WhiteCoat

Archive for July, 2010

The Downside of Being a Teacher

Tuesday, July 6th, 2010

Recently I was asked if there were any downsides to being an attending in a teaching program. I came up with the following example of how being someone else’s teacher can be a detriment sometimes.

Mrs. WhiteCoat slipped on the stairs and injured her middle finger a few years back. I was working in the ED when it occurred, but was getting off of my shift. I told her to wait and I would come home and look at it, but she was in a lot of pain, so she went to the closest emergency department – at a hospital where I’m not on staff.

Once she got there, an x-ray was done and it showed that her finger was broken, not dislocated as I had suspected from her description.

The nurse practitioner who evaluated her in the fast track asked if she was my wife. When she told the nurse practitioner that she was, the nurse practitioner wouldn’t reduce her finger fracture because she worked with me at the teaching hospital.

Then the emergency physician came in. He wouldn’t reduce the finger either since I used to be one of his teaching attendings. He wanted my wife to see a hand specialist.

The other emergency physician working that day also didn’t feel comfortable reducing my wife’s finger. I used to be his medical director.

When I got to the hospital after the shift, everyone came up and said “hi” to me, then asked me what I wanted to do. I told that someone needed to reduce the finger. No one wanted to be the one that screwed up Dr. WhiteCoat’s wife’s finger, so they all said that she needed a hand surgeon to do it. Unfortunately, the hand surgeon wasn’t available until late that afternoon. I called the surgeon’s office and he had surgery scheduled all day.

So what did I do?

I asked the NP to go get a syringe and some lidocaine. Then I pulled the curtain, numbed my wife’s finger, and reduced it myself. Did a pretty damn good job at it, too – if I do say so myself. Good alignment, no scissoring. Now you can’t even tell it was broken.

The thing that sucked most about the whole experience was that about a month later, the hospital sent me a bill for reduction of the finger fracture … when I was the one who performed it.

At least my wife can still flip me off with a pretty normal looking finger.

Open Mic Night

Saturday, July 3rd, 2010

I wanted to try something new, and got the idea from Ace of Spades. We’ll see how it goes.

Tonight and tomorrow, I’m leaving an open mic for comments. Anyone can comment on anything that they want to get off their chest. I’ll throw my two cents in the comments section when I get some free time on Monday.

Only requirement for the open mic is that the comments have to be medically-related. I don’t want to get into political arguments on this site.

Please keep things civil. Remember that if you disagree with a comment, attack the idea, don’t attack the poster – no ad hominems.

Let ‘er rip.

Healthcare Update — 07-02-2010

Friday, July 2nd, 2010

Also see the satellite edition of this update at www.erstories.net.

You’ve heard of GEICO Direct? Now there’s MedMal Direct. A 20 minute call could save you 20% or more on your med mal insurance.

One physician with 350 medical malpractice claims and 22 criminal counts against him. He had an international warrant for his arrest and was finally caught in Italy after he disappeared from his vacation in Greece. Now he gets a long term chateau in the Greybar Motel.

When did Jerry Springer get into the emergency medical business? Two dimwits in Ithaca, NY decided that they hadn’t sufficiently stabbed someone they were involved in a fight with. So they followed him to the emergency department and started hitting and kicking the guy, screaming “bleed, bitch, bleed!”. Victim’s girlfriend then retaliates with a mop handle. Now the attackers are charged with felonies.

More evidence for having TASERs in emergency departments. Drunk emergency patient punches one nurse, scratched the forearm of another nurse, and punched a third nurse in the face. Now she’s been charged with three felonies.

Jerry Springer Part III. Georgia dimwit hits emergency nurse in arm leaving red marks and leaving herself with $1430 less money in the bank.

Jerry Springer Part IV. Florida patient spits in the face of the emergency department nurse. Nurse later gets low Press Ganey scores because she forgot to say “thank you ma’am may I have another!”

Don’t mess with the nurses. Minneapolis nurses set for another strike. At the heart of the matter are fixed nurse-patient staffing ratios, benefits, and increased pay. Hospital executives respond by stating that they can’t maintain profits without having one nurse and two medical assistants staff the entire hospital. Madness isn’t looking forward to a strike, either.

Good advice from Penn State (boo hiss) about how to save your fingers this Fourth of July weekend. Please be safe and keep your kids away from explosives.

The ultimate Ponzi scheme. Hey everyone, let us deduct some money from your paychecks all your working lives and … you’ll have INSURANCE!
Growing number of physicians no longer taking Medicare – just as baby boomers hit Medicare age. Thirteen percent of AAFP family practice physicians don’t take Medicare – more than double the number from 2004. Even those physicians who still accept Medicare assignment don’t accept anyone who wants to see them. Almost a third of AMA primary care physicians restrict the number of Medicare patients they take. Thirty four percent of AOA members either don’t participate in Medicare or don’t accept new Medicare patients and expects that number to double if the Medicare cuts go through. 117 North Carolina doctors have opted out of Medicare since January and 1,100 New York doctors have left Medicare.
But don’t worry. Everything is going well as we integrate 32 million new insured patients to the government insurance plans and as baby boomers begin to turn 65.
By the way … has anyone seen their Medicare A and B deductibles rise significantly?
Yeah. Great system.
Medicare patients: Get health care while you can.

47 governors ask for additional Medicaid funding to stave off massive budget cuts and potential double-dip recession. Pending cuts would cost 300,000 teachers their jobs nationwide. The federal government imposed “maintenance of effort” requirements on state Medicaid programs which prohibit cutbacks in Medicaid eligibility. Now states must make up the costs by cutting other services.

Pennsylvania hospital considers closing emergency department

St. Louis psychiatric center definitely closing — due to budget cuts

Decrease in narcotic pain prescriptions equals decrease in patient volume. Dosher Memorial Hospital in North Carolina sees decrease in patient volumes after creating and publicizing policy that it will no longer use or prescribe narcotic prescriptions for chronic pain complaints. Have migraines, back and neck pain, dental pain, fibromyalgia or other chronic pain syndromes? Hope Toradol works because you aren’t getting any codeine, morphine, or oxycodone.

Another Reason They Call It “Dope”

Thursday, July 1st, 2010

In case you wanted another reason not to use drugs, here it is: You don’t know where the drugs have been.

A woman got brought into the emergency department in police custody. She was intoxicated and complaining of pain to her ankle and hip. The story we were given was that she jumped out the window of a house that was being raided by police and injured her ankle and hip in the jump. Following the trauma protocol we did the Airway/Breathing/Circulation/Disability/Exposure routine.

As the patient was being undressed, the nurse noted a piece of newspaper sticking out of the crotch of the woman’s underwear. A little more investigation determined that there was a wad of newspaper stuck into a place where I’m guessing that not many police officers frisk.

When the newspaper was removed, multiple little rocks of white material that appeared to be crack cocaine dropped onto the bed.

“What’s that?” The woman asked. “Whatever it is, it isn’t mine. I just stuffed some newspaper up there because I thought I was starting my period.”

Rrrrrright.

Glad I wasn’t working in the police evidence room that day.

Recently on Twitter: