在美國行醫之道 (網友討論)

在美國行醫之道 (網友討論)
http://www..com/pc/pccon.php?id=2289&nid=39521
作者：USMedEdu
發表時間：2008-06-10
更新時間：2008-06-10
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評論：0篇
引用：0次
地址：10.0.
::: 欄目 :::

◇ 現代醫學vs中醫
◇ 生物醫學人物
◇ 國內外醫學交流
◇ 中外醫學網站精選
◇ 住院/FELLOW單位
◇ 社會、藝術與醫學
◇ 醫學書籍照片及圖譜
◇ 社會與醫學瞬間定格
◇ 醫學典故／醫史雜談
◇ 醫學新進展及新聞
◇ 中美醫學臨床教育比
◇ 美加醫學院申請及MC
◇ 醫學科普及問題解答
◇ 醫生就業、工作及生
◇ Ｆｅｌｌｏｗｓｈｉ
◇ 住院醫生生活和工作
◇ 申請和麵試住院醫生
◇ USMLE/專科複習和考
◇ 力刀美國醫學教育專


在美國行醫之道 (網友討論)


發信人: canberry (coco), 信區: MedicalCareer
標 題: 問中國人在醫療界從醫之道。
發信站: BBS (Tue Jun 3 20:45:51 2008)

最近大家都在討論英語與交流的話題，我也湊熱鬧，問問在這的各位如何磨練自己的英
語在美國的醫療係統生存的。

每天接觸的都是老美，雖然大多數顯得比較友好，但僅是打打哈哈。日常用語還行，但
老美聊起天來要麽聽不懂，要麽完全插不上嘴。沒有相對固定的朋友，在美國人堆裏總
感覺的孤獨，不安。這些還不算，說起專業英語更是舉步維艱。雖然有的老美嘴上不說
，但從他們的目光中我感覺的到那份懷疑：這麽不地道的英文，能做臨床嗎，能取得病
人和同行的信任嗎？

心情越來越糟，真不知自己當初信誓旦旦，躊躇滿誌的勇氣到哪裏去了，甚至都有點懷
疑自己是不是這快料，打起退堂鼓了。

真的很佩服在這從醫的前輩。能不能談談你們在臨床工作中是如何從心理上和口語上克
服語言障礙關的，又是如何與美國人交流的？
I really don\\\'t know how to make friends with Americans. The reason
I want to do that is I think studying in a group in which people are willing
to help each other will make study life easy.
Actually, now I am not confident that I am able to study well by myself.
I never thought I would enroll in their group. I just workhard under the
table. At first, I couldn\\\'t understant what they were talking about, I just
listened and kept smile on my face. When I graduated from my program, I
was the ...., well not the best one, but at least the second one. And, I
still have my classmates as \\friends\\. Don\\\'t worry too much, just do
whatever you can do. Study hard when you go home. You will be fine.
Actually, I think you just think they are 懷疑：這麽不地道的英文，能做臨床嗎
，能取得病人和同行的信任嗎？ You will be fine. My coworks always thought I
was so smart that I could use two languages so well. They said they can
never use Chinese as well as I use English.

Good luck.
--

※ 來源:•WWW 海外: .com 中國: .cn•[FROM: 75.183.]
發信人: yf (麥地fanfan), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Wed Jun 4 10:28:02 2008)

不要緊的，會好的。在病房跟著查房一個月就會好很多。至於聊天，不必強求。多看看
電視，如果有時間的話。反正我覺得醫生們之間也很少有時間閑聊的。交朋友麽，人到
了這個年齡，能交往很深的朋友本來就少了，就是沒有語言障礙，也不一定會交到好朋
友。真誠待人就是了。

發信人: fogsail (pathguy), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Wed Jun 4 13:33:50 2008)

dont expect to make friends the same ways as in China ... even when u have
some, American friends are very different from your chinese friends ... not
that one is better or worse than the other, they are just very different,
considering what you expect them to do for u and what u should do for them .
.. it takes years for you to learn the differences and knows how to copy
with them ... there is no book/advice/guildline for that, it is not a
medical procedure :) ..... you just have to be patient, be quiet, observe,
listen, dont rash to make friends et al ... things will work out evenually .
.. good luck!
--

