Med Mal

Our daily schedule varies in terms of what/when we have classes, but there is a standard lunch hour. Knowing this, a lot of organizations have meetings, lunches, and events during this hour. The other week I was fortunate enough to 1.) be in class and 2.) actually read the chalkboards' listing of events. One of the talks I noticed was a medical malpractice one.

The talk was put on by a higher-up in anesthesiology, pediatrics, and patient safety/risk management...an M.D./J.D. I'm just gonna throw out some random bits that I can remember from the talk.

• In Cook County, med mal is a $1 billion dollar business.
• The two most expensive counties in the country to practice medicine are Miami-Dade and Cook County.
• The average Illinois malpractice premium for family practice is $30,000. Head an hour southeast to Indiana and you're looking at $4000.
• Neurosurgery malpractice carries an 8x higher premium compared to FP...making it an average of $240,000.
  
• Nine percent of physicians account for 50% of patient complaints.
• As UIC medical students, we carry $65 million in coverage. (!)

Obviously, I don't have any references or credible sources other than this guy's mouth. But, it still got my attention and was probably one of the better hours I've spent in a classroom this year.

A Picture Is Worth a Thousand Words

This half of the semester is pretty heavy in that part of the body above your chest. Neuroanatomy, head and neck unit of anatomy, and neurophysiology. And those were listed by amount of information in descending order; interesting/coolness factor in ascending order.

Anyway, one of our neurophys lectures covered brain motor control and motor diseases. That day's lecture ran long by a decent amount, which would usually upset me. However, the prof showed some videos of a few of the diseases, and they were well worth the time. I left that lecture feeling pretty sad for anyone who suffers from motor disease. It's one thing to know how and why shit works/doesn't work. It's another thing to see it. These videos are kind of similar to the ones that the prof showed us.

Huntington's


Parkinson's


Hemiballismus


Like I said, it's one thing to learn the different motor pathways' regulation, interaction, and pathology. It's another to have faces to those diseases.

Chicagoisms

Most of the stuff I'm gonna talk about could be said for any city. But since I'm living in Chicago, I'm calling them Chicagoisms. Not anything exciting, but they all happened today.

Cab Drivers
I was trying to pull out of a parking lot and noticed a tow truck somewhat in the middle of the road. I mostly noticed it because it was keeping from pulling out of the lot in a timely fashion. Since I had to wait a bit before pulling out, I checked out what the commotion was about. A cab had rear ended another cab. That brought a definite (guilty) smile to my face. My opinion of cabbies is situationally biased. While I'm in them, I kinda like them: they get me to where I want to go probably faster than I could. On the flip side, there are a LOT of cabs in Chicago, and usually I'm usually driving amongst, not in, them. And (stereotypically) they all think they own the road - pulling right turns out of middle lanes, riding shoulders, and whatnot. So why the smile? Because (in my mind) the accident was due to both cabbies pulling stupid shit on each other. End result: crunch.

Intersections
Any big city is going to have it's fair share of busy intersections. And at most busy intersections, there are traffic lights. If you've got enough of them close to each other, then you start to run into the problem of nonmoving green lights. Downtown around rush hour, they've got traffic cops at all the intersections. Unfortunately they're neither throughout the city nor around all the time. What do these guys do? Cut off traffic to avoid gridlock. And by gridlock I mean dumbasses who think they can pull through a yellow light into an intersection. Sooo, what's the problem? The cars they just zoomed up to aren't going anywhere and/or are sitting at a red light...and now Speed Racer is stuck in the middle of the intersection. Sooo, when the other lights turn green, everyone else is shit out of luck. Oh, and most likely pissed. Bottom line? Don't block the damn intersection. I've seen some intersections with hefty blocking fines posted and are video enforced (I think). I rather like the idea.

