Did I say that?
Embarrassing…. Not for me! (Just spit out out!)
It takes a lot to make me blush. It’s not the same for my patients though. I never fully understand when they say:
“Sorry about this, it’s so embarrassing”
Rightly or wrongly I reply:
“No need to apologise, it’s not embarrassing for me!”
This patient embarrassment does however cause me problems on occasions, especially when patients regresses to using non-anatomical phrases that confuse me, and rather than making it less embarrassing for the patient, I find myself interrogating them further.
Now I’m not completely unaware of common slang, so if a patient reports “an itchy cock” rather than a “pruritic penis”, I’m not gonna call a vet!
However sometimes embarrassment is enhanced by a poor descriptions.
I sometimes do know what they mean…but have an urge to reply in a naïve manner….for example….
Blushing patient: I’ve got a problem downstairs, there’s a smell and sticky stuff…
So I’m tempted to say: So you’ve come to see me because the drainage in your basement is over flowing, you really should get a plumber out
or:
Patient: I’ve got a blockage in my back passage.
Max retorts: Ask the council to unblock it. (Could prove a very difficult conversation)
There are so many names for genitals I sometimes get confused between my anatomy books and children’s characters… From Enid Blyton’s Fanny, Dick to the Teletubbies….
Recently I have been subjected to a very confusing conversation where I had to push to understand the information I was being given. Enhancing the patients embarrassment more than if she’d just said what she meant in the first place.
You have an advantage over me….you know this is embarrassing already.
The lady advised me she had put tissue in her underwear to make it feel nice, but was worried some tissue might have got stuck inside her. I therefore assumed she was having some abnormal discharge and was putting tissue in her underwear to stop it getting (sorry, I know you don’t like the word…) “moist”. I asked about the discharge and why she wasn’t using a sanitary towel if she was having problems. She denied having any discharge. So I asked why she put tissue in her underwear again, and she said “so it feels nice”, I wondered if her underwear was irritating an inflamed labia and asked why it didn’t feel nice without tissue. Realising she was still confusing me, she pushed past her embarrassment and secret code and in a voice considerably louder than I think she planned, she yelled “I was masturbating”.
I, of course, stayed cool and proceeded with the consultation in the knowledge I actually knew what she was talking about!
Still not embarrassing for me.
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Relapse of Max’s chronic condition…
I have been so good lately, but this week I have had an exacerbation of my Chronic F-i-M syndrome. It amazes me that when it occurs I don’t get more pain in my knees or dental problems. Yes, it’s proven Foot-in-Mouth syndrome (- thankfully I think my writing style has improved since this early blog)
2 main exacerbations this week:
Firstly a patient who was a little snotty – both in psychologically and physiologically, presented with sinusitis. Now sinusitis is a condition that always gets on my nuggets. I can sympathise having had blinding sinusitis myself, but sometimes patients come in with such minimal signs and symptoms and demand antibiotics. So I confess in this particular case my heckles were well and truly up, as she had symptoms for a few days and very little to show for it clinically. Now I kindly pointed out to this nicotine stained, eau d’ashtray adorned lady, that smoking was one of the worse things she could do.
She then snapped in snotty tone that last time she stopped smoking she nearly killed herself. As she was apparently exaggerating her sinusitis symptoms, I assumed she was exaggerating here also, and thus I blurted out:
“Well killing yourself would prevent sinusitis of course!”
She then pointed out that she really had attempted suicide when she last quit smoking. Furwham!!! (The sound of my foot smacking its way through my teeth). At which point I agreed to give her an unnecessary prescription for antibiotics and let her go and have a fag!
Secondly, a pleasant chap came in complaining of penile warts. I should explain that he had a bit of a northern accent. For those not in the know, British Northerners tend to skip a few word out of their sentences. Now I love Northerners, and have even dated them, and I am fond of the accent, so I am not taking the mick out of their accent, cos ee by ‘eck the last thing y’want is ‘ mardy northern on yer case!
To avoid the wrath of my silly/inappropriate comment what the gentleman should have said was: “I’ve had warts ever since I was a boy”
What he actually said was: “I’ve had ’em from a young boy!”
