Wasteful admissions

I admitted a patient for an uncomplicated case of fecal impaction ... a bad case of constipation a few days ago. While fecal impaction requires treatment it usually doesn't require hospitalization in on otherwise healthy patient. When I talked to my supervising residents they told me that there is no way to stop this senseless admission. The patient was easily treated with fleet enemas at a a ridiculous cost. Even the attending physician wondered what was going on. The decision was made by a busy hospitalist for reasons that are unclear.
--Ralf

Location:El Rio St,Houston,United States

Moving to a new blog

Now that I'm a resident, I set up a new blog about my residency: Ralf's Internal Medicine Residency. This is the last post on this blog....

First day of call as intern

It's my first day of call. Still have old duty hour system with 24 HR call. At least I'm rested and happy to start.

Location:Cambridge St,Houston,United States

Done with Medical School!

I'm sitting in a Bank of America branch while my oldest daughter is setting up her first checking account and I'm enjoying one of my few remaining days of "freedom" before my Internship. I'm finally done with medical school and it feels great. The reality of Internship in Internal Medicine at Baylor College of Medicine hasn't fully set in and I'm able to enjoy my family for a little while.

I do feel like a different person than when I started on this journey of becoming a physician. I have learned a lot about the medical field and already I feel like I have the knowledge of how to take better care of myself and my family's health. I feel like I have better insight into my strengths and weaknesses and how to make the most happen with my abilities. I learned a lot about work-life balance and feel like I'm a better husband and father than I was in the business world and left much of the home life to my wife to manage.

Now I am a about to embark on a new training experience that I expect will have a steep learning curve initially. Based on what I have been told by others, this will probably be a much steeper than medical school was at first. Although I expect internship year to be challenging, I am so happy to finally be at this point. Very soon I will be able to help care for patients to a much greater degree than I ever have before. Yes, I will have many limits in what I can do. I will depend on the patient to provide information for a good diagnosis and in implementing a plan of care.

As in my earlier training, I will be supervised and work in a way that suits my upper level resident and attending. However, I will be able to write orders and perform evaluation and procedures with greater independence than before. I'll have much less time to spend with patients than I did as a medical student, but I like the idea of having more patients and being able to contribute more. Getting paid for my work will also be a huge plus!

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Ralf B Lukner, MD, PhD

Location:Dixie Farm Rd,Pearland,United States

Done with 3rd Year

Third year of medical school was pretty much everything everyone says about it ... busy, intense, and a great learning experience. It's nice to look back on it now and look forward to 4th year. I start my sub-internship at the VA next week and I'm really looking forward to it. Meanwhile I am working on pulling together the information for my deans letter that we need to submit at this point. Residency applications and interviews are not far away, and I hope that I can stay in Houston and not have to move my family. I feel very much "at home" in the medical profession now and look forward to my final year of medical school and residency training beyond that.

iPhone: Sync in Progress: 4 hrs

I have mostly switched over from my Palm TX and Blackberry Curve to an iPhone 3G as my PDA. There are still a few PDA books / medical applications that are either not available for iPhone or that I don't use often enough to justify the expense of moving and thus I'm still hanging on to the Palm TX for now. The Blackberry is history for now. I do miss the Blackberry keyboard (no surprise that the new Palm Pre has one).

I must say the iPhone has been a hit for me. I love the thing; the applications are considerably faster than on the Palm TX and that makes a pretty big difference when it comes to clinics and speed counts. Also, iPhone has some amazing applications that just aren't available for the Palm (like the Netters flash cards, for example). Skyscape has many of the major references that I think I'm going to need for Internal Medicine coming up.

The big down side to the iPhone right now are the intermittent 4 hour "Backing up" times when the iPhone sync's. Yes, that's right, 4 hours. It seems like it does this when there is a major change, such as downloading an e-book. It's not really clear. I called Apple about it, and they had no idea why it was taking so long. The data on the device doesn't take that long to transfer. You could transfer the contents of the iPhone in far less time than that over a USB connection. Apple support made me an appointment with a "Genius" at a local Apple store, and he had the earth-shattering suggestion of removing the data from the phone -- hmmm, well given that he was sure that the backup times would go down after the pictures on my camera roll came off and there was no change in backup time status-post removal of the photos, I wasn't too interested in exploring that path until Apple recognizes what the issue is and provides a fix. These long backing up / sync times don't prevent me from using the device. They are just an inconvenience. Overall, I'm very happy with my new PDA.

Art Camp

Houston has a nice museum district that offers art classes for the kids in the summer. For the past several summers my kids have been taking art classes at the Glassell School of art. They attend fir a few hours in the middle if the day and they love it!









There are several classes for kids to sign up for. They work on painting, clay schulptures, and even cartoons... whatever they are interested in.