I hate cellphone providers...

This is probably a very common topic in the news, so I thought I'd share my frustrating stories with cellphone providers.

I think Canada has one of the worst cellphone services in the world, for several reasons, the main ones being that there's limited competition and the fact that it's quite difficult to file a complaint when problems arise. I've unfortunately experienced those two problems over the last couple of months.

It all started about two months ago, when I decided to change over to a monthly plan from prepaid, since my cellphone needs had changed. Like any diligent shopper, I looked up various cellphone plans to see what was being offered and then tried negotiating a deal with my provider.

In most businesses, if you find a deal, you can get another store to match the price or deal if what's being offered is comparable. With cellphone companies, however, I found soon enough that this is not the case. I found another essentially identical plan with another provider, the only difference being that the other provider was offering more minutes per month, only to find out that my provider refused to match the deal! Even though I had been with this company for years, because I was on a prepaid plan, I was told I was out of luck trying to negotiate any deal - which is completely ridiculous, since I think I'm a better customer than some people who sign up for three months and then try negotiating for better deals at that point. It's an insult to my loyalty and offers very little incentive for me to stay with them in the future.

Anyways, in the end, I was resigned to the fact that I wouldn't be able to negotiate a better plan, so I instead focused on signing up for a monthly contract so that I could then argue for a better deal in a few months' time. At that point, I hit another snag: I was told that if I wanted to switch to monthly, I would need to pay a $100 deposit.

After some delving, I learned that Equifax (one of the credit agencies) had apparently 'flagged' my account, which I think stemmed from something that happened a few years ago, when MD Management lost a laptop containing information about thousands of medical students. The funny thing is that I don't even have an account with MD Management, but they get our personal information as soon as we're enrolled in medical school. I was essentially told, though, that the $100 deposit would have to be paid unless I could get Equifax to change my file.

That in itself proved to be an ordeal. If you look on the internet, there is no easy way to get a hold of a representative from Equifax by phone. Instead, the numbers provided only give you automated systems. I eventually had to fax a request for my credit file before I could get a hold of a representative, since everything else I tried (including contacting my credit card company and Transunion, the other big credit agency) wasn't deemed sufficient by my cellphone company. Unfortunately, for some reason, Equifax did not process my first request, so I did not receive my credit file until yesterday.

At that point, I thought my problem would be resolved, but lo and behold, my credit file was clean! And when I spoke to an Equifax representative, they could not figure out why I was being charged a deposit. To add to that, I was told that it was my cellphone company's obligation to tell me why I was being charged this deposit and not in fact a part of Equifax's jurisdiction (their only role is to provide a credit score). So essentially, I had been sent on a wild goose ride for almost two months when this should have been dealt with right away by my cellphone provider.

Eventually, after several discussions with a representative with my cellphone provider, I was directed to one of their kiosks in the city (only a few of them could do what was required, apparently, so I ended up driving across the city to get this addressed), where I was then connected to a representative on the phone who was able to waive the deposit which I shouldn't have been charged in the first place!

Even though things were resolved in the end, I think it's frustrating how hard it is to deal with these cellphone providers. Because of their essential monopoly over the market, they can afford to do whatever they choose, since the alternative options are not much different. Additionally, if someone wants to change something on file, they make the process very cumbersome and near impossible to do if you work regular office hours. I had a horrible experience over these last few months and hope that once the new cellphone providers emerge on the market, things will improve, since the current quality of service in Canada is rather dismal.

Old people are great, but...

My geriatrics rotation was eons ago (okay, only a few months ago), so the details are a little foggy; but what I do remember was that as much as I enjoy interacting with patients, the 3-4 hours spent on one patient consult was a bit too excessive for me. Especially when you're not sure if the patient's demented, so EVERY patient needs collateral history from family.