I knew what he meant.
What I should have said was: “OK”
What I actually said was some comment about him being a paedophile.
Lead balloon anyone?
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Logical Oxymoron!
OK so I am in my consulting room alone, comfort eating. I am suffering a severe case of being illogically logical. Before this morning I would have said that was an oxymoron, I no longer feel it is, I’ll explain in a bit.
Fab Oxymoron example!
Last week I went for an job interview, working with a friend of mine, closer to home, more annual leave and a damn lot less time in the car and money going to fill my car. (Currently I commute a 50 mile round trip daily, that’s 250 miles a week, and about £40 a fortnight in diesel, which is nearly a grand a year just on fuel and I spend over 7 hours in the car each week).
As you might appreciate I am sometimes silly, this exacerbates when I am a tad nervous for example in interviews! So before I get back to my logic oxymoron, let me tell you how I answered the interview questions…(my wife laughed and then said.. “you can’t say that in interview!” (Actually you can, perhaps you shouldn’t, but you can!))
Question: What do you consider the worse part of working in General Practice?
Answer: Hmmm, going home after work??
Question: Where do you see yourself in 5 years time?
Answer: I’ll be 40, so potentially having a mid-life crisis, tattooed and riding around on a motorbike.
Phwoar!!! Look at the shiny metal…Hey…oh yeah… blogging. Sorry got distracted….
Question: What do you do to combat stress?
Answer: I’d like to say go home and drink 1/2 a bottle of scotch but…(more sensible answer then given).
Question: Name 2 things you’d like to change about yourself.
Answer: “Oh, if I say nothing that sounds really vain. Urm.” “Nasal Hair”
No I don’t have a moustache.
I did clarify with more sensible answers after initially blurting out the above answers, and I obviously can say things like that in interview as they offered me the job. Now we get to the logic oxymoron…
The new job has a tiny commute, therefore less cost getting to work, more time with my children. It is a good opportunity to develop my skills working in a teaching unit with new people. Logically move really.
I love my current job, every tiny aspect of it.
Environmentally, developmentally, financially and fatherly it’s logical to move. It is also illogical to leave a job you love in every aspect, so I should stay. The problem is I am a moron oxymoron. I am logical yet soppy and emotional.
So I have accepted the new job, and will enjoy it when I get there and make the most of every opportunity, but I shall cry every day before I leave my current job. Look! I’m an ex A&E nurse, and I still can’t cope with compliments, so anymore of this; “I’m really pleased for you, but we will miss you sooo much/the place won’t be the same without you” stuff and I shall explode.
Anyway if an oxymoron is illogical by its very definition, an illogical oxymoron must be the same as a double negative and therefore is logical! If you don’t understand me, then just smile nicely and say “yes dear!” If you do understand me seek help immediately.
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Dick Tations case files…
This week something in a patients notes was drawn to my attention.
I had sent a lady in her late 30’s for a chest X-ray, the report that returned read…
“Chest Xray clear, no evidence of infection or abnormality, as far as I can tell this lady has a very nice chest”
“Blimey” I thought. Did he actually mean to put all of that information into his report? Had he either forgot to switch his Dictaphone off or assumed his secretary was actually paying attention to what she was typing and would just laugh and leave that bit out.
This reminded me of some of the classics entries in medical notes. These are doing the rounds and I can not vouch for how genuine they are, but in this job you soon learn the dafter something is, the more likely it is to be true. So for those of you that haven’t seen them…
1: No previous history of suicides.
2. Patient has left white blood cells at another hospital.
3. Patient’s medical history has been remarkably insignificant with only a 40lb weight gain in the past three days.
4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. The patient is tearful and crying constantly. She also appears to be depressed.
