Business attire what happened?

[Nephrology]

I'm trying to think of the last time I saw a doctor wearing a suit at work. [...] I don't think at this point I would want someone who wears a suit involved in my care.

There are certain specialties/parts of the country where suits are more routine in clinic. Surgical oncology at our university hospital wears suits de rigeur. Residents (ie me) can wear suit or standard biz attire (shirt/tie/slacks/leather shoes) and the long white coat.

That said I 100% of the time prefer to wear scrubs. Sometimes in surgery clinic you are changing wound vacs/pulling drains/etc and I don't especially want to be wearing nice clothes when I do that. Probably the reason the attendings wear suits and not the residents...

Even with ear plugs, I was constantly being woken up by the endless paging, people laughing, alarms going off, "code blues", and the twice nightly checks for my BP (Both times) and blood draws (once), and the thing that as the days went by, angered me the most, when they came in, they asked, "Are you having chest pains?". I came in Wed, and by Sun, I was severely sleep deprived, and was like a cocked gun with a hair trigger. I wanted no BP checks, no blood drawn, and especially nobody asking me the dumbest question in the world, IMHO, "Are you having chest pains?", I would call the nurse ASAP if I was, so why are they asking it?

Sorry you had a bad experience. That noise is unfortunately life in the hospital. Alarms from bed alarms, tele monitor, IV pumps, etc are a constant background noise. Unfortunately those alarms serve a purpose, but there is a reason that "alarm fatigue" is a term.

Depending on why you were in the hospital, asking about chest pain might be perfectly reasonable. We have to ask. I ask people that question all the time even when I am 99% certain I know what their problem is and don't expect them to have chest pain at all.

you would be surprised how many people have chest pain with an associated acute coronary syndrome (aka heart attack or something on the same spectrum) and don't think twice about it.

When it happens outside the hospital, it's a tragi-comedy, when it happens inside the hospital, it's lawsuit material. We make no assumptions about common sense with patients. It's not common.

edit: to illustrate, when meeting patient for first time, I always ask "what medical problems do you have." Then I ask "Do you see a doctor for any reason on a regular basis? take medications every day?" then " No diabetes? high blood pressure? ever have a heart attack? stroke?"

Basically every day I will get the answer "No" to the first question and then with the rest of the questions, something like "Oh well I take a pill for my blood pressure, and also a water pill, now that you mention it I did have 2 stents placed in 2013 and oh yeah a doctor once told me I have heart failure I guess"

[revchuck38]

I'm trying to think of the last time I saw a doctor wearing a suit at work.

Around here, it's typically shirt, tie, and lab coat for office appointments, and scrubs for when they're going hands-on. My GP is a nurse-practitioner, and he's always in scrubs, but at his level, he probably goes hands-on on a daily basis. Plus he's a younger guy.

[Hemiram]

There are certain specialties/parts of the country where suits are more routine in clinic. Surgical oncology at our university hospital wears suits de rigeur. Residents (ie me) can wear suit or standard biz attire (shirt/tie/slacks/leather shoes) and the long white coat.

That said I 100% of the time prefer to wear scrubs. Sometimes in surgery clinic you are changing wound vacs/pulling drains/etc and I don't especially want to be wearing nice clothes when I do that. Probably the reason the attendings wear suits and not the residents...



Sorry you had a bad experience. That noise is unfortunately life in the hospital. Alarms from bed alarms, tele monitor, IV pumps, etc are a constant background noise. Unfortunately those alarms serve a purpose, but there is a reason that "alarm fatigue" is a term.

Depending on why you were in the hospital, asking about chest pain might be perfectly reasonable. We have to ask. I ask people that question all the time even when I am 99% certain I know what their problem is and don't expect them to have chest pain at all.

you would be surprised how many people have chest pain with an associated acute coronary syndrome (aka heart attack or something on the same spectrum) and don't think twice about it.

When it happens outside the hospital, it's a tragi-comedy, when it happens inside the hospital, it's lawsuit material. We make no assumptions about common sense with patients. It's not common.

edit: to illustrate, when meeting patient for first time, I always ask "what medical problems do you have." Then I ask "Do you see a doctor for any reason on a regular basis? take medications every day?" then " No diabetes? high blood pressure? ever have a heart attack? stroke?"

Basically every day I will get the answer "No" to the first question and then with the rest of the questions, something like "Oh well I take a pill for my blood pressure, and also a water pill, now that you mention it I did have 2 stents placed in 2013 and oh yeah a doctor once told me I have heart failure I guess"

I had, and to this point at 67, high BP, but no other problems, my arteries, according to ultasound tests on my carotids, have "minimal plaques". That whole deal when I had that test done was simply due to doctors never explaining that the Ocular Migraine Auras I've had my whole life (not the headaches, just the light show) were what happened one night at work. It was a different type than the usual "flashing snake" as I called it when I was a little kid.


The whole thing that got me into the hospital for the meltdown was just a train wreck. I had fallen and slammed my right knee in a sidewalk the worst possible way, and it was totally numb for over 3 years. But when it happened, I was unable to extend my leg for over three months, and was told to not go to PT until I could extend it. I was driving home from work and it was like a switch was thrown, my leg worked! It was still dead numb, but at least I could drive without using my left foot to keep my right foot on the pedals. So I went to PT. On the third day, the day before Thanksgiving '07 I was on the "Total Gym", the Chuck Norris plugged machine, and I was done and was told to go home and they would see me Friday. As I got off, my right knee folded up as it did for a long long time after I was hurt. I twisted my left knee, and unlike the first fall, it hurt, a lot. I yelled the F word for about 20 minutes. The same paramedics who took me to the ER the first time came again and loaded me up. At one point my BP was 257/180, totally due to me being as pissed as I've ever been, probably the most anger I've ever felt. By the time we got to the hospital, it was down to a semi-sane 180/100, it would soon be back to 120/80 before the sleep deprivation and rage built up again over the five days. At first, they weren't even going to admit me at all, "We can't admit you for a knee sprain!", and I was shocked as I couldn't walk at all. Both knees were injured from the second fall, and I ended up calling a friend who was going to let me stay in the apartment he had built onto his house for his late mother in law. As he was coming to get me, I had to use the bathroom. I had been given Demerol for the pain, and when I sat on the toilet, I started sweating like a faucet had been turned on and saw flashing lights and had tunnel vision. "Oh, you're having a Vaso-Vagel (Spelling?) attack, just low BP!". Well, that got me admitted to the cardiac observation area, whatever the hell it was called. And you know the rest of that deal.

When I flipped my lid, a woman came in the next morning, to get me set up for inpatient therapy and I picked a place my mom had been that was close to work so I could have friends make me food runs. I was taken over there at 1130pm. My roommate seemed to be a sane older guy. Seemed. At first, everything seemed fine, and then at 445am, he turns the lights on, the TV is full blast, he's yelling into his cell phone, "Hi Honey, it's Dad!", and I was NOT a happy guy. I said, "WTH are you doing?". "Oh jeez, everyone is so damn sensitive". His daughter, who I could hear clearly said, "Maybe We should talk later dad, after I get off work!". "Oh no honey, it's fine!", and I went off, "Oh no honey, it's not fine! Get off the damn phone and go back to sleep!". One of the aids came in and told him the same thing. Finally, he went back to bed, but laid there sighing like my dogs used to when they were told they had to stay home. After breakfast, at therapy, he's telling other patients "He went crazy when I called my daughter!" without telling them why, so I went behind him and told them why I was so pissed. "Oh, well, he was being ridiculous!". He says, "Everybody is just so damn touchy!". I told the aids that I wanted to move ASAP. It turned out I wouldn't have to worry about his insanity for too long. On the third day, the morning session was fine, but as I was eating lunch, I began to get a feeling of doom, I don't know how to explain it, but I knew, somehow, something bad was going to happen at PT that afternoon. I was a mess during the afternoon session, waiting for whatever it was going to be. As I went along, I started to think I was just being paranoid, and I would be OK. Nope, as I have been quite a few times in my life, I was 100% correct, something bad was going to happen. The last thing the therapist did was tell me to go to the parallel bars and go up and down on each leg 10 times, switch legs, and then repeat it. I went up and down fine on my right leg, but on the first push up with the left, my quadricep ripped off my kneecap, and the therapist slammed me into the chair behind me. I was about as angry as I was in the ambulance, and yelled, "When is this shit train going to stop?". I punched the arm of the new chair I was slammed into and broke it. I thought I broke my hand, but I didn't. After I got done raging, they took me back to my room where I stewed and ended up watching a couple of quad repairs on my laptop, and the next morning they took me to my orthopedist for a scheduled visit that ended up doing surgery. The surgery was no big deal at all, but I found out I am totally immune to intravenous Morphine. I had bad cramps in my left leg and they gave me three hits of it with zero effect. They gave me a couple of Percocets, and I went to sleep for 4 hours. My roommate's wife who stayed with him 24/7 was stunned when I woke up and started eating beef jerky at 4am.

At this point neither knee works right, the left is "off". I don't know how to explain it, but every so often, it folds up without warning, and steps over about 4" are a nightmare. I can get out of a chair ok, or off a toilet, but steps mess me up.

This is my right knee and leg almost three weeks after the first fall. The pics I took a couple of days after were amazingly bad, but I lost the drive they were on. I had about a quart of clotted blood on my thigh that took a long time to finally go away, and my foot looked like bacon for over a year.

