June 27, 2005

Pissy Little Work Post

Move along, now! Nothing to see here but childish, unprofessional, ungrateful biting of the hand that feeds.

Where to start, where to start? Oh, my: So many candidates making me want to set phasers to "KILL" today.

Let's start with physician assistants and nurse practitioners. This doesn't speak well of me, but it's the bald truth and I'm tired of hiding it:

I probably hate you.

I'm sure you're good and thoughtful people with many talents and abilities, the kind of people who give to charity and tell the most marvelous anecdotes at parties . . . I'm sure the problem with me hating you is me, that is, and not you.

But there it is. Odds are real good that I detest you.

Why? Well, because in my experience, you're almost invariably guilty of one or more or even all of the following:

1. Giving me the supervising physician's name in a big slurred rush so that neither I nor any other speaker of English can possibly decipher it.

I know you're in a hurry, but listen: I need that name, see? So slow the fuck down. I'm not so stupid as to ask you to spell it--I know you would never do that and more importantly, I know that when doctors do try to be helpful by spelling the name, they almost always spell it wrong--but, you know, maybe pronouncing it? It would be helpful to me.

2. Interrupting the dictation to confer with other hospital personnel and not putting the fucking phone on hold while you do it.

You know, it's one button. Oddly, all the M.D.'s appear to be capable of locating it and depressing it at appropriate moments. So I have to ask: Why aren't you? Is it something they teach only in medical school?

Yes, I know you need those lab results on that other patient right away, but you'd be pretty pissed off if some dingbat transcriptionist, me for example, started typing them into the present report on another patient, wouldn't you? So help me out here. Put the phone on hold! Help me not be dumb and piss you off.

As for interrupting the dictation to gossip about personal shit, well, an awful lot of you do that, too, which is even worse, and I'm embarrassed to report that a lot of you doing it are women. Quit setting the movement back forty years, bitches, and gossip on your own fucking time.

3. Playing Chinese fire drill with the report sections.

This is a flaw you do share with various M.D.s--but whereas I have some M.D.s who, in the midst of the lung exam, will suddenly inform me that the patient vomited twice last night and once this morning, requiring me to page back up to the history to insert that tidbit there--whereas I have a few scatterbrained doctors who do this occasionally, I have maybe only one or two of you P.A.s and N.P.s who don't do this like, constantly.

And guess what?--Most of the M.D.s who do this warn me first ("oh--note to transcription: Could you go back up to . . . .") or apologize afterwards ("I apologize for that. Back to physical exam . . . .") or thank me for bearing with them or even, believe it or not, all three, warning, apology, and thanks (which isn't necessary--the warning beforehand is really all I need--but it's awfully sweet nonetheless, don't you think?)--but you people? From you I get NOTHING. You're being a pain in my ass and you don't even have the courtesy to warn me that you're about to commence being a pain in my ass. I have to believe you're giving intramuscular injections to your patients sans warning, too. Not even a "this may sting a little" first.

4. Taking three times as long to say half as much.

It's a simple 1-cm laceration repair on an otherwise healthy patient. How is it that nearly every single one of you is able to stretch that out to eight minutes of yak, yak, yakking? Even residents can wrap up a suture repair faster than this. It's embarrassing. Shut up already!

I know I should just be grateful for the sweet, easy lines you give me as you yak, yak, yak about how the patient has no history of recent travel, no polyuria or polydipsia, no hematemesis, melena, or hematochezia--I got macros for all this, I should just shut up and type it in my neato macro shorthand, but fuck! You people are boring the daylights out of me!

And yeah, it's just a thought, but maybe you wouldn't have to rush-and-slur through your attending's name, the lab results, the current medications, the ALLERGIES, or any of the rest of that marginally important stuff, if you just wouldn't take eight minutes to describe a simple laceration repair.

Am I so off base about this? Is it that your attending's a real stickler for detail, a real ballbuster, so to speak? Because I notice your attending can dictate a simple laceration repair on an otherwise healthy patient in under a minute, usually. So I have a feeling I'm missing something here, but I just don't know what.

5. Slanging it up all over the place.

This sucks on accounts for which my company has been instructed not to type slang, which as of this writing is all the accounts I work on regularly.

Holy tele-for-telemetry, non-M.D.-people, but you sure do loves you some slang!

You love crit and lac and vanc and subQ and osmo and segs and you love 'em all way, way, way beyond how much even the most cryptic, shorthand-speaking M.D. loves it.

Three words: Trying too hard. Yeah, yeah, I know you're "inside" a very "exclusive," "elite" industry, one that has its own special language, its own special mystique.

That's nice. Now just say vancomycin like a normal health care provider.

6. Using the transcription as an outlet for your frustrated creative writing career.

All I'm asking for, here, is a little conformity.

If everyone else at your hospital calls that section, "Medical Decision-Making," then how 'bout you say "Medical Decision-Making," instead of "Clinical Decision-Making."

If everyone else at your hospital refers to it as "Medical History," then how 'bout you say "Medical History," instead of "History of Past Health."

If common phrases to describe successful treatment of a patient's hypertensive urgency include:

blood pressure decreased to . . . .

the patient's hypertension resolved following administration of clonidine, down to . . .

after Lopressor, the patient's blood pressure came down nicely to . . . .

patient's hypertension abated on its own . . . .

we were able to reduce his initial blood pressure to . . . .

her hypertension was alleviated with . . . .

. . . then why do some of you have to do dumb shit like say "his hypertension resigned down to 146/77 at the time of discharge?"

Resigned? Yes, okay, I can kind of see how you might think that almost works but--no. No, I lied. I can't see it. What I see in my mind's eye when you say it resigned is a cardiac monitor flashing "I QUIT" or even "TAKE THIS JOB AND SHOVE IT" where the blood pressure numbers should be.

I know it would be totally hampering your individuality and repressing your True Self to ask that you just say "decreased" when you mean "decreased" and, frankly, I don't care about your individuality nearly as much as I care about my own, and you're driving my individuality completely insane with this "resigned" shit, so KNOCK IT OFF. Decreased. The blood pressure decreased! Or "came down nicely." I admit I'm kind of fond of that one, too.


Don't mind me. It's just one of those days.

Posted by Ilyka at June 27, 2005 01:14 AM in in praise of idleness

Howinhell did I miss this?! Oh, I guess I was lost in the "Bitchfest" posts. LOL These PAs and NPs sound an awful lot like my "newbie attys".

I've been saving up a work rant, myself.


Posted by: Margi at June 29, 2005 01:44 AM