Sawbones: A Marital Tour of Misguided Medicine - Sawbones: The Secret Life of Doctors

Episode Date: April 5, 2018

Ever wonder what doctors do when they're not giving you a check up? Wonder how to get the most out of ever doctor's visit? We've got the answers for you in our new episode: The Secret Life of Doctors. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. We came across a pharmacy with the two in that's lost it out. We've washed on through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth Hello, we're ready and welcome to Saul bones marital turf miss guy to medicine. I am your co-host Justin McElroy And I'm Sydney McElroy. It's a little too much sort of like barfato for my name I think I regret it. It sounded a little more like like a radio DJ. Yeah, that's not me folks I'm just regular Justin in fact, I'm less than regular Justin because I come to you today, hat in hand. Like on behalf of my wife and the maximum fun network, it's Max. Our lovely children.

Yeah, our lovely children who just want to square meal. Three hots in a cut. No, this is a max fund drive. It's an exciting time. I don't feel humble. I'm thrilled because it is a time where we all get to come together as a network and with one voice, hold hands and say, hey, you, give us money for this.

We've been on the max fund network since we launched our show in 2000 and 13. We're at 220 some episodes. That's rough. It's been five years. Almost five years. I think in the summer, right? It'll be five years.

I can't believe that. Believe it or not. But Max Fund Drive is when you, if you're not familiar, it's when we ask our listeners if they are able to really join the maximum fun network. Not just like listen, but really become a member. And by that we mean pledging a certain amount of money that you can are able to comfortably donate each month. We're going to talk about what you will get in exchange for these donations. These thank you gifts. You're not really buying them. We are paying for is the content that you've enjoyed and it's way to say, hey, I like this

being in the world. And we really appreciate you showing that support and so and if you're already member, maybe you want to think about upgrading your membership. That would be wonderful too. Maximumfund.org Ford slash donate is the address. If you like our show, if you can spare a few bucks to support it or and the other shows on the network, you choose when you donate or upgrade what shows you listen to and the majority of your donation goes right to those shows. A smaller percentage goes to Max fund, the paper it's employees and the great team over

there. And then the rest goes straight to the shows. So that is the way to show your support and to help make it possible for us to do this. Just to you have a personal story. Sydney works fewer hours than she used to because she wanted to make more time to research and make solbona's great and record solbona's and do more live solbona's and stuff like that. So yeah, and that's thanks to y'all. So thank you. That will talk more about that at the break, but that actually Sydney dovetails,

not ductails, dovetails. Whoa, was that actually Sydney dovetails. Not ductails, dovetails. Whoa, was that intentional? Ducktails and dovetails. Like ducktails, dovetails, is that a thing? I don't know if anything else, ducktails would have been a playoff of. Yeah, because it's really, it sounds like it's intercapped in such a way

that it should be something, but anyway. You know, ducktails instead of, there's nothing I can say though that is. Nothing makes sense. No, well, and some of them are inappropriate or exploitive, so we'll just stop there. Today we're going to do an episode that is kind of different, but I think it'll be kind of fun and interesting.

You're giving Cooper some weird looks. Is she okay? No, she's just squirming all over the place. She's gonna need to be picked up. Also ducks, is it just because of duck tails like tails? Yeah, like they have tails and also... Well, they don't have tails, but they've got that pointy part. They do have tails. There's an end to a duck. Ducks do have an end. Okay. In the hair do, there's the hair, the hair style of the duck tails hairstyle. In that't, isn't that what that's called? You'd understand it would be pretty wild

to call a hairstyle a duck tail if ducks did not have tails. You realize that would've been the first thing at the hairdressers' stage. That's a way that's like smooth like a greaser, right? Yeah, no, I'm not debating the size and style of the duck tail sort of look. I'm saying that it would've been wild if ducks did not have tails to call that style a duck tail.

It's like a butt. So what we are going to do today, I'm going to, I'm calling it because it sounds dramatic the, the secret life of doctors. But really what we are going to do, and because I think it's interesting, you know, the doctor comes in when you have your appointment from a patient perspective, the doctor comes in. They see you for, you know, however many minutes your appointment is, we'll get to that here in a sec. And then they disappear. So what are they doing the rest of the time?

We're going to break this into two chunks. I mean golfing. Golfing pretty much. We're going to break this into two chunks. The first will be sort of Sydney's regular day today. I mean golfing golfing pretty much We're gonna break into two chunks The first will be sort of signet Sydney's regular day today And although she's a family practice doctor. I'm sure it's somewhat different for other specialties But maybe you can address that sort of as we go sure and then in the second half of the show

We're gonna talk about a hospital service which is like working at the hospital itself So Sid let's let's actually start. And now this would have been obviously, we talked about residency a couple times. I don't think we want to focus on that so much. I'm kind of thinking where you're at now as an attending physician. Sure. First off, why don't you talk a little bit about what that means being an attending physician? And then let's get into your day to day.