發信人: cancidas (michael knight), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Wed Jun 4 20:00:32 2008)

醫學英語和普通英語是完全兩種語言. 我以前的寫作老師嘲笑我們pre-med, 說你們學
醫的那破英語連我們學前班的都不如.
想練好口語隻有一個辦法, 脫離中國人的圈子.
慢慢來吧. 推薦你看friends. 如果你能倒背裏麵的台詞, 聽說就基本解決了. 如果需要腳本可以pm我,我email給你.
--
※ 修改:•cancidas 於 Jun 4 20:02:33 2008 修改本文•[FROM: 24.186.]
發信人: scrub2008 (jobsmac), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Wed Jun 4 20:30:18 2008)

我覺得關鍵是文化的差別，我認識些已經作了醫生的人，他的朋友圈子主要也都是中國
人。當然練好口語也是非常重要的，但沒有必要一定找老美做朋友。當然你要主動和他
們交流，不要怕說錯。
--

※ 來源:•WWW 海外: .com 中國: .cn•[FROM: 67.173.]

發信人: canberry (coco), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Wed Jun 4 22:54:55 2008)

I am wondering if you guys come across someone (either health care providers
or patients) in your practice or study who does not trust you or respect
you, just because of your English or your are a foreigner, how do you react
? Never talk them anymore or treat them as others?

--

※ 來源:•WWW 海外: .com 中國: .cn•[FROM: 75.183.]

發信人: ericusa (eric), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Wed Jun 4 23:04:08 2008)

This is common and understandable, just act as a professional. If you work
hard and prove your ability, you\\\'ll gain respect from others.

發信人: WHATEVER4 (靜靜的麥穗), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Wed Jun 4 23:04:24 2008)

PA=Physician assistant or PA=Pathology assistant?

When I visited my Dr. there were lots nurses talking spanishy English. Don\\\'
t worry, Cranberry MM, relax, you will be fine. Or, you can attend some
class for english as second launguage to improve your spoken english. I
know some liberaries have such program.
--

發信人: ericusa (eric), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Wed Jun 4 23:12:02 2008)

Practice, practice. Kaplan lecture videos are very good, the teachers are
Americans not foreigner TAs. :)


發信人: pbusmle (GL2008), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Thu Jun 5 00:04:03 2008)

Practice makes prefect. Put time and efforts. So glad that you put this
topic. Like above discussion.


發信人: inthemood (兩隻眼睛四條腿), 信區: MedicalCareer
標 題: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sat Jun 7 20:32:56 2008)

I fully understand Canberry. I am struggling in my DPT program now,
especially this summer, 13 credit hours in 10 weeks. Canberry, you are not
the only one.

Ericusa, is it possible that you share the inxxxxation about Kaplan lecture
videos with me? Thanks in advance!

--


發信人: sixtyfour (never forget), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sat Jun 7 20:43:28 2008)

find a boy friend whose English is first language. just kidding. find some
native speaker as friends and talk as much as you can, hang out to bars,
resturants etc. it will be embarassing as first,cause they may not fully
understand you. but they will understand this is your second language, and
you will be surprised to find out how fast you can improve. Americans are
just just regular people, they don\\\'t know 2 languges. one of the joke my old
department chief used to tell is if you speak 3 language, it is called
trilingual, if 2, biligual, what is called when you speak only one?
American.

some of my collegues make fun of my accent, I just told them, let me hear
you speak some Chinese with perfect tune.

I think for a language, the goal is to let people to understand you, that is
very important. because in medical profession, communication is very very
important, it will hinder your career if you can\\\'t do that. but if you just
have an accent, and people can perfectly know what you are talking about, I
think that is fine. some people even think foreign accent is sexy. I am
serious.

some scrub nurses in the OR make fun of my accent when I ask for instrument,
they just joking, and I laugh. they said we like you so we mass with you. I
make funs of them in other areas too. we all veiw it quite normal as have
an accent, so what. people still respect you if you are good. you can speak
perfect English and do a xxxxty job, or being lazy, no one going to like you。

I think for the begining, the key is to speak slowly and clearly, if you can
talk to your attending over the phone and he can understand you perfectly,
you will be fine then.

