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The Most Disgusting Hand-Shake Ever

Shaking hands is not really such a good idea, especially in a hospital where there are all sorts of nasty bugs floating around, seeking whom they may devour. So generally I do not shake hands unless the patient absolutely insists and I think the cultural slight may be more than he can bear. But one incident highlighted to me the reason you generally don’t want to shake hands so well it could just have well been written all over the hospital in bright neon lights.

I was on call that night so it fell to me to evaluate and treat the patient in casualties which the casualty officer said had a perianal abscess. I approached the bed and introduced myself, but I made a point of positioning myself in such a way that the patient wouldn’t be able to greet me with the traditional handshake. Experience had taught me that this was one case where this cultural idiosyncracy was patricularly ill-advised.

I asked what the problem was. without saying a word his hand moved to his gluteal cleft in one smooth motion. Moments later I found myself staring with morbid fascination as he pulled his butt cheeks apart and started prodding what was clearly an abscess with his finger. It had already broken open slightly so there was a thin stream of pus oozing out and following the natural pull of gravity. The patient’s grubby finger scratched, prodded and poked this poor stream of sepsis, completely disrupting its attempt to soil the bed linen. Read more »

*This blog post was originally published at other things amanzi*

Early Colostomy Reversal: Not A Good Idea

I have already spoken about the hazards of doing favours, but recently I was reminded of another example when I was still a registrar where I only just escaped the proverbial falling anvil.

It was not an unusual case but still fairly challenging for a registrar like myself. The old man presented with an acutely tender abdomen and free air revealed on x-rays. If you ignore the outside horses for a while, this is either a perforated peptic ulcer or complicated diverticulitis (some people would throw complicated appendicitis into the mix, but I’m going to leave it in the stable with the outside horses if there are no objections). The patient needed an operation and soon. So with the sun shining happily over Australia somewhere, I took him to theater. Read more »

*This blog post was originally published at other things amanzi*

More Care Can Lead To More Complications

I have a patient that comes in every so often that demands a PICC line (peripherally inserted central catheter).  PICC lines are convenient for patients and nurses and doctors because they can be used to obtain blood without needing to stick the patient on a daily basis.  They can be kept in for weeks and weeks and weeks with proper care.  They can maintain adequate IV access when old ladies and drug addicts present with poor veins.  Often they save the patient during acute decompensations of their critical illness.  However, they come with frequent complications.  I have had my share of patients return to the hospital with sepsis from their PICC line. Read more »

*This blog post was originally published at A Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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