An attending physician just means that I finished all of the training portion of being a attending physician and then let's get into your like day to day. An attending physician just means that I finished all of the training portion of being a doctor. You know there's the years your medical student. They're the years that are kind of like apprenticeship years where you're a resident where you are a doctor and you do get paid but you're also still in training. And then following that you become an attending physician meaning you're also still in training. And then following that, you become an attending physician, meaning you're done with training, you're out there on your own. If you mess up, it's your fault now. Flipper 5.

Yeah. So, uh, so I am an attending physician. I have been since 2012. Um, alright, so let's start with a typical, let's, because your days are a little bit different. Let's start with Tuesdays. Okay. And so first of all, let me preface with, I do family medicine. Okay. So I see all ages of patients,

and I largely do outpatient medicine, and when we say outpatient, we mean in the office, not in the hospital. That's inpatient. Okay. So I largely do outpatient, we mean in the office, not in the hospital. That's inpatient. Okay. So I largely do outpatient medicine. And I do not do a lot of like procedures. So that that just kind of is a broad view like that's where I fit in the medical spectrum.

So I see you for like checkups, you know, I see well child visits or immunizations or just to make sure they're doing okay. And then I also see people for chronic disease management, you know, diabetes hypertension, that kind of stuff. And then if you're like sick, you got a cold or something. So that that's kind of the gamut of where I fit into the world. I work in an academic practice. So we have medical students and residents that I teach. And then I also see patients in that setting. Which is a little unique because doing what I do, you could work in an academic practice,

but most docs don't. They either work in a private practice, which is kind of what you think of as like the doctor's office where you go and there's one or two doctors and the nurses that work with them and that's kind of it, you know, free standing. Or... There's a strip mall between a gun store and a fortune teller, is that kind of thing?

Is that usually where doctors offices? There's like different places they could be, I guess. I mean, I guess it could be. It could be. Sure. And then there's also, you know, large group practices with many, many doctors still outside of academics, still outside of a hospital, but they would all do this similar kind of thing. I start my day seeing patients at 8 a.m. generally on Tuesdays specifically, but I mean at our

office everybody starts at 8. Pretty much. And the way that primary care visits are generally broken up, and it varies from place to place, but this is usually, this is the most common schedule. I am scheduled a patient every 15 minutes. So if I've already seen you before, that means you're an established patient with me,

you get 15 minutes scheduled for your visit. If I've never seen you before and you're a new patient to me, you get 30 minutes scheduled for your visit. If I've never seen you before and you're a new patient to me, you get 30 minutes scheduled for that visit. Subsequent visits, of course, will be 15 minutes. This would be different in different specialties. I know, for instance, that if you're in psychiatry, your visit may be scheduled for an hour, you know, if you are in some other sub-specialties, you might get 30 minutes for every visit. But in primary care, this is pretty standard. There are some that do 20-minute visits, but for the most part, 15 minutes is all we are given per patient. Okay, so when you are going to go into a patient's room. How do you, do you like review them before you go in or has

our? So I have access to their medical record through we now have an electronic medical record. And again, this is the, the rule rather than the exception. There are still places that have paper charts in which case you would have literally a folder of old notes, you know, old lab results, old, whatever testing they've done that you could flip through first. But I just open up their chart in the computer and I sit and I usually, if it's a patient I've seen before, I usually just review the last note that when I saw them previously to remind myself what specific issues did we cover, what did we want to make sure and follow up on this time. I look at any other labs they've had done since then, any other visits, maybe they've

seen another specialty, I can look at all those notes. Where are you doing this? So I have an office that I share with one other physician where I could actually go and sit and have a little more privacy to review charts, but I generally work out of my nurses station. So when you go into a doctor's office, especially one with like a multi-physician practice like mine, there are ours has eight different nurses stations, I believe, and at each one, the nurse is stationary. So it's tied to whatever nurse works there.

So they tied the nurses to the station? Yeah. Yeah, he or she does not move. They don't know, not taught, not literally. But the doctors might move about now. It feels that way, doesn't it sometimes, my fellow nurses? I'm just imagining that's an issue that nurses complain about. I don't know. The main thing I'm afraid about is that since the hospital bought our practice We can't have coffee at the nurses' desks anymore

Pods we actually call them. There's a called pods. Oh like the curic those are I those are fine, but I don't Not now. We call the Nersetation's pods. Oh, not okay. Um, do you know what kind of pod six? Pod six. Uh huh. Okay. Generally, but I mean, doesn't it get in the nerves like get out of our pod? This is our pod. You have your at office. Does that bother? No, because a lot of your mom's fun. So maybe it's that helps. No, I think it's, I

think it's better for me. and this is, again, this is personal. For me, I like that I have, so at our pod is a little desk with two computers. The one that is the nurse's computer, you don't mess with it because that's their computer and they use it all day long because they're doing a million things on it. And then there's the other one that the whatever doctors working out of that pod can use. And we're right next to each other. And I love that because my nurse will go out to the waiting room, get the patient that I'm going to see while I'm reviewing their chart, bring them in, take their vitals, find

out what they're here for, open up a note in the chart, and then come to see me. And that time that face to face time I have with my nurse is great for if there's any issues right off the bat, she can warn me quickly. Like you should see that patient right away. There's something going on or just heads up. This bad thing happened. The sad thing that they were telling me about,

just so you're aware. Or they mentioned to me that they saw a doctor outside of our practice. And so I'm going to go try to track down that saw a doctor outside of our practice. And so I'm going to go try to track down that record while you're seeing the patient. So maybe we can get that record before they leave today. And for me to ask questions like, hey, did you get a call back from so and so? Or have you read this task that I said, yeah, that kind of thing. It's really important to take care of patients.

