Rules of the House

Inspired by "The House of God : The Classic Novel of Life and Death in an American Hospital" (Samuel Shem) here are my rules (ever evolving). Not all of these are original, but rather than compromise these fine physician-teachers, I have not included their names.

1. Science seeks the most elegant solution, while medicine seeks the best solution at that time.
   
   
2. Don't forget to look at the patient.
   
   
3. Blue is not a good color in a patient.
   
   
4. The body has a finite number of pathophysiological responses to an infinite number of insults.
   
   
5. The generic/stall out answer to the question, "Student doctor what do you do?":
   
   
   
   • CBC
     
   • Basic metabolic panel
     
   • X-ray of the affected area
     
   
   
6. Understand and learn your doctor's three keywords.
   
   
7. Bottom line its all about the Benjamins.
   
   
8. The VA is full of HONDAS:
   
   
   
   • Hypertensive
     
   • Obese
     
   • Noncompliant
     
   • Diabetic
     
   • Alcoholic
     
   • Smokers
     
   
   
9. A lab test or imaging study is ordered for a specific reason, know why, what it means, and what to do about it...and always, always follow up.
   
   
10. Ninty five percent of the work in the world is performed by five percent of the people.
    
    
11. Laws of Radiology
    
    
    
    • Symmetry is good.
      
    • Straight lines and sharp corners are bad.
      
    • Real findings are in a perpendicular view, too.
      
    
    
12. All females are pregnant until proven otherwise.
    
    
13. Happiness is good shoes.
    
    
14. It's good day if you can go home and wipe your own @$$.
    
    
15. On "doctoring"
    
    
    
    1. Make a diagnosis
       
    2. Find a treatment
       
    
    
16. Nun's don't get cervical cancer, but do get endometrial cancer. The first is an STI, the second is high risk for nulliparity and obesity.
    
    
17. Cardiology in a nutshell: Dead meat don't beat.
    
    
18. Trade names should leave a bad taste in your mouth.
    
    
19. Anaerobe treatment: clindamycin above the diaphragm, metronidazole below.
    
    
20. If they have don't have a story they are schizophrenic.
    
    
21. If they give you a headache during the interview they have one or more personality disorders.
    
    
22. Getting drunk, smoking some pot, and popping 5 benzos of your choice is not a suicide attempt...its a party.
    
    
23. Observed or ordered is recorded: The medical chart is the lab notebook of medicine. When you come back a few years later it must have enough evidence to write a thesis, publish a scholarly paper, or defend your actions in a court of law.
    
    
24. Medicine is a function of time: Acute problems are treated acutely, chronic problems are treated chronically, and to truly cure anything, prevent it in the first place.
    
    
25. The YIVAS Criteria, what we wish we and all our patients were:

    Young

    Intelligent

    Vocal

    Attractive

    Supported

26. The condition called life has a 100% mortality rate.
    
    
27. The best way to learn to be a doctor is to be a doctor.
    
    
28. Be cautious of the charming, affable patient, they will unintentionally circumvent your diagnostic inquiry and complicate the appropriate therapeutic intervention.
    
    
29. Placebo effect, both blessing and curse.
    
    
30. There is no such thing as an interesting patient. They are all interesting.
    
    
31. Your patient's agenda and your own are not the same. You worry about what will kill them soonest while they worry about what scares them the most. Stick to your agenda but recognize theirs.
    
    
32. Patients come to the ED for one of five reasons:
    • An x-ray
      
    • Antibiotics
      
    • A note for work
      
    • Pain killers
      
    • Pregnancy test
    
    
    
33. Do not argue with the person without pants on.
    
    
34. On doing "everything": Just because we could, doesn't mean we should.
    
    
35. One fun thing at a time has a low probability of mortality, two or more are a virtual guarantee.
    
    
36. To sleep comfortably on call never go the bed with a guilty conscience.