Wednesday, September 08, 2004

patients check in, but they don't check out

So it's set, I'm taking Step 3 of the Boards at the end of October. I planned it that way because 1.) LOGICAL NECESSITY: I'll be on elective in October, so it's really the only block this fall that I'll be able to take two days off for the exam, and 2.) CONVENIENT POST-EXAM PARTY PERIOD: I go on vacation the following week so it'll be nice to have the Boards over and done with before we head off to Hawaii. The pineapples will taste sweeter that way. Who knows, my scores may even be in my mailbox by the time we get back.

Calling the hotline the schedule the exam was a strange experience once I finally got through, because I've never been called "Doctor" so many times in one conversation. I almost got to thinking that maybe she was making fun of me, but then maybe it's just their protocol.

And when would you like to take the exam, Doctor?

If I could schedule it for October 25th and 26th, that would be great.

Just one moment, Doctor. I'm just waiting for the computer to show me if those dates are available at your chosen testing location, Doctor. Just one more moment please, Doctor. (Pause) Thank you for holding, Doctor.

Stop calling me "Doctor."

So that's that. I've been admonished not to study for Step 3 of the Boards, so I guess I won't, really. Honestly, after finishing med school, I don't even think I can remember how to study anymore. My sister came over this weekend to pick up some old Anatomy texts that we don't use anymore, and looking through my old med school notes from second year, I just couldn't believe that I had actually ever learned so much. Or forgotten it all just as quickly. Well, maybe I'll just brush up on some old people medicine that I've forgotten. Speaking of which...

Maybe having El Presidente at our hospital wasn't quite the public relations boost as we had originally anticipated. I turned on the news on Labor Day (Fox News, it should be noted) and they were going on and on about the DEATH RATE at our hospital for cardiac surgery and how we had the HIGHEST DEATH RATE of any hospital in the region and it was unclear if the Clintons know about the DEATH RATE when they were transferred into our hospital from Westchester and was the President going to DIE because we were the DOCTORS OF DEATH? Also, did the Clintons know that our hospital was ONLY RANKED SEVENTH in the nation for cardiac surgery and why didn't he go to a HIGHER RANKED HOSPITAL and was he going to DIE now because we are a bunch of TWO BIT HACKS?

Now, I haven't looked at the raw data myself, but at least from working in the Children's Hospital, I know that we get transfers in from outside hospitals all over for complex patients that need a higher level of care. Sicker patients have worse outcomes, even under the best of circumstances. All this says to me is that our surgeons are willing to take the risk of operating on sicker patients. I know, because I've seen it. As a med student and a resident, there have been many, many, many times where I've thought incredulously, "You want to take this guy to surgery? This guy? Are you nuts?" Or, "You want to do chemo on this kid? Seriously? Well, OK..." Sometimes it turns out surprisingly well, and other times (unsurprisingly) it doesn't. But we're talking about the crazy sick patients. For "normal," relatively healthy patients like El Prez, we do a pretty good job, as do probably most big hospitals in New York.

And as for the issue of why Clinton didn't go to another hospital--it's funny how often people forget the issue of geography. The man lives in Westchester, when he needs medical care, he'll go to a hospital in New York. And if you hold stock with U.S. News and World Report, we're the "best" hospital in New York, whatever that means. If the guy lived in Ohio or Minnesota or North Carolina, then he'd probably go to one of the institutions there, and they could park all their crazy news vehicles and satellite dishes outside of those hospitals for a while.

Currently reading: "The Time Traveler's Wife." This is a great book, thanks for whoever it was that recommended it to me in the "Comments" section a while back. It helped me keep my sanity during a long post-call delay on the A train this morning, as I was wedged between a fat man's belly and another man's armpit.

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