--


發信人: againstwind (逆風而行), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sat Jun 7 23:53:45 2008)

在這兩年的住院醫生工作中，我隻碰到過一個病人評論了我的accent。
不是在我剛開始工作的時候，而是在我第二年下半年的時候。他是一個非常demanding
的病人，而且自己主意大得很，那天下午他一定要做血培養，說自己有感染，我跟他解
釋了半天都沒用。我最後明確地說，除非是有指征，我是不會隨便order test的。他愣
了一下，然後很mean地說，你的accent讓我不明白你在說什麽。
我說，i believe you understand me just fine. I WILL NOT ORDER ANY
UNNECESSARRY TEST.are we clear?
然後我就走出了病房。當然心情是很差的。sometimes it\\\'s easier to believe the
bad things. 後來我的attending跟我說，don\\\'t let him get to you, that\\\'s
exactly what he wants.

說這件事情的原因，是想讓同學們明白，隻要你努力工作，know what you are
talking about,明白道理的病人都會appreciate你的工作，而不會介意你的口音。那些
那你口音來說事的人，根本沒有必要去計較，我們在人格品質上，比這種人都要完整，
盡我們的本分做好工作，然後wish them the best，嗬嗬。

美國的醫學職業還是比較professional的，大部分時候是以工作為主。隻有我的
好朋友，還有跟我比較熟悉的attending，會模仿我的口音，跟我開玩笑，然後他們也
會解釋，we are just teasing you，make sure我沒有生氣。

我覺得說話的manner，口齒清楚與否對FMG來說非常重要，如果其他人沒有聽明白，不
要急躁，make sure你表達清楚，因為在給醫囑的時候，你的麵子遠遠沒有病人的安危
來的重要。
--


發信人: sunshadow (影子，MD Fan), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 00:16:54 2008)

狂頂這個~~~~~~~~
我記得我第一次在ER被病人奚落英文的時候很尷尬很尷尬~別人說的話我根本聽不完全
懂~~~我隻能訕訕的躲到旁邊放sheets的那些小房間裏麵去~~~ 一個人躲在很小的一個
角落裏麵看著牆~~那個時候周圍我誰都不認識~ 也沒有人跟我說話~也沒有人理我~然後
我就問我自己~~~你現在在這幹什麽~你腦子燒壞了來吃這種苦~~~當時快哭了~~~後來把
頭仰起來讓眼淚回去~~~等情緒穩了一點走回去跟那個病人麵對麵說，你剛才說什麽不
好意思我是新來的我沒聽明白請你再說一遍謝謝~~~ 我一直記得那個病人當時驚訝的表
情~~~他可能永遠沒想到我會有勇氣再回去問~~~雖然那天回到家我大哭一場~~~


發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 00:31:32 2008)

I can feel you pain. initially when I saw patient, I was nervous, I was
afraid what if they could not understand me. but later I found out who is
actually nervous? it is the patient, because in the middle of night in the
ER, you are the only surgeon in the hospital, she really wants to know what
is going on about her. for young patient they have no problem to understand
me at all. but the 90 year old with hard of hearing, when I have to yell
near her ear, I saw she was trying to moving her lips to repeat my words to
understand me. then I just try to go slow, and repeat if I have too. some
times my medical student or resident have to translate my word to the old
lady.

發信人: againstwind (逆風而行), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 00:31:39 2008)

i was really burned out by the end of last month, patients came and died,
one of them was only 27 year old with chron\\\'s disease, end up with multiple
perforation and sepsist. it was aweful to talk to her parents, i cried after
we lost her.

oh well, life goes on, sometimes i think i should do a rotation in ob, just
delivering new borns, to balance my depressed mood. hehe.


發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 00:39:52 2008)

I just lost a patient couple of days ago, aortoenteric fistula, very
complicated case. we tried to delay operate on him because we know if we go
in, he will die. but at that time he was eating talking, so family does not
want to give up. my pager went off 3 am, my intern told me he is bleeding.
we went to OR, 6 hour case, lukily able to get off OR, but he died 2 days
later. altough it is expected. I just keep thinking about of him, he was
sitting in the ICU talking to us, and there was a bomb in his body tickling
and we can not do anything about it. So I can\\\'t do critical care. I can\\\'t
tolerate facing death every day, once a while maybe ok, not on daily basis.

