Apparently the state frowns upon ordering a $300 free and total PSA when the $6 serum PSA works just fine. Who knew? I didn't yesterday when I ordered it. But now I know and I figure if that's the worse thing I ever do in medicine, I think I'll be alright. I can think of a whole lot of other things that would be much much worse. I was even the bigger person and didn't mention to the Dr, after she finished chastising me that one of the PAs occasionally orders what I now know is the wrong (more expensive) lab test. I say take it out of my paycheck.
Today was busy and yet slow for a Thursday - or maybe that was just my work pace. One of the PAs (same one who is ordering the spendy tests) dumped one of his patients on me. That's fine, but what irked me the most is that he passed off my treatment plan and idea off as his own, which was a 180% different than what he wanted. Pt scenario: uncontrolled diabetic bumped shin when getting out of bunk - a month ago. Now has cramping calf pain, swelling on the medial (inside of the leg) calf and tender to palpation. I think he's just a poor wound healer - he still has some bruising on the shin - I also ruled out why it's not a DVT which was the PA's thought (he wanted to try and ship him out to have an ultrasound). So time to consult the doc and Mr. PA changes his mind - which is fine, we can have a change of heart, but I had the exact same findings as he did. Who knows. Interesting case for the day: 19y/o with no testicles. Pt's story: had undescended testes as an infant - bilaterally - never had surgery to bring them down. Flash Forward to 17 years later, he had laparoscpoic abdominal exploratory surgery to find his testes for removal since they put him at higher risk for testicular cancer and I guess they looked and looked and they couldn't find them. His testosterone is low, hasn't hit puberty yet and has slight gynocomastia(man boobs). He started testosterone, shows up at our door and voila! I also had my first quasi famous person in today for intake (former pro-baseball player). Oh and one of the patients I saw today had the most bizarre presentation of tinea versicolor and scabies - regardless these patients always make me feel itchy.
I am thankful tomorrow is Friday. It's the 3 week marker for this rotation. Whoohoo! I should probably catch up on Typhon. I'm only, oh, 3 weeks behind.
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