Weekly Whine: CMEs

For those of you early in your training or not in medicine at all, CME stands for Continuing Medical Education. Basically, you have to earn a certain number of CME credits each year (each credit = 1 hour) in order to maintain your medical license.

The number of yearly CMEs you need varies from state to state. Some loser states, like Wyoming, only require 20 per year. (Just kidding, Wyoming! You're not really a state.) Other more awesome states like mine require up to 50 CME credits per year (in my case, it can be averaged over three years). Some states have crazy requirements for the CMEs, like you have to take 20 credits while, like, balanced on your head.

Now I do appreciate the importance of continuing medical education. I just don't see the importance of CMEs. I think it's important for doctors to constantly be reading and learning, but I question whether CMEs really contribute to learning. Here's why I think so:

1) I think you learn best when you read about something right after you see it. Seen a case of Klinefelter's Syndrome? Read about it! But you might not necessarily find something that gives you a CME for doing that, so instead you have to read about, like, Turner's Syndrome. Which is totally different.

2) CME courses are rough. I don't know about you people, but after being out of a classroom setting for close to ten years now, I find it very hard to sit in a lecture hall for eight hours straight several days in a row. By the end, it's less about Pain Management and more about Words with Friends.

3) It's WAY too tempting to cheat on online CMEs. Just sayin'.

4) I think I read a study somewhere that said CMEs don't contribute to doctor knowledge.

But I guess if we got rid of CMEs, there would be a very real risk that older doctors would be running around, trying to cure pneumonia with leeches or something, so I guess CMEs are here to stay.

Cirrhosis rumors

Me: "How do you know you have cirrhosis?"

Patient: "They told me I did."

Me: "Who told you?"

Patient: "Oh, you know."

Me: "Did you ever have a liver biopsy?"

Patient: "No..."

Me: "Well, the ultrasound and the CT in the computer actually just show that you have some liver inflammation, not cirrhosis, so I'm just wondering who told you that. Was it a doctor?"

Patient: "No."

Me: "Then who told you?"

Patient: "A friend told me she thought I had cirrhosis because my eyes are yellow."

And then it goes on her problem list FOREVER.

Mini-lectures for primary care

Things I Loved As a Kid But Now Hate

1. Being tickled

2. Roller coasters

3. Slides, especially long twisty ones

4. The 'Burbs (and mostly Tom Hanks)

5. Cotton candy

6. Twister, Operation, basically any board game

7. Care Bears

8. Play-dough

9. Bunk beds or anything other than a normal bed

10. Trampolines


Possibly yet to come:
Things I loved as a kid and still love
Things I hated as a kid but now love
Things I hated as a kid and still hate

Purposeful?

Do you think if someone gives their child a name where both their first and last name are other words for "penis", that is likely to be purposeful? I'd think it sort of has to be.

(e.g. Peter Johnson)

Many emotions

I recently discovered this collage I made:



Hmmm, guess whether I made this for my first or second kid...

Weekly Whine: Steamers

I really hate all the bags of vegetables in the supermarket that you are supposed to steam in the bag.

1) They're twice as much money as normal vegetables

2) You can't decide how much of the vegetable you want--you are essentially forced to use the whole bag. I prefer to use a little bit of several different vegetables rather than a whole giant bag of, say, asparagus.

I know, I could just not buy it. And I don't, believe me. But when 75% of the vegetables in the aisle are taken up by the steamfresh bags, then there isn't much room left over for the frozen veggies I actually want to buy. So I'm constantly unable to get the vegetables I really want.

Surgical knot

Yesterday my daughter found a piece of long string and I decided to see if I could still tie a surgical knot. It took one or two tries, but against all odds, I was able to do it! Unbelievable what you can still remember after so many years. I guess it's like riding a bike. (Except that I can't really ride a bike anymore.)

My husband was unimpressed: "What's so great about a surgical knot?"

Me: "Well, when you tie someone's stomach closed, you want a knot that won't come undone, right?"

Actually, during one of my first surgeries, the surgeon let me tie the knots. I had not yet mastered the technique and as the patient was waking up, two of the knots came undone. The chief resident looked like he wanted to murder me as he quickly retied them with the tiny ends.

Husband: "Is a surgical knot really so much better than a regular knot?"

Me: "Yes."

He tried tying some regular knots in the string, which we were able to undo easily. Then I tied some surgical knots, which could not be undone, thus proving my point and thereby, the superiority of the surgical knot.

Butt Balm

Do all hospital have "butt balm"? It's an ointment that the nurse or whoever rubs over the buttocks for a rash.

I feel like I've written so many orders lately for Butt Balm qShift that I don't even giggle anymore when I write it.

I Quit

I just received the following letter from my ENT (I went to him once, when I had labyrinthitis):

To all my patients,

After over 46 years of practicing otolaryngology I have decided to retire. I have enjoyed my medical life and leave it with some regrets. Although I am still in good health, the economics of medicine today leaves me with little choice.

All business costs steadily increase, but much of our reimbursement is fixed by our government at a level it considered reasonable 15 years ago and is going down this year.

A recent statement by the St. Mary's Hospital Chief of Staff is very true: "Federal and state laws and imposed regulations have made doctors wage slaves of the federal government and insurers, medicine a public utility, and patients victim of an unjust system of health care delivery."

The cost to practice medicine will continue to increase, even without the gigantic outlays expected for implementing electronic health records, yet the federal government plans to continue to decrease physician reimbursement annually.

Of course, this is a guy who spent about ten minutes talking to me, looked in my ears, and charged about $300 for this.