To free it for you and the nurse to have that proximity. Yeah. Yeah, for us to, I mean, my nurse and I have, we've worked together essentially since I started there and we have a great rhythm now. Like we were a good team. The idea of using different computers throughout my day and having a using a computer that other people also use makes you want to scream and throw my head to the play class window that is in my office.

You're painting the grimest hell for me. I cannot imagine using multiple computers and having to share them with other people. I want to cry. That's the sad thing I've ever had. I use a different computer, essentially, every 15 minutes. Because each room has its own computer. Oh, you wound me.

Oh, it's a smear. Which a lot of people complain about, like, you know, then the doctor's looking at the computer and said to the patient, I try really hard to make sure that the majority of the time I'm focused on the patient talking and interacting and examining. But it would be impossible to practice medicine without a computer in the room.

Okay, so once you go into the patient's room, I think we pretty much, I mean, I think people are pretty familiar with that part, you know, you're asking them what's going on, you're doing the checkup. And while I'm doing that, I'm also responsible for generating a note based on the encounter, which is just a record of what you said, what we talked about, what I recommended, and any exam findings that could affect. Do you do that note while you're in the room? I do part of it while I'm in the room. Some doctors are fast enough to finish it while they're in the room.

I like to talk too much and I like to talk about stuff that isn't important to the visit too much. I spend time chatting with my patients probably more than I should. So as a result, my visits take too long probably and I don't finish the note in the room. So they always go 15 minutes because you said average 15 minutes are patient so. No, they go at least 15 minutes. I would say that I probably in an average day,

I don't have a single appointment that only lasts 15 minutes unless somebody just happened to come in for my nose as runny. Can you just make sure I don't need an antibiotic kind of visit? Those can last 15 minutes, but anything with chronic disease management, anything if we're dealing with like mental health issues, you can't cram that stuff into 15 minutes. If I'm only running an hour behind at the end of the day, I feel pretty good.

Well, you should eat your lunch break, right? I haven't gotten a lunch break since I started medicine. You just... I mean, I think as a medical student, I may have gotten lunch breaks, but since residency started, I've never had a lunch break. It's scheduled in your day, theoretically.

Yes, there is an hour between 12 and 1 when I am supposed to be eating lunch. I am never eating lunch at that time. That's a lovely said. Well, good doctor you are. And I think, I think, my- That also is why, by the way, I'm going to take my sidebar here.

Hi, it's Justin. Please show up on time for your medical appointment. Please, can you do that for me? So my wife is not even further behind and later in getting home and Messes up her whole day. So please be on time for your medical appointments. Hi, I know you have a lot going on. I'm sorry. We all do. It is hard. It is hard.

Especially if you're the first appointment in the morning because if my first patient is late, the rest of my day There's no way I can make up that time because I'm going to lose time throughout the day anyway. And that's something a lot of people say, well, you expect me to be on time, but yet you're running behind. How do you justify that? I don't want to run behind. I hate making my patients mad. I hate because I inevitably get yelled at maybe not every day, but every week by somebody who had to wait and is very angry with me.

And I feel very bad about it, but the reason you had to wait is that someone else had an issue that took longer. Sometimes it's an emergency. Sometimes it's, I mean, you'd be shocked how many times someone comes in to discuss, you know, their blood pressure. And five minutes into the visit, they're sobbing and they're talking about something that has nothing to do with that,

but that they really need to talk about that day. And, you know, I believe a good doctor goes where the visit leads them and doesn't try to force a visit on a patient that they don't feel they need at that moment. Sometimes I just have to look at people and say, listen, let's focus on this today. And I'm just going to have to bring you back to talk about

your glucose readings have been too high. We'll talk about that next time, because clearly, this is more important to you today. Is that a pretty good summation of your standard when you're in the office? Like what I do. That's pretty good. Especially that.

Yeah, I see. And then at the end, once I'm done seeing all my patients, like what I do. That's a pretty good solution. Yeah, I see. And then at the end, once I'm done seeing all my patients, that's when I have to finish all the notes and submit all the billing for all of the patients that I've seen. So, which is just me sitting at a computer, typing, typing, typing, and submitting on the bills electronically. And that is just the patient part of it.