8. The patient has been depressed since she began seeing me in 1993.
9. Discharge status: Alive, but without my permission.
10. Healthy appearing decrepit 69-year old male, mentally alert, but forgetful.
11. Patient had waffles for breakfast and anorexia for lunch.
12. She is numb from her toes down.
13. While in A & E , she was examined, x-rated and sent home.
14. The skin was moist and dry.
15. Occasional, constant infrequent headaches.
16. Patient was alert and unresponsive.
17. Rectal examination revealed a normal size thyroid.
18. She stated that she had been constipated for most of her life until she got a divorce.
(Perhaps she got rid of the little sh*t)
19. Both breasts are equal and reactive to light and accommodation.
20. Examination of genitalia reveals that he is circus sized.
21. The lab test indicated abnormal lover function.
22. Skin: somewhat pale, but present.
23. The pelvic exam will be done later on the floor.
24. Large brown stool ambulating in the hall.
25. Patient has two teenage children, but no other abnormalities.
26. When she fainted, her eyes rolled around the room.
27. The patient was in his usual state of good health until his airplane ran out of fuel and crashed.
28. Between you and me, we ought to be able to get this lady pregnant.
29. She slipped on the ice and apparently her legs went in separate directions in early December.
30. Patient was seen in consultation by Dr Smith, who felt we should sit on the abdomen and I agree.
31. The patient was to have a bowel resection. However, he took a job as a stock broker instead.
There was also a segment in one of the GP magazines, where people write in funny occurrences, and one GP was saying how (like me), his typing goes out the window when he is running late and subsequently realised he had written a patient was to have his “arse syringed”. A simple case of right letters, wrong order, but could have led to a particularly unpleasant colonic irrigation.
Let me know what you find…
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My mouth strikes again!
As you may know, in moments of spontaneous talking I sometimes say things that may be deemed inappropriate. Well alas I’ve been at it again.
I recently had need to change a patients oral contraceptive from Loestrin 20 up to Loestrin 30. I explained that the increased strength may have effects aside from the desired reason for increasing it, and incorrectly joked about her “growing a beard”…
…off she went….
A few days later she was back. Explaining that she actually had needed to shave and pluck her facial hair for several months, and was there something I could do to lessen her problem.
My observation skills were not at there best!
Phew I thought, my warped sense of humour actually prompted someone to address an embarrassing condition and feel relaxed enough to discuss it with me.
I asked her if she had a facial hair problem prior to using the contraceptive pill. She wasn’t which started first facial hair or oral contraceptive. I actually said:
“So it was a close drawn thing” What I very nearly said and just managed to stop myself was:
“So it was a close shave between which was first”. Again I managed to get away from my usual foot in mouth attack.
But it isn’t just me that is effected by saying the wrong thing.
I had a patient come in 1 week post vasectomy, stating he was concerned as one of the wounds from his surgery had a “ball hanging out”.
Oh my god! It’s supposed to be keyhole surgery. I had vision of a gaping pus filled scrotal wound with a testicle hanging out. (Yes – my mind is so warped I can easily conjure up such images).
Thankfully what I actually saw was a neat scar, with a small area of granulated tissue – Phew what a relief!
Change of shift is up with the fantastic Dr Anonymous, who is out of favour for a few minutes as he skipped my entry! Still it’s still a good edition, and if you are following my link, then you have probably already read my bit!!
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Run, before the nurse stabs you!
In my former life as an Emergency Room Nurse it was often dangerous. Various incidences occurred that could turn your hair grey(er).
I’m not a grey hare…
Some “classics” spring to mind…
Like the time a mother and father stormed into their son’s cubicle to attack his hypnotherapist – who they had hired, but felt had corrupted the boys way of thinking (is that not what they are paid to do?) The situation was FAST getting out of hand. Myself and a colleague where trying to calm and separate. My colleague was about to get punched when my mouth opened and out fell the words….
“This is a hospital, not the bloody Jerry Springer show…”
Amazingly it had a calming effect and the situation resolved….
I also had the typical dispute in triage, with a guy who didn’t want to wait 4 hours for his girlfriend to be seen with conjunctivitis, as HE had to meet his parole officer.
I advised she was the patient, SHE that needed to wait, and he could leave at any time. I also explained the usual bumph about triage, and if I made one exception the rest of the waiting room would riot. He became increasingly verbally aggressive, threatening my family (I didn’t like to tell him they lived miles away!) but I coolly stood my ground, until he left.
