Psych!

I'm in OB-Gyn. I'm here on purpose, seeing as how it was the specialty that I loved in medical school. And ideally, I would be doing only OB-Gyn. Not primary care. Not psych. I'm not trained in it and more importantly, I can't keep up in them...it's hard enough to keep up with the stuff in my OWN specialty.

But anyway, I have figured out that I see about 15% OB, 15% Gyn, 30% primary care stuff, and 40% psych. Because I know this, I went the other night to listen to a talk on depression. It's bad when I know the ICD-9 code (a billing code for insurance companies) for that, but yet not for fibroids (311 BTW is depression).

I had a day a few months ago out of my 4 new paps, 1 was binge drinking, 1 had thought about suicide last year but had never told anyone, 1 is likely anorexic. I'm glad that they felt comfortable enough to talk to me, but I will admit, I am not the best person for this.

And THAT is why women need a family doctor.

Understanding Tests

Docs do a lot of testing. Sometimes, we have a diagnosis in mind and are confirming it. Sometimes, we're just screening.

As an OB, I do a boatload of screening tests. Quad screens, pap tests, mamms, FOBTs, 1 hour GTTs. I also do a fair number of diagnostic labs: CBCs, GC/Chlamydias, biopsies.

I have found that people get confused as to what exactly screening means. Screening tests do NOT give you a diagnosis! Instead, they say, "Hey! You might want to investigate a little further." A positive pap test leads to a colposcopy, possibly with biopsy. A positive FOBT leads to a referral to GI for w/u. Many positive screens turn out to be a big fat nothing.

Diagnostic tests, OTOH, lead me to a diagnosis (duh) and treatment. A positive chlamydia test buys you a dose of zithromax and a repeat test in 2 months (as well as offering further STD testing and reminding you that your SO needs treatment too). I positive endometrial biopsy invokes the cancer talk and treatment.

I could now talk about pre- and post-test probabilities, but most people's eyes would glaze over.

First day of school

There is NO possible way I'm old enough to have a second grader. There's NO way that my little girl is that old.

She was wearing jeans yesterday, and I swear, her legs appeared to go on forever. I'm not ready!!! :)

Craptastic

The call gods have not been kind to me lately. Between the incredibly stupid other doctors that I have had the displeasure of dealing with (their lack of responsibility and PATIENT CARE!!!!), the stupidity of patients (if you are 29 weeks pregnant and think you have been contracting for 36 hours, why the FUCK DO YOU HAVE TO GO TO LABOR AND DELIVERY AT 4 AM?!?!?!?!?!?), and the just plain bad luck (spontaneous pneumothorax in the middle of my tubal ligation), I have about had it. For the last one, I had one of my General Surgeons buddies come in to place the chest tube; he was laughing at me as I was muttering "And this is going to go in my case file for boards." I was not amused.

I knew that I was leaving a mess for my relief (but at least they were all delivered). I offered to pray to the call gods for my partner when she relieved me. Her reply: "Please don't. You have obviously pissed them off."

My nickname in residency was "Shit Magnet." I wish that I could lose it, since now the nurses on L&D have taken to referring to me by it. Sadly, it seems to be accurate.

I can't even say "At least no one's died" since I had a term still-birth recently.

ER's Mom

OMFG

Appalachian State 34, U-Fucking-M 32.


The Devil is having a snowball fight. Here in Big-10 (the conference that can't count and, apparently, can't play football, since another U-M lost to BGSU), shockwaves are falling.

My FIL is in shock. DH, an OSU fan, is in shock.

wow.