WhiteCoat

Archive for June, 2010

Overheard in the Waiting Room …

Friday, June 11th, 2010

The registration clerk in the emergency department overheard the following statement from one patient waiting to be seen made to another patient in the emergency department waiting room who is on “The List“:

“Just remember – you’re the addict and I’m the dealer. You get what I give you after they prescribe it to me. Understand?”

Hmmmm. Wonder how much you’ll get for that Tylenol prescription the doctor gave you.

Back …

Thursday, June 10th, 2010

Just got back from an unexpected trip out of town for the past few days.

Will be back up and running soon.

Murphy’s Law of the ER

Tuesday, June 8th, 2010

Hey, it’s ERP from ERstories.net doing a guest post.

The other day during a shift I said to myself “Dang it, it’s Murphy’s Law again” when something went all FUBAR. That made me decide to compile a little list of how that law applies to my job.

1. The GYN cart will only be stocked with the extra large and “virgin” sized speculums when you have a normal-sized patient to examine.

2. The GYN speculum light will not work and you will need to have your chaperon use the odoscope.

3. You will have three or four pages out to various doctors for an hour and no one calls back. The moment one finally does, so do all the others. They get annoyed being on hold and hang up.

4. There is guaranteed to be an issue whenever a patient needs transcutaneous pacing. Of course everything worked fine on the practise, model patients, but the moment you need to use it, the thing does not sense or the wires are not compatible with the pads.

5. The IV is going to blow the moment you have to push Epi – even though it was working fine for an hour before hand.

6. The nurse you need for a patient is always on break.

7. The nurse tells you that the patient in room 15 is getting annoyed waiting for an hour with pelvic pain. When you finally go into the room, the patient is either in the bathroom, waiting room, or fully dressed in a wheelchair.

8 There is never a nursing home’s number on their transfer paperwork, making history taking on a demented, bedridden patient a true joy.

9.The SMA-7 on a critically ill patient is always haemolysed.

10. The rate of RN, tech, and unit secretary “sick” call-ins is directly related to the niceness of the weather outside.

I am sure there are many more. Feel free to submit your own!

Healthcare Update — 06-07-2010

Monday, June 7th, 2010

See more health care news from around the web over at the Satellite Edition on ER Stories.

“I liked your testimony. By the way … would you mind taking a look at this mole on my back?” Juror in trouble after asking defendant physician for medical advice during medical malpractice case. The now former juror gets to sit in the defendant’s seat while his attorney explains why the judge should not hold him in contempt of court.

Another attack on the Feres Doctrine which prevents malpractice victims in the armed forces from suing for their injuries. A patient goes to surgery for an appendectomy and ends up dead. The nurse anesthetist who managed his care put the breathing tube in his esophagus instead of in his windpipe, essentially suffocating the patient to death. The court dismissed the case. Now the family’s attorney vows to take an appeal to the US Supreme Court.
Isn’t it ironic how the government can put the big hurt on private hospitals for failing to follow basic safety precautions but how government hospitals can ignore those same precautions, kill people, and suffer no consequences whatsoever?

News crew in Bakersfield, California follows around an emergency physician
. To make things more realistic, the crew will have to film ten different physicians at the same time, will only be paid 20% of its usual and customary salary, will have to wait several months to get paid, and will have to sit through a malpractice trial for the next 5 years because they didn’t film the physician correctly.

He’ll be carrying around an oxygen canister at his senior prom. Two year old smokes 2 packs of cigarettes per day and has temper tantrum when parents refuse to give him cigarettes.

Neat idea to curb abuse of prescription medications turned down. FDA nixxes idea to put niacin in Vicodin tablets to deter abuse. Niacin is a vitamin that is also used to lower cholesterol. Take too much niacin at once and you get the undesirable side effect of skin flushing. Higher overdoses can cause palpitations and liver damage. The FDA advisory committee was concerned that adding niacin did not have “a definitive advantage, and it has associated side effects.” The definitive advantage is that it causes side effects to curb narcotic abuse when added to pain medications. Added advantage: Lower cholesterol in chronic pain patients. Oh well. Good idea, anyway.

Health care plan savings at work. More than 84,000 seniors in Medicare’s prescription “doughnut hole” will get $250 rebate check for their prescription drug costs, totaling more than $21 million in health care savings.
Why don’t we forget the “doughnut hole” and provide generic medications to seniors for free? Make them pay some percentage of the cost (33% perhaps?) of any name brand medications and give them their generic medications. The market forces would create a huge demand for generic medications at that point. Tell me how such a policy wouldn’t cause a downward trend in pricing for most medications — and a huge cost savings for the health care system.

More health care plan savings. According to the Congressional Budget Office, the Obama health care plan could add at least an additional $115 billion in costs over the next 10 years, pushing the total cost of the package over $1 trillion.

Here’s one way to retire early – file a whistleblower lawsuit against your employer. Christ Hospital in Cincinnati settled a whistleblower lawsuit alleging that it provided improper kickbacks to cardiologists who brought in the most money to the hospital. The Justice Department sought $1 billion in damages. Christ Hospital and other defendants agreed to pay $108 million. The cardiologist whistleblower, Dr. Harry Fry will walk away with $23 million of that money.