What I found for my geriatric assessments was that either the patients were extremely pleasant, or outright nasty. My worst encounter was with a patient who I was assessing for possible physical rehabilitation on our ward. It should have been a simple encounter, but the problem was that when I proceeded with the cognitive assessment (something all geriatric patients receive), he did not do very well on it and refused the rest of the assessment. He agreed to let me see him the next day, however, so I didn't think anything of it: after all, we were seeing him for rehabilitation and not for dementia (which he probably had an early stage of, so nothing too severe).

However, when he saw me the next day, the patient refused to see me at all and was actually quite rude to me. He became so fixated on his cognitive assessment, that he refused to go to our ward for rehabilitation, and we ended up signing off from his care because of this. This experience was initially upsetting, but my preceptor spent some time putting things in perspective: his behaviour was part of his disease, and not because of something I had specifically done. It also did not help that his family seemed suspicious of any help from the health care team, as they only further validated the patient instead of recognizing that he might in fact have an early stage of dementia. Luckily, he rehabilitated well without our help, so I was comfortable signing off from his care.

Although the rest of the patients that I saw were pleasant enough, I do not think I would be able to work as a Geriatrician. I don't mind working with elderly patients, but as a Geriatrician, you're expected to deal with the ones who have done poorly in some respect: cognitively, physically, or medically. I have a lot of respect for the people who can work in this specialty, but it seemed to me that the difficulties encountered with patients outweighed the benefits of the few patients who appreciated your care. The ward work itself was nice, since the patients had to be motivated to get help in order to be admitted; but the process of actually finding appropriate patients meant that you had to deal with a lot of crap before finding a suitable candidate.

On the bright side, I gained a lot of independence during that rotation. Since consults were never urgent, I could plan my day so that I could get coffee breaks and leave on time. I started leaving without informing my staff (although it wasn't like I was leaving early or shirking my responsibilities), and somehow ended up with one of my better evaluations. It kind of makes me wonder if I could have left early on some of my other rotations instead of waiting hours for a resident or staff member to 'let me leave'...

I've only been gone for two months :P

Yah, I know, I haven't posted in 2 months. A lot has happened, so I'll probably have to make multiple posts to catch things up to the present. I'm currently on my Emergency Medicine rotation, but between this and my last post, I've spent time in Geriatrics, Family Medicine, and another Internal Medicine elective in Toronto, so there's quite a bit to write about.

During this time, I've also been working on my residency applications, which are probably the biggest waste of my time and are the main reason why I haven't been updating my blog. Anyways, it's been a little frustrating hearing about the things some people will put on their applications to make themselves 'look better'. I'll be glad when this is all over and I can focus on my future and life beyond medicine...

And for those of you wondering what I'm going after, I can honestly say that I could flip a coin between Internal Medicine and Family Medicine and be happy in whichever one I happened to get.

Being a patient advocate

My elective in London (Ontario) finished on Friday, and I have to say that it wasn't great, but it wasn't bad either. London itself is a fairly quiet city; it reminds me very much of a smaller version of Edmonton. There isn't much to do, and the transit system isn't that great. That being said, if I were to move here, it's not like I would be doing much except going to the comic book store (which is amazing, may I add), eat out, and see the occasional movie, since I'm not exactly a social butterfly. And the transit wouldn't be much of an issue, since I would bring my car over and drive around.

In terms of my actual experience in hospital, I'm a little torn on how things went. My patient experiences were amazing, but I unfortunately found myself struggling every day to make sure they were taken care of at the standard of care that I felt they deserved. Since I don't want to say too much on such a public forum, I'll limit my comments to the fact that I think it's unfortunate that our system is so focused on the short-term rather than the long-term goals of the patients.

Although there were several examples of this during my time in London, one case comes particularly to mind, mainly because I fought so hard to have my patient stay in hospital. This lady came in because she had a one day history of fainting episodes. On examination and on checking her labs, it became quite clear that she was dehydrated and also had acute renal failure.

Looking further into her history, it became apparent there was more to her story than this one visit; over the last four months, she had been in hospital more often than she had stayed at home because of heart attacks, bowel surgery, and just a general sense that she was not coping well. She had in fact lost 50 pounds over this time period, and I was quite concerned. We could easily hydrate her with IV fluids and send her back home; but chances are, if we did that, she would be back again.

