Saturday, October 02, 2010


So I'm oncall again, and whining. And so, here it goes.
I did not become an endocrinologist to:
  • Figure out why the orthopedic hardware you implanted failed (yes, this was a real consult from an orthopod)
  • Drive 12 miles to a hospital to see a patient for a history of hyperprolactinemia 5 years ago, who is admitted for cardiomyopathy. Her menses are regular and she denies any breast discharge. And you couldn't even be bothered to at least check a Prolactin now before you put in the consult? Are you really a doctor? I expect more from my medical students.
  • See patients for the sake of seeing patients. To not "turn away potential business even if it may not be endocrine in nature". I'm sorry if I disagree with your philosophy. I'm here to help patients who have endocrine disorders. I'm not smart enough to figure everything out.
  • Figure out why your patients have trouble losing weight, or gaining weight, or are losing hair, or have mood swings, or are depressed, or tired. Seriously, before you put in a consult for a subspecialty, think: are there any lab abnormalities or clear endocrine pathology that justify the consult?
  • Cover all the diabetes patients in all 5 hospitals in the city, even the simple ones. Considering there is a 20% prevalence of diabetes in middle-aged patients, there are at least 250 patients currently in the hospital with diabetes. Learn to look after your own patients, and if you need help, I'd be happy to assist.
  • Also see clinic patients while oncall. And take nightcalls from all the nursing homes in the city, and from any patient at home. While many calls are justified, there is only so much one person can do. And when you get 11 pm calls like "I just came from a wedding and did a lot of dancing, and now my foot hurts. What should I do?" you discover you have an endless supply of exotic words you'd like to use (but can't).
In many ways, I miss my alma mater. I miss working in an academic institution where the consults seem more reasonable, and it's not all about numbers and keeping your revenues up. I miss having an hour for consults (real consults) when you can really get info from patients. Or more time with your diabetes patients to really explain how to adjust their insulins.
There, I've vented. Time to get back to work. And no, you may not leave a comment this time. I know, this is my childhish vent. As my friends say, I'm lucky to have a job in these economic times...