After which the girls in reception told me he was the local gun dealer, with a history of GBH etc.
“Swap these for some chloramphenicol mate!”
Next time tell me before not after! I suppose the whole “need to meet my parole officer…” discussion should have given me some kind of warning…
I thought perhaps moving to a sleepy towns primary care service would be a safer environment…..however this week I have had two potential dangerous occurrences.
My first near death experience was trying to do an ECG on a patient with 100% polyester floral blouse. The static was rising before I had even put the stickers on. I was worried I was going to end up defib’ing both of us!
Her ECG was fine, but there was nothing I could prescribe for her fashion sense!
The second incident was typical. One of our receptionist has printed off a huge amount of huge signs reading “FLU CLINIC THIS WAY” with whopping big arrows pointing towards the practice nurses room. Every year when the practice nurses given the ‘flu’ immunisations, these signs get bigger, as no matter how big the signs – someone will ignore them and get lost….
Consequently when the Practice Nurse found a patient wandering in the corridor, she promptly told him to stand round the corner in the ‘flu’ queue, and so he did….meanwhile, I sat at my desk, wondering what had happened to the patient whose name had just gone on the waiting room screen. If I had been 30 seconds longer before getting off my arse and finding him, he would have had a needle stuck in his arm!
Patient safety indeed!
Just when you thought it was safe to go on line again….Change of Shift is out again…
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You don’t buy me flowers
One of my colleagues is regularly described by patients as “lovely” and “ever so nice”. In fact she probably is. I sometimes hear her in the corridor: “Oh hello, it is lovely to see you!”
If she is seeing a woman who has bought her children with her, she’ll ask them what their names are. I even saw her holding a childs hand as she met them from the waiting room. It’s all so “lovely”.
Her patients send her flowers and cards.
I’m not on commission, they’re just good flowers.
MINE DON’T. Sure I’m not soooo sweet, but I do have my regulars, patients that actually ask to see me. Even a couple that won’t see anyone else. Two I can think of that actually think I saved their lives. So, why do I never get as much as a card? Is it because if I went to the waiting room and offered to hold a young girls hand I’d get funny looks? Is it a boy thing?
Well they could always buy me other types of flowers…
Warm!!
I don’t think it’s a bad thing, I’m just not sooo “lovely”. I do joke with my patients, but I also tell them that if they don’t stop smoking they are going to loose ten years off their life, that in real terms is ten years of their grandchildrens lives that they will unneccessarily miss. I think I know how to make a point that is relevant, rather than just a nag.
I think (and it is just my humble opinion) that us health care workers have a responsibility not to always be nice to our patients. I have often said to patients that having a consultation with me is sometimes a wake up call, and the next wake up call might be them coughing up blood or having a heart attack. OK so I’m not “lovely”, but I’m more “lovely” than sitting in the back of an ambulance.
Let’s face it: If we don’t tell our patients – who is going to? We know they ignore family and friends as “nagging”.
Perhaps I’ll try being “nice”, it might be good for me! But I’m not going to be “lovely”, because I’ll be the one that tells you – your overweight or that you are addicted to sleeping tablets, or that you drink and smoke too much and are going to cut your life short because of it, but it is lovely to see you (while your still alive).
I actually wrote this a week ago, and since then have recieved 2 presents – amazing. The first was chocolate, always a good call. Second was a kidney stone, so my diagnosis the week before was right, but a phone call would have done!
Also….
I’ve just started a facebook group, for nurse bloggers….well anyone interested in nurse blogging really, so pop by and help get the place running. It’s a Nurse Blogging Lounge.
AND HOW EXCITING…A list of the top Nursing blogs has been published. Obviously the big hitters like Kim’s Emergiblog are in the top spots….but little old Max squeezed into the top 25….
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Name games.
In staff-nursitis I looked at tricks to play on arrogant or bored staff within the A&E. Well it occurred to me I forgot something significant, and we used to do this to newbies, but also try to catch each other out.
The name game. The basic idea is that you give your co-worker a piece of paper with a patients name on it and ask them to call them from the waiting room. This sort of thing happened regularly, so the occasional trick name would not be recognised until it was too late. My favorite example is Hugh Janus.