Homeless
Homeless and cities kinda go hand in hand. Hell, even Champaign had a few. By the very definition, homeless don't have anywhere to go when things get shitty weather-wise. I see some huddle up in nooks against skyscrapers, others in parks, some on bus shelters benches. Those are all good and fine (?) when it's warmer.
Today was not the definition of warm. I've never bundled up more than I did today (including thermal pants, scarf, puffy jacket) only to still feel somewhat cold (mostly my face). Walking back last night in a sweater and peacoat was literally painful. It didn't feel like I even had anything on. Stupid alcohol didn't even keep me warm (it actually makes things worse - vasodilation). Damn wind. Anyway, one of the places the homeless go when it's cold is the L. The Red Line is 22 miles long, the Blue Line is 27 miles long - and they both run 24/7. That's well over an hour of warmth and sleep for them. If you pay your fare, I figure you should get a ride. However, that does not entitle you to stink up half the car.

Coming back on the Blue Line tonight, most of my car's riders were homeless. I figured that would probably happen, given the weather and time. The dude who situated himself next to me literally smelled like shit though. I've sat around other homeless before and they've never smelled that bad. On top of that, as I walked into the car, he was retucking in his shirts and pulling up his pants. I didn't really wanna put too much imaginative thought into what preceded those actions.

Standardized Patients

Most people probably have heard about standardized patients and how some medical schools use them. Since I'm in med school, there was a good chance I was going to run into one. About a week and a half ago now, I had my first encounter with one.

Since our clinical class is focusing on history related stuff this semester one of our classes included a history taking workshop. It basically was a chance to practice some of our history taking skills, without any grading whatsoever. Lame as that may sound (and as I thought it sounded) it was actually a really useful experience.

For one, part of our final exam is based on a standardized patient encounter. Apparently that grade's based on both what and how we communicate. But I think that any chance to practice talking to patients is pretty useful. Practice talking to people? Weird some might say, myself included. But trying to get a pertinent history while making the encounter smooth and non-awkward is actually harder than it sounds. Mostly since we've got certain things that we're trying to elicit and learn about. And at this point, we're not too practiced in it, so it ends up being a checklist type of progression - as opposed to a more natural flow that would happen with a bigger knowledge base and more practice.

As for the actual encounter, there's a "patient" waiting in an exam room, with their chief complaint, age, and sex on a chart outside the door. Oh, and the exam room has a camera in which you are both taped and watched. Take a gander, knock, enter, and fire away. For the workshop, the patient gave feedback on the personal communication aspects; the classmate (through the camera) on the medical aspects of the interview. For the final, the patient will give feedback on both personal and medical communication. And there'll also be a written part in which questions will be asked based on questions that we were supposed to ask. AKA - what, if any, past surgical history did the patient have? What family history, if any, is related to the chief complaint? Patient's tobacco, alcohol, drug, and sexual histories? Didn't remember to ask those? Oops.

I actually wish we had more workshops like this, since we don't get many opportunities to practice history taking. Sure we're in the hospital and clinic throughout the year. But in the hospital (especially the VA), most patients are unable to communicate effectively and/or unwilling to. In clinic, my peds doc doesn't present many chances to take a real history. He's on a schedule, and doesn't really allow time for a slower, more comprehensive history that I'm trying to learn. Both these situations are things that I'll have to deal with eventually. Just not now, when I'm trying to figure out what things to ask and how to ask them. Regarding the latter, one comes to mind.

During the "review of systems" part, I was trying to ask about the urinary system. In trying to think and talk at the same time, things didn't work out so well. "Urinary problems? Having any...not so much, or...?" Immediately after I said that, I thought "did those words just come out of *my* mouth??" WTF is wrong with me?

Overall, the patient said I did fine, although I would disagree with that evaluation. As for the medical aspects, I definitely missed quite a few things - one of them being past medical history and a gamut of related questions. Oops. You'd think that'd be something that would come naturally, since it's kind of a big deal. Stupid checklists and having to remember stuff. At least I found out the patient didn't have any urinary problems.