[Hemiram]

Around here, it's typically shirt, tie, and lab coat for office appointments, and scrubs for when they're going hands-on. My GP is a nurse-practitioner, and he's always in scrubs, but at his level, he probably goes hands-on on a daily basis. Plus he's a younger guy.

I've never seen my eye doctor in anything but scrubs. He's insanely busy, and even when I ran into him while he was picking up take out, he had the scrubs on.

[Nephrology]

I had, and to this point at 67, high BP, but no other problems, my arteries, according to ultasound tests on my carotids, have "minimal plaques". That whole deal when I had that test done was simply due to doctors never explaining that the Ocular Migraine Auras I've had my whole life (not the headaches, just the light show) were what happened one night at work. It was a different type than the usual "flashing snake" as I called it when I was a little kid.

They'll still ask you a generic review of symptoms set of Qs on morning rounds as a reflex because that's what we're trained to do. Lots of people with minimal risk factors have heart attacks/strokes/PEs/etc. Again its just part of being thorough and taking the abundance of caution because you can't miss something like an MI when they're admitted to the hospital. A big no-no. The cost is about 20-30 seconds of time, the benefits can be significant if a positive answer is elicited and found to be significant.

At first, they weren't even going to admit me at all, "We can't admit you for a knee sprain!", and I was shocked as I couldn't walk at all. Both knees were injured from the second fall, and I ended up calling a friend who was going to let me stay in the apartment he had built onto his house for his late mother in law. As he was coming to get me, I had to use the bathroom. I had been given Demerol for the pain, and when I sat on the toilet, I started sweating like a faucet had been turned on and saw flashing lights and had tunnel vision. "Oh, you're having a Vaso-Vagel (Spelling?) attack, just low BP!". Well, that got me admitted to the cardiac observation area, whatever the hell it was called. And you know the rest of that deal.

Yeah, my guess is, ER consulted internal medicine because you had a history of falls, the knee injury being a mostly explanation for these (ie mechanical fall/orthopeic problem). When you vasovagal'd in the bathroom, that's a 3rd fall, this one in the hospital (which is a BIG deal in the hospital; every time a patient falls in teh hospital it is a reportable incident and is an incident reviewed carefully by JHACO among other national bodies) and that was syncopal in nature (ie you lost consciousness and then fell). Syncope + fall in hospital + history of falls in the hospital = rule out cardiovascular causes for syncope, every single time. Thats an internal medicine job so you got admitted to internal medicine despite their bitching the first time around.

When I flipped my lid, a woman came in the next morning, to get me set up for inpatient therapy and I picked a place my mom had been that was close to work so I could have friends make me food runs. I was taken over there at 1130pm. My roommate seemed to be a sane older guy. Seemed. At first, everything seemed fine, and then at 445am, he turns the lights on, the TV is full blast, he's yelling into his cell phone, "Hi Honey, it's Dad!", and I was NOT a happy guy. I said, "WTH are you doing?".

Sounds like an asshole. I don't love shared rooms. What can you do.

At this point neither knee works right, the left is "off". I don't know how to explain it, but every so often, it folds up without warning, and steps over about 4" are a nightmare. I can get out of a chair ok, or off a toilet, but steps mess me up.

This is my right knee and leg almost three weeks after the first fall. The pics I took a couple of days after were amazingly bad, but I lost the drive they were on. I had about a quart of clotted blood on my thigh that took a long time to finally go away, and my foot looked like bacon for over a year.

Yikes. That looks very painful. Big hematomas take a while to resolve and are very uncomfortable Sorry that happened to you. I don't really know orthopedic stuff at all or I'd have more useful input. Ongoing PT can be helpful for stuff like that sometimes - they can work magic - but it's very slow progress. I have long-standing patellofemoral syndrome and good PT really did make it mostly go away, but it was a long and slow road. IT's back now that I am not in the same muscular shape I was when I was younger but so far it's tolerable. I imagine I'll be seeing more of them in the future though.

[Hemiram]

They'll still ask you a generic review of symptoms set of Qs on morning rounds as a reflex because that's what we're trained to do. Lots of people with minimal risk factors have heart attacks/strokes/PEs/etc. Again its just part of being thorough and taking the abundance of caution because you can't miss something like an MI when they're admitted to the hospital. A big no-no. The cost is about 20-30 seconds of time, the benefits can be significant if a positive answer is elicited and found to be significant.


Yeah, my guess is, ER consulted internal medicine because you had a history of falls, the knee injury being a mostly explanation for these (ie mechanical fall/orthopeic problem). When you vasovagal'd in the bathroom, that's a 3rd fall, this one in the hospital (which is a BIG deal in the hospital; every time a patient falls in teh hospital it is a reportable incident and is an incident reviewed carefully by JHACO among other national bodies) and that was syncopal in nature (ie you lost consciousness and then fell). Syncope + fall in hospital + history of falls in the hospital = rule out cardiovascular causes for syncope, every single time. Thats an internal medicine job so you got admitted to internal medicine despite their bitching the first time around.