That's actually just a small part of what I have my duties at the office. All right, well listen, what are we here for? What else do you do? The other thing that fills every minute that I'm not seeing a patient. Any second that like, let's say I have a cancellation and I have a free second. I'm waiting while my nurse puts patient in a room or over my lunch break, so-called lunch break. I, through the electronic medical record, I am sent tasks. I have an inbox with tasks in it. And the tasks are questions from patients who've called, who electronically sent me tasks, who dropped off paper at the front desk. They're questions about refills, their lab results, or X-ray results, their messages

from other physicians, proving refills, and I have to do all of those every day. So most days I get probably anywhere from 30 to 50, 30 on a light day, 50 on a really heavy day, varies throughout the week. And all those have to be done, which can either be sending the electronic task back to my nurse, calling a patient, ordering more tests, you know, it varies. And then there's my actual mailbox of paper mail, which is filled every day with faxes from pharmacies, for medication refills, for equipment refills, approving home health nursing orders, physical therapy orders.

All that stuff has to be reviewed by me and signed. So I have a mailbox every day that's full of probably again like 10 to 20 pieces of paper that I have to read any of their scan into the medical record or sign and mail back or fax back to somebody. Can you talk about Richard Park? I also work at a psychiatric hospital in our community. And there, I'm not a psychiatrist, obviously.

I'm in charge of medical management. So in order to get admitted to a psychiatric hospital, you have to be medically stable, you know, not need some sort of acute medical care first. And so when you are first admitted, you're examined by me or one of my colleagues. I do a full head to toe physical exam, take a history. And a lot of it is make sure that patients who are on chronic medications are continuing to receive those. If they need special labs ordered because of other medical conditions they have, I make sure those get ordered at admission. And then people get sick

while they're there. You know, some people are there for a long time. And so I see the usual coughs and colds. I manage like medications that get out of whack. People who are on a blood thinner called Warfare and it always goes all out of whack once they start different medications there. That kind of thing. And lectures, right? You do lectures sometimes. Yes, I do lectures to medical students. I do lectures to the rest of the world. You do lectures to them. That is the way of describing it. And I also precept, that's another thing I do. So because I'm in an academic facility, any residents who are seeing patients

have to have an attending who's overseeing them while they're doing that. So that's always good to know. If you're seeing a resident physician, you might, you might, it might give you pause because you think, well, they're still in training. That's not safe, is it? And you're right. No. Oh, because there's someone like me sitting in an office that they

are talking to about every single patient they're seeing. The earlier in their training, the more likely you might actually see me, I'm actually coming the room before your visits over to like shake your hand and reassure you, don't worry. We just talked about everything. You're fine. Um, but as residents progress, they usually don't have to bring us in the room. But I'm discussing every single aspect of your care or someone is who's already done with training and you know, making recommendations and suggestions or just saying, yeah, you're on the right track, good job.

Anything else outside of hospital service? You want to touch on? Meetings. Meetings? Everybody's got meetings. I was going to say, I don't think that's particularly. I meet a lot with medical students, one-on-one meetings, like advising, mentoring, that kind of thing.

Make generation, right? Yeah. It's beautiful. Anyway, we were going to talk after the break about hospital service, but first we're going to take a trip to the, not really the billing department. No, this isn't the billing department. This is the giving department.

Oh, that's nice. This is the Max Fund drive folks. We only do this once a year. Once a year we come to you and say, hey, if you've enjoyed this show or the other shows on the Max Fund network, can you spare a few bucks to help support that? And that money does go directly to the shows

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I think we veered into like five days of bonus content. All the shows put out a new episode, a bonus episode. It's always pretty cool and special. And you get access every year, you get access to every year's bonus content. I mean, hours upon hours of stuff. For example, we just did an episode live from a local pharmacy, where I basically talked about how bad a lot of over the counter-counter medications are and how many don't actually do anything for you. And we did one about like medicine in the future,

I think, was that one of them? And we've done an ASMR episode. We did an ASMR episode. We did a two and a half men finale commentary track. That's right, we did. Do you remember that? That's right, we did. We absolutely did do that.

That's the thing that we did. So we have done a lot of those and and they are all there waiting for you. With every other show. Yeah, every other show. What is still buffering you this year? We did a team quiz challenge. How much have we learned from each other? Excellent. Well, you and those are there and available for you to download. You're also with the adventure zone. We played Dungeons and Dragons with little man, one Miranda for the first time he'd ever played. That's in there. We also worth it just for that. Really? It's fun. There's a you get a demo of a song called Ghost Horse that he wrote.

It's parody of a shoot for 10 Horns. Is that right? Yes. I think that's what they want to song. But as for guys and also. And this is just at the $5. That's just the $5. I love it.

You can do $10. You are going to get a very cool pin designed by Megan Lynncott. Every show, you get to pick what shows pin you want. And every show has a very cool one. R's is a sort of patent medicine looking bottle. It says cure all cure nothing on the pin and it's really cool. You can come to the website and check out all of the different pins to entice you. They're excellent.