I had quite an argument with my team about this; my senior said that everything had been done in the past to find out the reason for her weight loss (and accompanying nausea), and there was no need to keep her in any longer than necessary. On the other hand, I was arguing that something had to be done given that we hadn't fixed the problem, just the effect of it all.

In the end, there was a compromise: my patient ended up staying in hospital longer than intended because her family 'refused' to take her back (that's a trick I learned, btw. If you think your family member should get further investigated, but the team wants to boot him/her, refuse to take them back, and then it'll buy that person some more time in hospital). We're going to try and get her into a clinic to get some further investigations and stabilize her with a feeding tube for now. However, I have a feeling that now that I'm not around, she'll be discharged pretty quickly from hospital, but at least I feel better about her situation.

The patient herself was also quite appreciative towards me, and she told me that if I'm ever back in London, to give her a call, and she'll have me over for dinner with her family.

This elective has actually made me realize that patients are quite astute when you're trying to look out for their best interests. There were many times over these past two weeks where I've had to argue for certain things to be done for my patients; and by the time I finished on Friday and said bye to them, I was surprised how many of them thanked me for what I had done. It's nice to know that I actually made an impression on some of these people!

In summary:

- London is a small city and very similar to Edmonton; which is fine, considering all I'd probably do is see the occasional movie, go to the comic book store, and go out to eat once in a while

- My actual experience was mixed. I had several frustrations with the system, but in the end, I think it was worth it because of the meaningful patient encounters that I had

- One patient that particularly sticks in my mind is one who had come to hospital on numerous occasions because of her medical issues and significant weight loss. I had to fight for her to stay in hospital a bit longer to get further investigations; and I have a feeling that now I'm gone, she'll be discharged soon. But at least I bought her some time to get a bit more testing, and she was quite appreciative of my efforts.

- Back to Edmonton I go now that this elective is at an end!

Milk bags = disaster

It's been a hectic week in London ON, but I'll go over my ward experiences later. I just thought I'd tell my rather embarrassing/amusing story about milk bags.

For those of you that don't know (since I didn't know they existed), milk bags are 4 L bags of milk that come in 3 smaller bags. They're supposed to be easy to use and cheaper than buying milk cartons/jugs. All you do is pour the milk into a jug, and voila! Use the milk to your heart's content. Sounds simple enough, right? Well, not if you're me...

The person who was staying here before me bought a 4L milk bag and never ended up using it, so the couple I'm staying with told me to use it since they don't drink milk. I was pretty happy with that, thinking I'd save myelf a few bucks. I had never seen a milk bag before, so I didn't know you needed a milk jug for the milk once you opened it.

As I'm sure you can imagine, bag #1 didn't last very long: as soon as I opened the bag, I realized that I had no way of keeping the milk in the bag after I poured my glass of milk. So, after I very messily poured that glass, that bag went down the sink...

It was at that point where I went on the internet and realized I would need to buy a jug to store the milk...so I did that and proceeded onto bag #2. I cut a hole in the corner of that bag and poured it into the jug....I made quite a mess, but at least I managed to get most of the milk; and after that, things went more or less smoothly for that bag.

It ends there, right? Nope. For bag #3, I thought I would be 'smart' (note the quotations) and to save myself from making a mess and losing all of my milk, I decided to put the bag INTO the jug, puncture a hole on the bottom, and let it drain. That started off well; but in my brilliance, I decided it was going too slowly, so tried to make a bigger opening. I was a little too aggressive at doing that, and SPLOOSH, the milk flew into the air, onto my clothes, and onto the floor. After cleaning the mess, I still salvaged most of the milk...only to find the next day that it was expired.

I shall never use a milk bag again...

Physical medicine & rehab and Vancouver

I'm currently in the middle of a 4-week elective block, where I spent the first two weeks in Vancouver, and now I spend the remaining two weeks in London, Ontario.

