"But isn't it so sad?"

-Use the password taped to the monitor

How to hack any hospital computer (L337 version for advanced security systems)

But then some mega-genius upstairs realized something: the system was only alerting for critical vital signs, but not for all vital signs that could possibly be bad.  Like, yeah, 200/130 is potentially life-threatening, but 130/90 is above ideal and can have negative effects on health.  Should the doctors be allowed to just ignore something that could negatively affect a patient’s health?  Heavens no!

So now the system generates a pop-up for any vital signs that are even slightly abnormal.  A pressure of 120/80 (once considered textbook normal, now considered slightly high) will create the pop-up.  We have increased our vigilance!

Well, no, what we’ve actually done is train doctors to click through a constant bombardment of pop-ups without looking.  We’ve destroyed their vigilance and made it much easier for them to accidentally skim past life-threatening vital signs.

But you can’t tell that to management, because you’d have to confess that you are a flawed human with limited attention resources.  They’d tell you “well, all the other doctors take every abnormal vital sign seriously, it sounds like you’re being negligent.”  And if you’re smart, you back down before you start telling the big boss all about your habit of ignoring critical safety alerts.

Pop up 2 - note, patient is on kidney disease register

Pop up 3 - note, patient is on hypercapnia scale 2 observations

Pop up 4 - WARNING VTE assessment 72 hours overdue

Most people think that working in pediatrics is like this:

And it’s pretty true. But when it gets nasty, it gets really nasty.

 I started my rotation in the ED last week, and my second patient was a 4 week old with a finger fracture.

 Read that again.

 FOUR weeks old. Meaning that he can’t roll over, can’t crawl,  can only see about a foot in front of his face and can’t lift his head. So that fact that he reportedly just “woke up like that” sketched us all out.

So we got a skeletal survey, which is a series of x-rays of every bone in the body that we get on babies when we’re concerned that they’re being abused. And the results made me literally gasp out loud and feel like I was going to vomit.

12 fractures. 9 posterior rib fractures, which happen when adult hands squeeze a baby so hard that it breaks them. Two leg fractures, which happen when an adult picks a baby up and swings them by their leg. And then the finger, which I don’t even want to imagine. 

 It was then my job to go tell the parents what we had found and what was going to happen now. I took care of all of my other patients first and fiddled around on my computer for a few minutes. When I finally couldn’t put it off anymore, I walked towards their room, shaking so badly I wasn’t sure my voice would work. I was so afraid of what their reactions would be. Would they scream at me? Be physically violent? Take the baby and run (it happened to another resident earlier this month!)?

 "The x-rays came back and we found multiple rib fractures and two leg fractures. They are already healed and are older than the finger injury. At this point, we are required to contact CPS and admit him to the hospital to make sure that he will be safe at home before he can leave.”

 The mom was shocked beyond words and wanted to know how this could have happened. I thought “You tell me and we’ll both know,” but said “I can’t tell you how the fractures happened, I can just tell you that they’re there.” The dad had his face in his hands and… didn’t seem too surprised. I’ll never know the whole story.

 When we were in med school and all deciding which field to go into, people would often say, “I can’t go into Peds because seeing kids get sick with cancer is too sad.” I disagree. Our cancer patients are some of the strongest and pure-souled people on the planet. I am so honored to get to walk along side them on their journeys, and getting to know them is one of the best parts of my job.

But child abuse sucks. It keeps us up at night and makes us lock ourselves in the bathroom at the hospital to cry. It puts fire in the eyes of even the sweetest and gentlest pediatric nurses and doctors. It’s what I hate the most about my job.

Child abuse is one of, if not THE, worst thing that could ever happen to a child, and is 100% preventable. There are no excuses for hurting a child and there are no excuses for turning a blind eye when you see it. Everyone who works with children has to be on high alert and always trust their instincts.

If you want to learn more, check out:

“Increases your chances by 80%” does not mean “there is now an 80% chance”. 

If your chances were previously 10%, your chances are now 18%, not 90%. 

if your chances were roughly 1%, they’re now just slightly less than 2%. 

They seem to be based on the idea that people who completed four years of medical school and however many years of residency and worked hard and sacrificed and were constantly pushed out of their comfort zone and didn’t see their family or friends as often as they wanted and made new friends and communities wherever they found themselves, and did this their entire young adulthood, aren’t actually resilient and that the issues they’re facing can be fixed by meditating for five minutes a day and taking a walk at lunchtime.

First of all, since when did physicians get lunchtime?

I get really mad when I sit through those burnout discussions because I feel very blamed.

It is not the fault of someone who works 80-100 hours a week, never sees their family, and puts 100% of their emotional energy into a job that takes and takes from them that they feel burned out. So DON’T tell me to “practice mindfulness” or “do more yoga” or “make time for my family” – like I could somehow fix myself.

I am strong. As physicians and trainees we are incredible to fight through what we do every day. So let’s change the conversation – we’re not burned out. We’re taken advantage of. Our humanity and our love of our jobs is taken advantage of.

Veterinary staff are a beautiful mixture of factual-thinking and intense superstition. 

PREACH IT!!!

Co-signed,