There is a fungus among us. FDA issues warning and Claris Pharmaceuticals issues recall after bags of intravenous ciprofloxin, metronidazole, and ondansetron found with “floating matter” in the bags. The floaters in one of the Flagyl bags was found to be Cladosporium mold.

Ohio punk assaults nurse in emergency department. Apparently too many energy drinks and not enough marijuana on board.

Long Island man fakes being police officer on four separate occasions to get pain medications in emergency department.

Here’s an idea to increase access to health care: Open up “health houses” like they have in Iran. The houses are staffed by community citizens instead of medical providers and the care provided is free. This was one of my radical ideas to improve the house of medicine a year or so ago – get rid of licensing requirements and let anyone provide care.

Most hospitals paying physicians to take call for emergency departments. Some specialists such as neurosurgeons make $1600+ per day just being on call. At issue are a shortage of specialists – 40% of hospitals couldn’t find orthopedic surgeons and neurosurgeons to cover emergency call and 30% of hospitals couldn’t find plastics, hand surgery, ear-nose-and-throat, and general surgery coverage. Lack of paying patients and fear of being sued for malpractice by an ED patient are cited as other deterrents to specialists taking emergency department call.
What? Lawsuits decrease availability of medical care? Blasphemy!
Next look for the Department of Justice to begin charging the specialists with crimes for increasing the market costs by refusing to be on call.

Government Declares War on Doctors

Friday, June 4th, 2010

I was going to include this article in the rest of the Healthcare Update, but pulled it out and made it a separate post after reading this related article in the Christian Science Monitor – “Justice Department declares war on doctors”

Five orthopedists sued for antitrust violations and settle case.

Workers compensation in Idaho wasn’t paying enough, so these orthopedists allegedly colluded to refuse to treat any workers compensation patients until the state raised the rates that were being paid. In addition, several of the physicians allegedly threatened to stop seeing Blue Cross Blue Shield patients because Blue Cross payments were insufficient. Orthopedists across Idaho even published articles in the newspapers regarding the Blue Cross dispute. Now, as a result of the settlement, the orthopedists won’t be able do this same thing in the future.

Other documents from the antitrust case are contained here.

The assistant attorney general stated that “The orthopedists who participated in these group boycotts denied medical care to Idaho workers and caused higher prices for orthopedic services.” No word on when this brainiac is going to file suit against all the state and government hospitals that deny care and cause higher medical prices. Oh. Forgot. States and insurance companies are exempt from antitrust actions, so no one can sue them for colluding to deny care.

I think I’ve discovered how patients will be guaranteed care under the new health care proposal. If too many doctors stop seeing Medicare and/or Medicaid patients because the reimbursement is too low, the Justice Department will just step up its antitrust enforcements.

Watch what happens to speed and quality of care then …

Quote of the Day #214

Wednesday, June 2nd, 2010

Lots of strange offhand comments from patients lately …

Patient who took an ambulance to emergency department at 2:30 AM when she noticed vaginal bleeding.
“When was your last period?”
“About a month ago.”
“Was there something different that made you think this wasn’t your period this month?”
“No. I just wanted to be sure.”
[after physical examination showing small amount of vaginal bleeding]
“OK. It sure looks like you’re having your period again. You can follow up with the on-call physician if you have any problems.”
“How am I going to get home?”
“You’ll need to call a friend or family member.”
“I don’t have any.”
“Well, then you’re welcome to call a cab.”
[Suddenly becoming enraged] “Why didn’t you f***ing tell me that I wouldn’t have a ride home before I came here?”
“O … K …. The waiting room is through the door and to the right. Have a wonderful evening.”

WhiteCoat Challenge #6 – Odd Chief Complaints

Tuesday, June 1st, 2010

I was going to just make a post about a weird chief complaint that a patient had recently, but then thought that we haven’t had a good WhiteCoat Challenge in a while.

A middle aged female patient presented at the registration window demanding to be tested for “aluminum toxicity.”
When she got back to the room, she stated that her genitals were inflamed and believed that it was caused by aluminum in the whisk that she uses in her kitchen. She called the manufacturer of the whisk and confirmed that the metal portion of it was indeed made from aluminum.

The nurse didn’t really understand why the patient thought aluminum toxicity might be inflaming her genitals. So, to make small talk, the nurse asked the patient what she had been baking. The patient cast her a strange look. She wasn’t using the whisk for baking. She was using it for … um … how should I say … um … autoeroticism.

So here’s the challenge …

List the strangest/funniest chief complaint that you’ve had.

Top three as judged by EP Monthly editors get a choice of any one product from EP Monthly’s online catalog. We’ll also try to publish as many of the top entries in an upcoming issue of EP Monthly’s print version – which is distributed to more than 25,000 emergency physicians around the country.

Contest goes through midnight Monday, June 7, 2010.

Make us laugh.

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