Not to keep bringing up still buffering. I really like the still buffering pin this year. I think it's the best one. It's a little like for dummies guide and says how to adult. It's very cute. It is very cute. But all the pins are great. You can't go wrong with the pins and that's a $10 month plus you get the bonus content. And now if you give $20 a month, you're going to get, I think this is so exciting. The Max Fun 2018 Max Fun family cookbook. Now Justin, you submitted a recipe. I did. All the Max Fun hosts, a ton of them submitted recipes for everything from cocktails to desserts, everything in between. Great recipes from their from their hearts. I donate a gave my mom's recipe for chest bars

and they are sitting and eating them multiple times. They are delicious. Quick review, they're amazing. Yes. They're real Baptist desserts. It's gonna take you on a journey. It's very decadent. It's got a box of confectioners sugar.

I mean, they're out of control. And it will make you the hit of every event you ever, people will be asking you to bring chest bars to their events forever once you make these if you make them by the Way, so you picture I love to see that you're also gonna get some cool space themed cookie cutters and all the recipe For my dad submitted one for we didn't episode of my brother my brother may a long long time ago called spaghetti Getten and that was an episode we recorded after our stepmother Carol made us some spaghetti. She submitted her spaghetti recipe

into the maximum family cookbook. That's all waiting for you. Plus you get the NAML pin, plus you get the exclusive bonus content. And the donation levels go up from there. There's 35, 50, 100, 200. And there's great gifts if you go to maximumfund.org for it's not to donate.

You can see those. but honestly, by the way, those continue to accrue. So you get whatever you get at your top tier, you get all the stuff before it, but honestly, I personally think it's less important how much and more important that you try to support again if you comfortably can. I don't want to put anybody in dire straits. No, we just appreciate you for listening, but if you're in a position that you can listen and support our network by becoming a donating member,

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Please if you can and then don't wait because you might forget you think I'm gonna do it just open up another tab Or just pop up your phone do real quick. It's fun. Mm-hmm. It's not fun. You're putting in your no and I Part of information stuff. It's fine, but it's not it's not owners I'll say that and make sure you check all the shows that you listen to and enjoy. That's a really important part. Yep. So maximum fund or for us donate Sydney. You are on hospital service now. Yes. I'm miserable. It's it's so hard. This week is so hard for me. And I did say week. And that's what we're talking about Tuesday to Monday, usually for you, right? Yes. So I also take care of patients who are in the hospital. And everybody does this a little differently, you know, back in the olden days, I should to draw, I mean, it's all bones. That's the show. Back in the olden days, this day would break down very differently.

An old timey family doctor would do what I do, see patients in the office just like I described. They also probably would have some home visits, some house calls to make that same day. And then that same day, they would also be going to the hospital to round on any of their personal patients who were admitted to the hospital. And that was the model for a long time,

wherever your patients were, you saw them at home in the office or in the hospital. As you can imagine, that's hard to have much of a life. And the bigger your practice grows, the more impossible that becomes. I mean, if you've got several people in the hospital and you've got, you know, 40 patients to see that day in the office, when are you gonna get all that done? Right. So what a lot of practices do is what our practice does, we, all of our patients who are admitted to the hospital are seen by one of our attendings each week,

and we alternate. Well, no, there's, there's seen by your attendings each day. Well, yes, yes, sorry, our attending each week. A different attending each week, and yes, we obviously, we see the patients every just day. Well, yes. Yes, sorry. Our attending each week. A different attending each week. And yes, we obviously we see the patients every single day. And that is the way we are structured to do it. A lot of practices do that.

More and more are going to a model where they will work with a hospitalist. So when you're admitted to the hospital, there's a certain group of doctors who just work inside the hospital. That's all they do all day. And they will take care of your patients while they're in the hospital, that's all they do all day, and they will take care of your patients while they're in the hospital and then hand over care back to you when they're released. Hospitals are better, the ones that have all the secret, like the best shortcuts, they know the best stuff in the cafeteria, they're the ones like the jazz for directions. Yes, they know that place.

They know the body. Yes. They know the body. The only place they work, that's all they do. They don't do any outpatient care. They just do the hospital. They are employed by the hospital usually. What, since I'm in an academic practice, not only do I, I see these patients in the hospital

of all my, of all my colleagues, I also guide a team of residents in doing so. So while all of the patients are technically admitted to me and I see them every day and I am ultimately the one responsible for making the decisions involved in their care, I am doing this sometimes through senior, junior and intern residents that I work with. I have a team of six.

Let's do this chronologically, because you go in just bafflingly early. It's really not that hard. It's not that hard. It's not that hard. I know, but it means I have to wake up at six. I mean, can you imagine it, folks? So I wake up at six, and I sneak out of bed to try to not wake up just in. It works.

Or Charlie, when she's in bed with us, which is often at that point in the day. Yes. And I try to sneak out of bed and get ready and quickly drive into the hospital to be there at 7 a.m. At 7 a.m. And every academic practice probably does this a little different, but this is the way we do it.