My time in Vancouver was spent at the G.F. Strong centre, in physical medicine and rehabilitation (PMR). I had initially gone there to see how the Vancouver hospitals are run and to potentially get a reference letter, but my latter goal changed on day one when I realized that although PMR is listed under Internal Medicine, it really isn't a subspecialty. As soon as I started, my preceptor started questioning me about neurology, and I very soon realized that I was quite out of my league in trying to impress!

While that may sound bad, I'm not too desperate in getting reference letters at this point, so I used the rest of this rotation to hone my neurological exam skills (which had admittedly been pretty poor before I started this elective). I also got the chance to speak to some of the residents about the programs in Vancouver, so it wasn't a total loss either from the perspective of residency program searching.

The patient population in physical med and rehab is unique in that they deal with a lot of stroke patients who do not always recognize that there is something wrong with them because of the nature of their brain injuries. Others were perfectly healthy prior but ended up paralyzing themselves secondary to a sports injury. All had a common theme of being extremely complex cases, and I was impressed with how well the doctors could manage the patients.

Multidisciplinary medicine is usually somewhat half-assed on the wards, but in the case of PMR, it was absolutely essential, given how many issues each patient had and how long most of them had to stay in the centre (a 'short' stay was 1-2 months instead of a couple of days). Each of these patients, although stable, still were often quite dependent on others to get their activities of daily living accomplished, and the goal of rehab was to allow them to become as independent as possible in spite of their injuries. I attended several family meetings, witnessed patient meetings in regard to driving for paraplegics (I never knew before that you could set up hand controls to let them drive!), and even got the opportunity to try joint injections on practice models.

The doctors were also great, in that they were patient with me in spite of my obvious lack of knowledge. I also appreciated how they would actually watch me perform my physical exam skills and provide suggestions for improvement. Although I'll never become a neurologist, at least I won't be completely embarrassed with reporting my findings if I need to refer to one.

I also felt more independent, as I wasn't required to report to someone every few hours, and could leave whenever I felt like it without feeling like I was shirking my responsibilities (although some days I left early because I felt like enjoying the weather).

The nice thing about the elective was that I also had a lot of free time in the evening, which was ideal since I was visiting a friend. While there were a few questionable moments (*cough* watching the House Bunny - which, despite my MSN name that someone surreptitiously changed, does NOT rock :P; losing my bank card; eating at an asian fusion place which refused to serve its lunch menu at lunch and did not have any sushi available even though it was on the menu; and almost getting my credit card broken!), all in all, I had a good time. We spent a lot of the evenings trying various restaurants in Vancouver and ended up going to the Seattle outlet stores, Richmond night market, and a store called Daiso ($2 for pretty much any item imaginable, including urine bags that solidified the urine!).

There were other moments that I rather enjoyed, including celebrating my friend's 25th birthday, having another friend join us, and getting the chance to play with my friend's dog; but certain things will remain unmentioned in case of potential backlash :P. Those two weeks passed by quite quickly, and it's going to be quite a difference when I start my next elective tomorrow, as things are a little isolated where I am, and I don't really know too many people in the city.

At least the place I'm at isn't a dump, like I was worried it would be, considering the cheap rate I got it for. Thank goodness some people still do things out of the kindness of their hearts and not to make a profit!

In summary:
- I completed my physical medicine and rehab elective. Although I didn't get a reference letter out of it, I learned a half-decent neurological exam and got to find out a bit more about the programs in Vancouver. I was also quite impressed with how well the doctors handled the complex patients they see in the program; even though they're all 'stable', they all have several issues to be dealt with and can still be quite sick when they first come in. For the amount of work that they do, these guys are probably underpaid relative to other physicians.
- Because I wasn't trying to get a reference letter, I was able to spend more time hanging out with my *much older* friend. I haven't had this much fun in a while; and even though she made me watch the Houe Bunny and poked holes into my ego, things were otherwise quite enjoyable.
- Now I'm onto an internal medicine elective. I guess we'll see if I can get a reference letter out of this experience!