“Hugh Janus please! – Is there a Hugh Janus in the waiting room?”
Other favourite patients included Melina Stools, Mike Litterus, Donna Keighbab and the one I never used: Mike Hunt.
On a similar tone, we used to challenge each other to say words of a given theme into a conversation with a patient.
For example: you choose a theme before going into a patients cubicle with you colleague – say colours (for beginners) and then compete to see who can mention the most colours during you time with the patient…. This is worth playing in whatever job you do….
“Hello, Mrs Jones – you look a little red faced” (1 point).
“So your chest pain is quite severe, well don’t be blue, we’ll get you some Ivy pain colours” (debatable 3 points – is Ivy a colour?)
“Well with all this attention your friends will be Green with envy” (1 point)
For the more experienced players choice a more difficult theme. “Song titles” is a classic.
“Hello Mrs, Mrs Jones , oh Sorry your not Mrs Jones”.
Gets you 3 points before you’ve even got in the cubicle!
Say “ahhh, ahhh – ah ah, close to you”
Moving on… I ‘ve just received a newsflash via email….reporting that Apple Computers announced today that it has developed a computer chip that can store and play music in women’s breast implants.
The iBreast will cost between $499 and $599.
This is considered to be a major breakthrough because women are always complaining about men staring at their breasts and not listening to them.
Hey you! Stop looking at my Ipod!
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Condom Advocate!
Sometimes I think I have been here too long…
Don’t worry – I’m not going anywhere, in fact I had an odd week on my blog.
Before this week – my record amount of readers per day was around the 150 mark. This week I had 695 views in one day – and I didn’t even leave a post with Change of Shift this time. (By the way it is out again – but finish reading here before you zip off to Erica). I think someone kept starting to read my pages but getting disturbed – 695 disturbances – sounds like a nurse – probably a male nurse (not multitasking!!- thought I’d say it before the girls got a chance)
Anyroad – As I have mentioned before, sometimes we use a bit of a script in this job. I am a condom advocate, I don’t like sexual transmittent infections (nothing personal – I HAVE NEVER HAD ONE) I have had crabs – but only in a sandwich.
So where is this leading???
Well in general practice it is a case of trying to find a balance between:
a: insuring your patients are not spreading their nasty sexual transmitted infections and getting new ones
and:
b: not getting that nasty little parasite in their tummy (AKA pregnancy)
Great condom ad: Protect yourself
Yes I can rant on all day about using condoms, but some people just won’t! During this ranting to my patients I have a bit of a habit of saying:
“I’m a big condom fan – well, actually I’m not necessarily a fan of big condoms, just a fan of condoms generally” and then rant on as stated.
So yes I should say “I am a condom advocate”, but it relaxes the patients when I say stoopid things, especially giggly teenagers, who sit there looking at me like I’m some nagging father figure. (Anyway they really shouldn’t be going out dressed like that!) – my poor daughter, merely two years old and has no idea how much she is going to hate me in years to come.
Anyhow (I’m easily distracted today)…I used my “Big condom” line again today, and my patient piped up:
“You said that last time I came”
OK so maybe I have been here too long or should just change my script a bit. Of course I was tempted to retort:
“I’ve never been near you when you came – and if I was I would have used a condom! – now go away and catch something nasty!”
Harsh, sorry. Bit teste today!
This is becoming a bit of a regular feature…In the news today...
Apparently “People who significantly cut back on the amount of salt in their diet reduced their chances of developing cardiovascular disease…”
HELLO!! My patients must think I spend hours doing unpublished research in my spare time, just for their benefit – I’ve been telling them salt is bad for years.
OK – so there is new research, and I suppose it is useful as it makes the news, thus making people think they have found out some fascinating new information and so they might just put 1 kilo of salt in the spuds – so they cook quicker.
For heaven sake – can’t researchers find something better to do, like find a cure for giggly teenagers! (I’m just bitter because most teenagers are half my age! – and what makes me bitter – too much bloody salt!)
That’s enough. Don’t forget to pop and see Erica…
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Did I say that?
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It shouldn't happen in health care 