At 7 a.m. we have a check out, meaning that the resident who was there all night actually slept in the hospital and took care of people all night long. It sits down, we have a list of all of our patients, and we each get a copy, physical list, paper list, and they run through the list and basically tell us what happened overnight. Here are any changes, here were any things that went good or bad, and here are the new people that I admitted last night. Our service is very busy with a very heavy service, so that number of new patients could range anywhere from five or six on a lighter day of work to, I think the most I ever personally admitted was 17 in one night. So it

can get pretty busy on inpatient service. That usually takes about an hour of us just briefly. This is a very brief check out at this point. Just quick updates. At that point, everybody breaks up to go see their patients. And that's when, if you are in the hospital, this is when the doctor shows up to actually examine you, talk to you, and let you know what's going on. This is a good piece of advice. If you have a loved one in the hospital and you're wanting to talk to you and let you know what's going on. This is a good piece of advice. If you

have a loved one in the hospital and you're wanting to talk to the doctors more, get more face time with them and actually be there when they come and you know, check out your loved one and make the plan, the morning is when we do that usually for the most part. Our patients are spread all over the hospital. Since we do family practice, we do all ages and all problems. So I started the top just, I do family practice, we do all ages and all problems. So I started the top, just, I don't know, we just do. We start at the top and work our way down. We go to the top floor and we go into each room.

It's myself and two of the senior residents and we examine and talk with the patient and make a decision based on how they're doing, what we're going to do that day, let them know what the plan is, and move on. Once we have seen everyone, we reconvene back in our call room. Every practice, by the way, has like a secret call room somewhere in the hospital. There are these, if you open the right door, you will find a large table covered in computers and paper and very tired looking residents and lots of coffee. So there's a bedroom? There are.

There has to be. Oh, there has to be a bedroom. Yeah, because I mean at least one of those doctors is staying there every night. So there has to be a bedroom and often there's a bathroom and a shower because you know, some of them shower. Usually, yeah, ours has a refrigerator. I make baked goods sometimes, so if you see one with baked goods in it, that might have been me.

And a holiday tree. A holiday tree. It's not really Christmas. We decorated it all season long. It's a holiday tree. It's good. Good for the spirit. Yeah, ours also had elevators, so it's kind of like the back cave, but then they took those away. So we reconvene in the call room. And at this point, I have seen all the patients, but the junior residents and interns have also seen all their patients too. So the way we're structured is we go down the list and one by one, the residents present the patients

that they're assigned to. And they tell me what you've seen them to. Yeah. Okay. I mean, I trust them, but this is still, you know, it's still like I was gonna say kind of life and death But like literally literally life and death, right? So I've seen them too But they present to me what they found you know what questions they ask their exam findings And then they also at this point we have lab results and stuff back

It takes a little while for that stuff to happen in the hospital So if we give them a few hours in the morning, by the time we sit down to actually discuss the patients, then we've got all your results. So when they took blood from you in the morning, if they did an x-ray, whatever, we have all that to look at. And so then we can make final decisions on what to do for each patient each day. We make all those decisions, and then we're back to the notes. So if there's a change to the plan I already told you or if you're gonna be discharged,

a doctor's gonna come back to the room to kinda tell you what the change is or to sum everything up and let you know that you're gonna be discharged and answer any questions you have, that kinda thing. If not, if things are kinda status quo, then the residents job is just right to note on you, put in any orders, all orders are put in electronically.

So basically, it's at this point, if you walked in the call room, you would just find a bunch of doctors frantically typing away, either putting orders in for new medicines or whatever or filling out discharge paperwork. And then on every patient, every day, there has to be some sort of note documenting how they're doing that you saw them. And so they type up all the notes and send them all to me to read, review, edit, and then append a little thing that says, yes, I read this and I agree. Yeah, this is more of a full time.

And I mean, like literally full time when you're on hospital service, right? Because there's stuff that you do in the evenings too, even after you go home. Mm-hmm. So I work seven straight days when I'm on hospital service. I am on call seven solid days. From the first, I take over Monday evenings around five or six, and I hand off the following Monday evening at five or six. Right. And from that time period, I am responsible for those patients every single second.

So as a result, even when I finally leave the hospital each day after all the rounds are done, the notes are signed, the plans are made, the questions are answered. When I go home, I start to be available the entire time by phone to answer questions. In an emergency situation, I may have to come back into the hospital, but honestly, that's pretty rare because most of the time, if something has to be done quickly, the patient probably is going to end up transferred to the ICU, which is a whole other set of doctors and stuff. And so it's often not necessary for me to actually physically come there because by the time I would drive there, it's already happened. When you're on hospital service, how do you decide if a patient needs to go to the ICU,

which is the intensive care unit? I know you know that. Thank you. There are a couple of reasons. It may be because they've become unstable. Then we start to worry that they're going to need something to provide extra respiratory support like a... What's that mean unstable? That could mean that they are not being able to breathe on their own. We're worried about their oxygenation. They're not getting enough oxygen in. It could mean that their blood pressure is dropping dangerously low.