Back after a month of inactivity

I haven't blogged in a while because I've been busy, and also because there was a recent article in the CMAJ about how medical students/residents/professionsals should avoid blogging about their experiences. After some thought, though, I've decided to resume my blogging. The article was an opinion article and I think was mainly directed towards those who like to write inflammatory comments about their patients online. I tend not to do that, and I think online posting is an invaluable way for people to share their unique experiences with other people, as long as personal identifiers are removed to respect confidentiality.

Since I last posted, I completed my pediatric ward experience as well as an elective in Vancouver in physical medicine and rehabilitation (most people know that specialty as rehab for short).

The time I spent on the pediatric ward was a lot more rewarding than I expected. Although most pediatricians say we shouldn't think of kids as little adults, that's how I treated my experience and enjoyed it more because of that, as I used it as a bit of a review for my upcoming electives. My most memorable experience was one of my patients that was admitted on my second day of the rotation.

This baby girl had come in to hospital because she had failed to gain weight over the last few weeks and was "throwing up" at home. When she had initially been seen by the team on call, they thought she had a faint heart murmur and something called laryngomalacia (collapse of the larynx - common in newborns) to explain her regurgitation. By the time I saw her, though, she had an obvious murmur and looked a little worse for the wear. As the investigations came back, it turned out she had a heart wall defect (called a VSD), was in heart failure, and had another problem with her respiratory system that was causing her significant problems with sleep and swallowing.

By the time I finished my rotation, she was still getting worked up, but it was impressive to see how much our system had to offer to this girl: in the past, with someone like her, she would have likely died in a few months of an infection or failure to thrive. Now, though, with a few simple fixes, she will likely live a normal life. Her parents were also great to work with, and they saw me as her primary provider even though I was just the medical student. At family meetings, they always asked for my opinion, and when I left, they gave me a thank you card - my first ever from a patient!

Other experiences on the ward included a girl who came in with a large pleural effusion (fluid in the lung) but was otherwise asymptomatic. There was a huge debate on whether or not she should be sent home given she was so stable, but I pushed fairly hard for her to get admitted to get further investigations. Good thing too: it appears that she may now have a potential cancer (by the time I was finished the rotation, she was still getting worked up, but the diagnosis was fairly certain). There was also an unfortunate girl who presented with probably schizophrenia, several chicken pox cases (in spite of vaccination), as well as numerous children presenting with croup and unusual kidney failures.

Surprisingly, my rotation on the wards went quite well; my preceptor thought I worked hard, and is willing to write a reference letter for me for my upcoming carms (shudder). I guess it helped that there was one day when there were no residents or students during the afternoon except for me (everyone else had teaching or was post-call) and my preceptor. Somehow, I managed to hold my own, and she greatly appreciated my help. Who would have thought a medical student could be of so much use, eh? :P

Expect to see another post soon about my rotation in physical med and rehab in Vancouver. I'm off to London, Ontario next. Let's hope things don't go too badly over there!

In summary:
- I have finally updated my blog after over a month hiatus. There has been some debate over whether or not medical professionals should blog about their hospital experiences; but after much thought, I have decided to continue. I tend not to write anything too inflammatory about my experiences, and I think as long as patient confidentiality is maintained, medical professionals should continue to share their experiences, as this allows others to learn from their mistakes and also keeps the whole healthcare system transparent.
- My last few weeks in pediatrics were better than I expected: I became quite involved in one patient's care, and because of this, her parents saw me as the primary healthcare provider and ended up giving me a thank you card in appreciation - my first of hopefully several to come!
- Being in the children's hospital allowed me to see a lot of the weird and wacky, and I ended up seeing a girl who will likely be diagnosed with cancer in the future. Other illnesses seen during my rotation included a potential schizophrenic, chicken pox, croup, and kidney failure patients.
- Somehow I managed to get a reference letter out of my experience, which was probably helped by the fact that there was one day when it was just me and my preceptor taking care of team issues, and I managed to hold my own.
- More will be posted soon in regards to my recently completed physical medicine and rehabilitation elective; but for now, I'm getting ready to go to London, Ontario, for yet another elective. Wish me luck!