The magical mystery land of community health

I don't make this stuff up!…but I do change identifying information.

Shortest post ever. April 30, 2009

Filed under: Uncategorized — lesbonurse @ 2:24 am

Wanna know my favorite medical word? Fomite. Go ahead, whisper it to yourself. Fomite. Foooohhhmite. What a wierd word. Here’s an example: “The child sneezed swine-flu-laden droplets all over his brightly colored fomite.”

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Problem list poetry April 29, 2009

Filed under: Uncategorized — lesbonurse @ 1:28 am

Our electronic medical record allows us to view our last 50 diagnoses used. Sometimes, just for chuckles, I like to view my list and remind myself of all of the interesting things that I see every day. Tonight I thought I would try to create some original poetry using only my most recent diagnoses.  I’ve titled this poem “The Perils of Aging”

Dementia, hearing aid problem, impacted cerumen…broken teeth.

oral thrush

Pelvic pain, pain in calf, pins and needles sensation!

Depression

Incontinence; acute vaginitis

D y s p n e a

at rest.

 

It ain’t always fun and games in this exam room… April 27, 2009

Filed under: Uncategorized — lesbonurse @ 1:50 am

Last week I was asked to do a pap on a butch lesbian in her late 30’s who has never had vaginal intercourse (including sex toys or digital penetration–I asked). Let’s just say that it was uncomfortable for both of us. Uncomfortable for her for all of the obvious reasons. And uncomfortable for me because the patient was clutching the edges of the exam table and whispering “Ow, ow, ow, ow…” This experience, plus NewFNP’s recent post on pap smear technique, got me thinking about some of my past bad paps. Like NewFNP, I pride myself on my gentle pap technique. Rather than opening the plastic speculum until it clicks several times (which is a sensation akin to having your vagina cranked open with a car jack), I hold the lever-tab-thingy down with my thumb during the whole exam and never click it open. This allows me to open the speculum only as much as necessary, and not a centimeter more. I also use a little lube on the speculum instead of water–it’s totally ok if you’re using ThinPrep instead of the old-school slide and fixative technique.

But even the gentle touch, extra lube and patience doesn’t always make a pap easy. I especially hate doing paps on women who have never been sexually active (with vaginal penetration) before. Although opinions differ on the initiation and frequency of pap smears, the U.S. Preventative Task Force recommends beginning screening at age 21, even if never sexually active. Therefore, I recommend at least a baseline pap to all of my patients over the age of 21. The problem is that I sometimes feel like a giant asshole when I implement this recommendation.  My only consolation is that at least the patients are seeing me and not some of the less…how do I say?…sensitive residents in my clinic. The other consolation is that I give my most anxious patients an Ativan 30 minutes before the exam. Sometimes that helps.

 

Healthcare haiku April 7, 2009

Filed under: Uncategorized — lesbonurse @ 1:17 am

Just read in the news:

patient of mine arrested

for stabbing someone

Alert! Lab result:

A reactive RPR

You have syphillis!

It’s that time of year.

Exam room hot like furnace

Turn the heat off, please!

Annual exam,

Supervising my student.

Taking FOREVER

 

Please consider these for addition to the ICD-11 April 1, 2009

Filed under: Uncategorized — lesbonurse @ 12:55 am

I’ve decided that although the ICD-9 and ICD-10 are exhaustive collections of diseases, diagnoses and procedures, there are a few conditions that seem to have been left out. Here are my suggestions for some additional billing codes:

  • “Mental illness, NOS”
  • “Pure foolishness”
  • “Extremely poor judgment”
  • “FUBAR” (if you’re not familiar with this phrase, you can google it)
  • “Failure to die” (as opposed to Failure to Thrive)
  • “Mysterious abdominal pain without known cause, despite exhaustive workup”
  • “Patient crying, counseling for [x] minutes”
  • “Patient hard of hearing, shouting for [x] minutes”
  • “Patient on cell phone for [x] minutes”