It could mean that their heart rhythm is out of control and we are not being able to control it. So the possibility of dying, basically. Yes, they have moved from a stable condition to a critical condition. And so at that point, they would be transferred there to provide a higher level of care. They can do things in the ICU, you can't do

in the rest of the hospital. You wouldn't be on a ventilator anywhere else, things like that. And you also have a, like the ratio of nurses to patients is much better. So if you are in the ICU, your nurse may only have you and one other patient that they're responsible for,

whereas on the floor, they would be responsible for many more patients. And then the doctors, in our hospital, for instance, in our ICU, it's a closed ICU, so you're only being cared for by intensiveists, people who are trained in intensive care. You're, it can be a stressful time when you're in the hospital, and especially like, if you think about what Sydney is describing, how rarely she is overlapping with patients. What is the, if you're in the hospital

or you got a loved one in the hospital, what do you think is the best way for people to sort of like get what they, to get the care that they want? I think the best thing, one is to, if you're, well obviously if you're the patient, you're gonna be there,

I was gonna say it's to be there, but if you're the loved one. That's not so obvious. I've seen quite a few people smoking outside the hospital. Well, maybe I should say that then. If you're the patient, the best way to get the information you want is to not leave the room all the time. I understand.

If you're there for a long course, you gotta get up every once in a while. I understand, I don't blame you. But this might be a great time to give up smoking. Especially if you're admitted for something like pneumonia. You probably don't want to be smoking. And especially if it's like really cold out or raining and you have to walk pretty far away from the hospital now

to smoke because it's a non-smoking campus. You're over it too, there's pretty much. Yeah, so I mean, or you're standing out, everybody's under that tree that's right out by the road. Anyway. The smoking tree. But yes, I would be. That would be one thing I would advise

is you'll get more contact and more answers and you'll probably get better faster if you're not outside all the time. The other thing is if you're a loved one, if it's possible for you to come in, that's great, especially in the morning. Now that's not possible for everybody, and I understand that.

We all got jobs, we all got stuff to do. So in that case, what I would say is a phone call to talk to one, the nurse can answer a ton of questions for you. So don't feel like if the nurse is giving you answers, don't feel like, well, this isn't the real story, I need the doctor. No, the patient's nurses, they know what's going on.

And a lot of the time, they can answer questions about like, what's the next step? Are they doing okay? Are they getting better? What do we think is going on? You can easily get those answers. If you are feeling like there's more that you're not getting or there's some confusion or something changes, letting the nurse know that you want to talk to the doctor is always effective.

We will get back to you. We might not instantly because it's the hospital and things are unpredictable, but somebody will call you. If you're in the room on our service, if you call and say I need to talk to a doctor, unless there is something absolutely emergent going on and we cannot leave it at that moment Somebody will come to your room and talk to you and answer your questions We'll do that and write them down as you think about I always tell patients that if you're just sitting there and you think You know this isn't urgent, but the next time I see the doctor. I really do want to ask him this question

Write it down. You'll forget by the time you see us and then we're gone. So Right down your questions. Don't be afraid to ask. The nurses are your best conduit to the doctors. They know almost everything that we know in terms of what the plan is. And when there are little changes, they can get that information from us right away. I would say those are the big things. Don't be afraid to ask.

I think a lot of patients are afraid to ask questions because they're afraid like, is this silly, is this obvious, is this not? What I'm getting at is this a dumb question? There are no dumb questions. I went to met, no there aren't really. I went to medical school to understand this stuff and it's still hard and it's still a challenge

and I still continue to learn and continue to read and continue to, you know, figure things out every day. I don't expect you to know what's going on. I expect my job is to make sure that by the end you understand it, but if you don't understand it, I haven't done my job. So tell me, you know, that's the big thing. And also in your hospital service, I guess it's worth mentioning that like theoretically you could get called at any time, right? Yeah, yeah, during those seven days I could I am at the back and call of the hospital and you do check in nightly for a while. Yeah, I so any questions things that urgent things that pop up throughout the day I get calls on and then I actually have a secret doctor text.

Okay, that's right. Doc Halo secure message. That's right. It's secret. It's hip-hop protected secret doctor text that I get messages from sometimes. And that is the notification noise. Yes. It is not like, it is dog halo secure message.

That is what it is. It cracks me up so much that I don't let Sydney turn her phone on silent while she's on service because I never want to miss a single dog halo secure message. So that, I'll get those multiple times throughout the day. It's also a great way to connect with specialists. Like if I've got consultancy in my patients, that's a, we are in doc halo has improved communication

between your primary doctor and their specialist so much you have no idea. We are in constant communication now. I wonder if there's another noise. If that's like the default, but like everybody's already changed it to like, burudu, like that noise I just made up. No, because I hear everybody else's while we're rounding and stuff.

There's no way to sample that. There's no way to sample that. There's no way to sample that. There's no way to sample that. There's no way to sample that. There's no way to sample that. There's no way to sample that. There's no way to sample that.