very complicated case, had endovascular repair of abdominal aortic aneurysm,
had bleeding from the graft, needs emergent surgery, they went in could not
get the endo graft out due to the fixing device, so they cut the graft and
suture the new graft to the endo graft. patient survived that surgery, have
good qulity of life for many years. now came back for aortoenteric fistular,
we know we had to take the who thing out, they could not do it last time,
we know it would be even harder this time. so we drag our feet on this,
knowing he would die with a trip to OR. I just did not think he bleed so
quickly.

you got to do what you got to do. like you said, life has to move on. we
often feel helpless with our limitations, we do as much as we can, but still
, many time we can\\\'t make a difference. I feel bad, but I don\\\'t blame my
self for that, cause we did our best already. if there is something we did
not do right, that is going to feel really really bad. I can still remember
the patient I lost back in China, if I had the knowledge I have now, she
would not die. it come to haunt me time to time.


發信人: againstwind (逆風而行), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 00:58:33 2008)

yeah, it\\\'s hard, esp when pt looks great, it would so awkward to ask them to
change to no code, no surgery. but then, everything is too late.well, he
appreciated you did your job.

我前天收了一個貧血的老年女病人，一個親人都沒有，查出來時colon cancer，手術前
也沒有家人送她，我陪著她一直到手術室門口，她說please tell me i will wake up
and see you again, 我說,you will。但是她現在在ICU了。


發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 01:36:56 2008)

I only have several days to graduate, kind of semi-retired now. so have time
for 灌水。

let me talk about one case in my graveyard.

when I was a first year resident in China, we had a lady hit by car. she
went to ER and the ER did CRX found she had rib Fx, and called CT surgery,
the guy on call happened to be 進修 doctor, he just admited the patient in
throacic floor for pain controll. after 8 hours, patient got unstable, low
BP etc. general surgery got called. we did abdominal tap, there was blood,
so took her to OR。

there was bleedin in the liver, we called our chief of surgery in and fixed
the bleeding, send the patient back. I was in charge of her.what a pitty, I
knew nothing about shock resussication, neither my attending and chief know,
they just told me, call me if there is any thing and left. In my little
mind, I though we stoped bleeding, patient should do fine. after 2 hours,
patient started criush, I was totally astoned, cause I did not have a clue
why this happened. I did chest compression for more than 1 hour, don\\\'t want
to stop, cause I think she should not die, does not deserve this. until my
department chief came out and stopped me.

then I started to read by myself, there is such thing as shock
resscucitation in the text book, but was couple of pages, most people ignore
that. I read a lot of articles and books stuff, though I knew something
about it. then I started my residency here, I just feel how much difference
in training, that is all intern\\\'s knowledge, back in China, the chief of
surgery has no idea, we could save that lady\\\'s life easily if things were
done correctly. this thing will never happen here.

the scary thing is, when I went back to China this Jan, visited my friend
who is somewhat cow in his field. I found out he has no idea about that too.
He asked me to teach his resident about one patient they managed totaly
wrong, several time, seeing them have no idea of what I was talking about, I
almost loss controll. they are lucky they don\\\'t work for me. how can be
called a doctor without knowning those basic knowledge? this case keep
haunts me from time to time, remind me how important it is to be a good
doctor, if you suck, patient die.

the lesson I learn is try to equip yourself as much medical knowledge as you
can. your patient is totally relay on you, put his life in your hand, if
you are not prepared, you failed their trust, and it is the patient who will
pay the price.

the other thing is I see the drastic difference in 2 medical systems. and
hope if there is some day, China can better training for its doctors. I know
this is not the only case that patient die when she did not have to, this
is happening every day, unfortunatly。

發信人: benpu (麥地大奔), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 02:10:20 2008)

cannot agree more. I think although Chinese Medical system has quite weak
link on training/education, but the weakest one is the ethics. without this,
a good health care system is just mission impossible.

I am not stating here that US docs are all like Saint, but you have to obey
the ethics rule, for the best interest of the patient, and for the
protection of yourself, otherwise the price is to high to pay.

Professionalism is still long way to go in China. So, I do think J-visa is
the right and quickest way to go.


