps implicitly, for you might end up with something like this:


View Larger Map

Note the portion of Dalhousie University located at right, and you'll notice something called the Halifax Infirmary. Sounds like a hospital, right? Well, it was, until it was replaced and later demolished... in 2005. In fact, the original building has been vacant since 1998, as the "New" Halifax Infirmary opened in 1996. What's notable about this? Well, Google didn't exist until Sept. 1998, and Google Maps didn't appear until Feb. 2005, admittedly a few months before the old Infirmary was torn down. Though it had been vacant for some seven years before that.

The question remains - why is the HI still appearing on Google Maps in a location which for three-and-half years has existed as a vacant patch of gravel next to a pay parking lot?

Naturopathy in BC?

I'm not surprised this is happening in British Columbia:

Naturopathic doctors in B.C. could soon be allowed to prescribe medications if the provincial government goes ahead with plans to change its health profession regulations.

The changes would make B.C. the first province in Canada to grant naturopathic doctors the authority to prescribe drugs such as antibiotics, painkillers, and antidepressants.

But the B.C. Medical Association is concerned about the potential move, arguing patient safety will be put at risk if the changes are allowed.

In a letter written last month to the province's medical doctors, BCMA president Bill Mackie said the association "is significantly concerned with the expansion of scope proposed for naturopaths... "

Thoughts on this? The College of Physicans and Surgeons of BC is very opposed, mainly on the grounds of patient safety (which are quite well founded - to start with, naturopaths don't have remotely equivalent training to physicians of any kind, much less nurses or pharmacists, when it comes to prescribing drugs, ordering diagnostic tests, or, well, making diagnoses of any kind.

And isn't it kinda ironic that naturopaths - who disdain pharmaceuticals as part of their MO - want to be able to prescribe them? (I'm not into the whole "holistic" versus "reductionist" argument either. There is a way based on evidence and science and another based on an odd mix of traditional/folk techniques (some with actual benefits) and wonky homeopathy.)

Plus, when I think of naturopathic "medicine", I am always reminded of this:

TOR: No. You know, I am not a business man. I'm a holistic healer. It's a calling, it's a gift. You see, it's in the best interest of the medical profession that you remain sick. You see, that insures good business. You're not a patient. You're a customer.

JERRY: (He thinks this, the audience can hear his thoughts) And you're not a doctor, but you play one in real life.

Just because naturopaths call themselves doctors and stick "ND" after their name like it's a university degree (it isn't, at least not in Canada) doesn't make them such or qualified to pretend that they are.

Rick Mercer Explains Politics

And it's not really that complicated: Canada Explained