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new patient admissions and questions and all that kind of stuff. We talked sort of about this probably would have made more kind of stuff. We talked sort of about, this probably would have made more sense earlier, but it's just sort of kind of me now as we're talking about the best way to sort of handle yourself in the hospital. When you are going to your doctor's visit, can you give people any tips for like the best way to make their doctor's visit really effective? I was gonna say to get what they want,

but like, and there's all, that's not always the best outcome for your health, I I guess for you to get you know quote unquote what you want Especially how many people are just trying to score opiates so not any of you listening of course but like How would you advise people like Best comport themselves Well, I mean, I I don't want to say that they're I don't want to that's such a personal thing I don't want to ever say there, I don't want to, that's such a personal thing. I don't want to ever say that there's a right way

to come receive medical care. Well, and obviously the impetus is on the doctor, but like, but, but, you know, I, like attitude wise, like, I don't know, there's a lot of times where I worry that I'm, like, if I'm having a problem, I wonder like, am I telling them enough? Am I telling them too much? Does this have nothing to do with anything?

And I'm just kind of rambling. Here's what I would say. Other than it really helps if you can show up on time, I'm not trying to be tough on that. But it really does help to make sure that you get the full, everything out of your visit. I would, and if the doctor has asked you to do any, like, tests before they saw you, like, take this new medicine, get this blood test done, see this other doctor before

I see you, and they've arranged for that to happen. I would really encourage you to actually do that because sometimes I feel like I do the same visit. It's like deja vu with some patients over and over again because like, I really need to see what their diabetes, how well it's being managed, get this lab test for me, and it'll be three visits before they get it done. And so every visit, it'll just be me saying, I still don't know how your sugar's doing. I want to help you, but I have no data to, you know, base my decisions on. So that would be one thing. And then

if you know, if you have a concern, what I would do is just think about ahead of time, what specific questions you have and what your worries are. And make sure you get to ask those. If you go in and you're waiting for the doctor to just like figure it all out, it's not like house. I think I've said this on the show before. It's not like you can drop a couple hints

and then I'll look at like, I don't know, something weird on exam and be able to instantly tell you what your diagnosis is. Medicine never works that way. It'd be cool if it did. But a lot of the time, it's a like narrowing down the diagnosis process. You tell me a problem. You tell me what you're most concerned about

or what symptoms have bothered you the most. I ask some questions. We get to what we think it is or a broad differential of it's probably one of these things. We do some testing to figure it out or we try a medication to try to address it. And then I you come back to see have we made progress are we on the right track or did we start on the wrong track. That's how medicine works most of the time. It is rare that you're able to come in tell me something and I go, ah, I know exactly what that is. This is what it is.

Here's the treatment. So, think about it, have some questions and don't expect that your doctor is going to have like an a-ha moment. There's a rare. Do you think we've covered everything? Is there anything else you wish people knew about what you do every day? I think so. And also you come home and then you research your podcast. And you record your podcast.

Yeah, and I do all the notes that I haven't finished and I do all the tasks that I haven't finished. And I like to say I've called sometimes for a later because people are off work and I have more time. I would say this, medicine at least in this country and especially in primary care, it is demanded of doctors that we see patients very quickly because that is how the big businesses

of medicine make money off of us. And that is not, please no, doctors are no more pleased with this situation than you are. I think most of my colleagues, if they could like have a wish list of things that they would ask of their bosses, high on that list would be more time to see patients. The problem with that is the more time you spend seeing each patient, the fewer patients you see each day, and so the longer it takes you to get back in with your doctor. So it's a balancing act. There aren't enough primary care physicians, so you know, there's a limit, there's a rate limiting factor here. But just be, try to be

patient patients. When I am running behind, I promise you it's not because, I'm, you know, golfing. I promise you it's not because I took a break to eat or pee. You don't know how many days I've finished seeing my last patient and I literally run to the bathroom because I've had to pee so bad for the last two hours. And I didn't want to slow myself down the extra five minutes it would take to run to the bathroom and run back because that's five minutes I would steal from a patient who's

already waited for an hour and is desperate to see me and needs to give back to work. Try to be patient because I promise you if you're waiting it's for a good reason, we are not messing around. And then in return, I always make this promise to my patients. I will give you every minute you need. I will give you a problem every minute that it needs. And I will not shortchange you. Just please be patient.

Thank you so much for sending for that enlightening tour of your daily life. Next week, me. It's a lot more relaxed. I bet you pee more than I do. I'm peeing right now. This is the Max Fun Drive. One last note on that. If you like our show, if you like what we do, if you like the other shows in Max Fun Network,

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or at City McRory, we try to think everybody that we see, we do have two kids. So it's not always the easiest thing. But we will catch as many as we can. I promise. Sometimes I'm up at 3 a.m. nursing, our seven week old, and I see those texts. They're those tweets, so.

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Until next week my name is Justin McRoy. I'm Sydney McRoy and as always don't drill a hole in your head Alright! Maximumfund.org Comedy and Culture, Artistone Listener Supported Comedy and Culture, Artists Don't. Listen or Support it.