Sounds like an asshole. I don't love shared rooms. What can you do.



Yikes. That looks very painful. Big hematomas take a while to resolve and are very uncomfortable Sorry that happened to you. I don't really know orthopedic stuff at all or I'd have more useful input. Ongoing PT can be helpful for stuff like that sometimes - they can work magic - but it's very slow progress. I have long-standing patellofemoral syndrome and good PT really did make it mostly go away, but it was a long and slow road. IT's back now that I am not in the same muscular shape I was when I was younger but so far it's tolerable. I imagine I'll be seeing more of them in the future though.

I wouldn't have minded them asking me if I was having chest pains, except waking me up when I was having a very hard time sleeping with all the noise. The blood draw one time a night sure didn't help. by the third day, I would get so pissed at the person waking me up, it was impossible for me to go back to sleep before they began the so important task of filling up the pitchers of ice water. Even that bugged me as they did it so early, and I had/have no real use for ice water at the hospital in the first place. Hospital water always tastes off to me. I brought my own Ice Mountain later on, but I complained about the water tasting bad back in 1962, when I had hernia surgery.

I did NOT fall in the hospital, I fell at PT, both times, even though I never hit the floor when my quad blew. I was sitting on the toilet for the entire VG experience. The nurses yanking me off the toilet afterwards instead of using the cherry picker thing was another thing that I wasn't happy about. It hurt like hell. They grabbed me, yanked me up, then pressed up against me to keep me from going down. I told them if they ever did that again, I would find the most obnoxious ambulance chaser and sue the hell out of them. They weren't happy about it, but they used the cherry picker until I could get up myself, about 3 days into that deal.

I fell the first time at therapy soley due to nerve damage in my right leg (I guesstimate it was over 150 times from August '07 until about a week before my quad blew the day before Thanksgiving), and then when the quad blew. For those 3 months plus, my right knee was prone to just folding up without warning. With my eyes shut, I had a really hard time telling the angle my knee was at, so I would step on it without it being locked, and down I went. After my quad blew, my right knee is the "trustworthy one". Not great, but it does nothing treacherous like the other one.

Now, it's my left leg that about 2 times a year tries to fold up and bring me down. It's not numb, but something is wrong with it. It feels perfectly normal almost 100% of the time, but going up or down stairs generates a feeling like I really can't explain. The front entrance to my house was a nightmare. I could and did get in by myself, but I did fall one time, and came close a few more. My right knee feels like bugs are crawling inside it and I guess that's permanent. It's not nealy as bad as it was when it first began to "wake up" in late 2010, but it's still enough to make me want to slap my knee to tell it to "knock it off".

You should have seen the earlier pics. I showed them to a couple of doctors, including my GP, who said he had seen people in motorcycle wrecks that needed surgery whose legs didn't look that bad. I wish I still had those pics, one was my late dog King, who can be seen in one of the pics above, looking intently at my knee and thigh, almost all of which looked like old hamburger wrapped in wax paper. My foot and ankle hurt worse than anything else the first week or so, then it moved up to my thigh, with most of the muscles being ripped up.

Anyway, thanks for replying to the long posts..

[rob_s]

Back on topic...

I had meetings earlier this week with the top leadership of a mid-sized general contractor.

I recall ecpvery one of them was in slacks and a company polo, while I was in dress pants and a dress shirt (and doc martens, of course).

After the first meeting I started to wonder if I would feel over-dressed at some point or if it would be awkward, but if anything it became more comfortable. Getting the tour of the office it seemed like everyone there was dressed that way.

I think that if I worked there I’d keep dressing the way that I do. Although I'd probably eventually backside into their standard, if for no reason other than the savings on dry cleaning. I just really hate that look for me (slacks and polo makes me feel like a geezer) and I really dislike wearing employer-logo’d gear unless I'm required to or visiting a job site where most people may not know me and the company short makes dealing with the ESOL gate laborer a little easier.

[BillSWPA]

I would much rather be overdressed than underdressed.

[Hemiram]

I would much rather be overdressed than underdressed.

You and my late mother would have gotten along great.

My dad, and I many years apart, to mom: "Why are you all dressed up?"
Mom: "I'm going to the grocery store".
Mom: "I'm going to the doctor"
Mom: "I'm going out to eat!"

Dad: "Where are you going so dressed up?"
Mom: (Real answer, her best friend's house), what she said: "Probably to dinner".

I feel like a huge dork in a suit.

[CSW]

Ten years ago, we moved here to NH.

A new flannel and a pair of jeans is about as dressy as I have to get. Like it that way.
Don't even own a suit...may never.