【 在 guidewire (guidewire) 的大作中提到: 】
: the lesson I learn is try to equip yourself as much medical knowledge as
you
: can. your patient is totally relay on you, put his life in your hand, if
: you are not prepared, you failed their trust, and it is the patient who
will
: pay the price.


發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 02:13:26 2008)

one day when I was rotating in Ortho, we got call from general surgery for a
consult. patient had femur fracture. It was my very first roatation as a
brand new intern, I was just out of med school for 2 weeks. I followed my
chief resident to see this guy, very young, in his 20s.

we put splint on that young man and left, patient still in general surgery\\\'s
service because he need something done in his belly. couple daily later we
got called by general surgery\\\'s service, said patient\\\' leg is black. we went
back, found out the splint got tight overnight due to edema, they call the
general surgery resident who was on call because he is his patient, and
patient had pain, guess what patient got? pain meds. instead of relieve the
splint. so the patient suffered from external compartment syndrome for
several days and his who leg dead. he could not accept in fact, firmly
refused amputation, because his family depends on him to do all the work.

I finished my rotation and don\\\'t know what finally happened to that poor
young man.

this can happen anywhere though. I had a senior resident could not recognize
compartment syndrom, and told me that patient had hand ischemia due to
vascular insufficieny, so when we did our morning round, I look at her hand
and arm, that is so typical compartment syndrome, I was so mad, patient went
to surgery immediatly but was too late, she lost her hand.


發信人: againstwind (逆風而行), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 02:29:18 2008)

oh my goodness, this is bad. i understand the intern\\\'s pain, so many
crosscover calls, most are minor things, but one of them might be a real
issue, which might be the one haunting your whole life.

last year, one of my patients was admitted for PE. she was started on
heparin. at night she kept complaining of headache, how many calls we got
overnight for headache? tylenol is the answer, most time. so the on call
intern gave her tylenol.

unfortunately, when i rounded pt in early morning, she was confused, her
pupils were unequal, and her stat head CT showed large intracranial
hemorrhage. she died during surgery.

when pt on anticoagulation complaining of headache, always make sure she/he
is not bleeding in the head.
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發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 02:34:17 2008)

my attending like to say that a good system makes you harder to make
mistakes than do the right thing. I think medical error alway occur, but a
good system make it down to minimum. and doctor\\\'s consciencious compensate
the rest.


發信人: againstwind (逆風而行), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 02:41:51 2008)

medical errors will always exist, it takes a lot of effort to force
ourselves to take that extra step to make sure things not going wrong,
unfortantely, we are all human beings...


發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 02:47:33 2008)

this is so true. I was moonlighting as an attending couple of days ago, we
had two trauma came at the same time one is intubated with his one leg
almost fall off. and the nurse could not give me his blood pressure, there
was something wrong with the cuff though. and they were so slow to fix that,
I know if that patient die, it is my ass on the line. I just hold my breath
and spoke as calm as I can, told the nurse, I don\\\'t care what happened, I
need a blood pressure reading now! there are around 30 people in the trauma
bay, they just like 看熱鬧 to me, because I knew I had to be responsible to
all those.

we do our best, we learn from our or other\\\'s mistakes, and move on. I will
blame myself if I did not do my best, if I did, then I just learn and go to
next step.

【 在 againstwind (逆風而行) 的大作中提到: 】
: 我覺得外科可能責任更大，轉瞬間都有區別，所以你們這些人火氣都很大。。。
每次run code，我知道那時候大家最希望看到的，就是一個鎮定的醫生，隻好強作鎮定
。曾經有另外一個resident跟我說，i will trade everything for your calmness,我
隻好笑笑，他們不知道每次code,我就覺得自己也要像病人一樣發v-fib了...
你們做外科的，更加是生死一條線阿，特別是trauma。

發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 03:05:02 2008)

one day I was doing moring rounds, that was couple of years ago, I looked at
my list and went in patient\\\'s room, asked Mr. Smith? my name is Dr. so and
so, the patient was demented and he said hello, and he was a new patient and
had ischemia leg according to the list, so I just went ahead check his foot
, and guess what, he did not have a foot, he had an amputation, I thought
myself, what the heck, when did they cut his foot off ? and later found out
the resident oncall that night did not update the list, our patient with leg
ischemia moved to another room and the patient with amputation is actually
not our patient. but because he is demented, he answered to me by calling
someone else\\\'s name. he probably say hey if I call him president Bush.


發信人: againstwind (逆風而行), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 03:08:42 2008)

:DDDDDDD
i always like the cute demented pt, they are just so cute, looking at me
with smile, all innoncent,whatever you aksed them, they\\\'ll say yes mam。

發信人: sunshadow (影子，MD Fan), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 03:10:13 2008)

原來要用demented啊～～～　我每次都直接問醫生～那個那個幾號病人是不是ＣＲＡＺ
Ｙ了。。。。。。
那天看到一個很明顯有智商問題的～　看完了我問醫生～俄～～～那個人是不是～～～
俄～～～RETARDED～～～然後醫生說~~~ you are absolutely right. but we don\\\'t
use that word any more. its not a nice word....
我就口無遮攔地說～那不是retarded是什麽啊～難道是slow？～說完了我就後悔得想縫
住嘴巴樂。。。。　我說得比想得還要快。。。
然後那個醫生慢悠悠的跟我說 we should say: she has some social disability～

廬山瀑布汗啊～～～


發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 03:14:08 2008)

let me tell you a story, 1 year ago, I was on call at night, a post op
patient crushed on the floor, need intubation, I looked at her airway, it is
a very difficult one. being corky as you can imagine as a sinior surgical
resident, I refuse to call anasthesia or ER attending, and figure I can do
it myself. when we paralysed the patient, I found out it is much harder than
I thought. first time I tube the esophague, I told myself F*** me, she is
going to die of my stupid ego, lukily, the second time I was able to make in
the trachea. when they hook her up the ventilator, I started to have
stomachachs, it was so intense that I could not stand up. I kown how much
catecholamines was in my body, made my stomach become ishemic. took me
couple of days to fully recoer. talking about stress ulcers? I have first
hand experince.

I like old patient. I had a patient,every time I change dressing, he told me
a joke, even before he went to OR, in the pre op area, he told jokes to the
nurses. sometimes his joke is too complicated, like involve sports, old
movie stars etc. I could not understant, I prentend I did, but I can see he
feels bad and try to make up for another one。

from that I learned I am not going to risk my patient again. hi, I am not an
anasthesiologist, not ER doc, I am not even going to Trauma, if it is easy
intubation, I will definitly handle that, but for a hard one, I will leave
it to the expert. my ego means nothing infront of patient\\\'s life.


發信人: againstwind (逆風而行), 信區: MedicalCareer
標 題: Re: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 03:19:53 2008)

i still not good at intubation, now getting to third year in one month, i am
still nervous about it... shame on me.

once we had a code at hospital parking lot, a pt AMA end up having AMI, that
\\\'s most aweful code i have ever had, i almost vomitted after i fnished the
code due to the stress, luckily the pt made it.

yeah, ego can kill people, most physicians have huge ego since they made so
far. it\\\'s hard to admit we all need help at some point.


發信人: guidewire (guidewire), 信區: MedicalCareer
標 題: Re: Re: 問中國人在醫療界從醫之道。
發信站: BBS (Sun Jun 8 11:07:41 2008)

what should I do now?

depends where I am. If here in the US, that is impossible to happen. because
that patient will definitly be a trauma alert, according to ATLS, she will
get her belly scan fairlly quickly. for liver lac, she may not need go to OR
now days, may be conservative or a trip to IR, she will be in hospital for
several days for sure, then PT/OT all that good stuff, I would say go home
average in 1 week. one thing for sure is she will not die

what if I am in China, as far as I know, ATLS idea was not a popular idea
yet, there is too much things beyond one doctors control. like this case, if
they don\\\'t have a trauma surgeon, patient just admitted to CT surgery with
pain meds for 8 hours. finally you may not save her cause is too late. but
even that, if I had knowledge that time, I would give her fluid, 20 ml/kg,
then blood, the first moment I see her, and check cbc, ABG, base deficit,
lactic acid level, etc. try to correct her shock before unreversible. she
may still have a chance.

【 在 againstwind (逆風而行) 的大作中提到: 】
: 恩，我在國內做住院醫生，也是一點急救觀念都沒有的，那樣的CPR，其實現在看來，
: 一點意義都沒有的。
: 等我找一篇以前寫得文章。