Archive for March, 2011
Thursday, March 31st, 2011
A guest post by Hueydoc
After almost 30 years in the ER, I have found that many of the Rules from “The House of God” are oh so accurate. But let me add a few new ones, based on my own experiences:
1) The correct answer to any problem is “Whatever screws the ER the most”. All policies and procedures end up leaving the patient as the ER’s problem. Period.
2) The staff in the ER are the only people in the county who are responsible for anything. Not the nursing home. Not the police. Not EMS.
3) Yes, it is true that if you say “Boy, it sure is quiet tonight,” you will immediately experience the worst night in the history of the hospital. This is also a felony — punishable by death in certain states.
4) The quickest cure for severe diarrhea is to ask the patient for a stool sample.
5) No hospital policy ever changes until an administrator is a patient and is adversely affected by the policy.
6) Administrators will never back you up. Ever. Get used to the view of the underside of the bus.
7) When you are firmly convinced that the patient with the bizarre complaint is a crock, you’ll be wrong. When you are firmly convinced the narcotic seeker is finally legit, you’ll be wrong.
8 ) If you page two different doctors, both will call back at the same time, no matter how far apart you paged them.
9) The more demanding a patient is, the less likely it is that they need medical care.
10) I have never, EVER seen a patient who told me “I can’t afford this medicine – you have to give it to me” who wasn’t smoking 2 packs a day. When you point out to them that they are spending over $200 a month to kill themselves but can’t afford their $4 prescription, they either get very upset or sit there with their mouth open like a stunned fish.
11) NEVER ever go to work sick. Not only will it be an incredibly busy day, but you will be sicker than most of the patients you see.
12) All ER physician schedulers are either hopelessly clueless, or evil and insane. I suspect the latter in most cases.
13) The more difficult the stick, the more likely the lab is to lose your patient’s blood sample.
14) There is a sensor on the bottom of the doctor’s bed that, when the doctor actually lays down, activates a Batman like beacon into the sky advertising “Free Vicodin” to the entire community, resulting in numerous patients suddenly checking in to the ER.
15) No extra shift that you reluctantly volunteer to work will ever be an easy shift.
16) You are more likely to see Elvis in the ER than a staff pediatrician.
17) No specialty will complain about the treatment their patient received in the ER more than the pediatricians – yet pediatricians are most likely to dump their patients in the ER.
18) The nicer the patient and family, the worse the outcome will be.
19) I can not tell the difference between very rich patients and very poor patients – they both act the same. “When it comes to my health, money is no object!”
Feel free to add your own!
Posted in Random Thoughts | 31 Comments »
Wednesday, March 30th, 2011
Just so that everyone doesn’t think I’ve bitten the dust …
Surgery went fairly well. First couple of days post-op were a blur. Developed a post op ileus which resolved by Day 4.
At home now and trying to get my body to heal. Had a little setback when part of the surgical wound popped open and began draining clear fluid. Guess I’ll have to hold off on doing those upside-down crunches for a while.
Jotted down a few notes while in the hospital and will try to put them to a post in a few days.
Thanks to everyone for their e-mails and text messages. All the positive energy gets directed right to the surgical site. And as an added benefit, they make me smile.
Will try to get back to regular posting soon.
Posted in Uncategorized | No Comments »
Wednesday, March 30th, 2011
One of my favorite stories. Originally posted October 2007
An old fellow got brought in by ambulance. His wife was waiting for him as he rolled into the room. A tire fell off of his bicycle, he fell, hit the curb, and got banged up. Ripped his shirt, ripped his pants, knocked the lens out of his glasses. He had a good sized hematomato and laceration to the side of his head. And he was not happy.
The paramedics sarcastically told us “he’s in a good mood.” He wouldn’t give the registration clerk any information at all — his wife had to give us his name. Taking his vital signs was a chore. The nurses tried to get a history from him. In a gruff voice, he would tell them “There’s nothing the matter with me!” One of the laws of nature is that defecation follows gravity down an incline. In other words, now it’s my turn to deal with him. The way my day was going, I was not in the mood for an argument.
I walked in the room and his is sitting on the bed. Fully dressed in ripped pants and torn shirt. Cervical collar in place. Obviously upset. Doing his best to fiddle with his glasses without being able to move his neck.
I asked him why he was so upset.
“There’s nothing the matter with me, that’s why!”
“Well you have a nasty looking cut on the side of your head that I need to fix up. That looks like a problem.” He was obviously tuning me out. Still fiddling with his glasses.
I cleared his cervical spine and took off his collar.
“Can I look over the rest of you to make sure nothing else is hurt?”
“I just want to get out of here.” Still no eye contact. As he was trying to pop the lens back in the frame of his glasses, the lens popped out again and dropped on the floor. I picked it up for him.
“Can I see your glasses for a second?” He stopped, frowned for a second and handed the frames to me.
While I continued getting a history from him, I washed the glasses off in the sink, cleaned them with a washcloth, bent them back into a pretty good semblance of their proper shape, and (with a little difficulty) popped the lens back into place. Then I handed them back to him.
“You know, I’ve been fiddling with these ever since the ambulance came and got me. You’re the first person who even tried to help me with them. Thanks, doc.”
All of a sudden he was a different person. Laughing, smiling, even cracked a joke. We got his head fixed up, radiated, and he was on his way.
His eye was already starting to swell up, but as he was walking out the door, I got a nod, half a smile, and a wink from behind that scratched glass lens.
That was a therapeutic encounter for both of us.
Posted in Patient Encounters | 4 Comments »
Monday, March 28th, 2011
Johnny Stickyfingers. Patient in Chicago suburbs arrested after breaking into a code cart and attempting to steal an I.V. catheter syringe, tourniquet band, roll of clear medical tape, several electronic monitoring pads, assorted bandages, and 25 thermometer probe covers. What was he going to do with these things?
Montana is the latest state to consider increasing the level of negligence for EMTALA mandated care to “clear and convincing” rather than ordinary negligence. Montana’s trial lawyers object to the bill, stating that it will make it much harder to pay for their multimillion dollar ranches “provide unmerited protection for those folks who really aren’t doing their job.”
What’s wrong with Obamacare? Authors of the book “ObamaCare Is Wrong for America” say that, among other things, it will “cause a staggering increase in the national deficit, will limit the creation of new jobs by discouraging companies from hiring, and will cripple innovation and research.”
Indiana family awarded $13 million after physician fails to diagnose lung cancer in family member. Doctor still faces more than 350 malpractice suits against him.
New Jersey family awarded $8.5 million in settlement for child born with permanent brain damage allegedly due to delays in performing a Caesarian section.
Law firm plans to file class action suit against West Virginia hospital for overradiating patients during CT scans.
Chicago area man gets charged with felony and possible five years in prison for threatening to kill judge because the judge’s scolding “made him cry.” Of course, when patients threaten to kill hospital employees, the hospital employees get in trouble for not “empathizing enough” with the patients and the patients get flowers sent to their homes because their low satisfaction scores forced them to threaten the employees. Sounds to me like all those sissy judges need to toughen up a little.
What stresses out surgeons? Phone calls? Fresh air? Patients? All of the above? According to the conclusions of a study in the Archives of Surgery, “surgery was associated with stress on surgeons ….” Longer surgeries and increased patient blood loss made the stress even worse.
The next wave of superbugs hits California. Carbapenem resistant Klebsiella pneumonia. The infection is resistant to most antibiotics and about 40% of infected patients die. But hey – keep popping those Zithromax and Levaquin prescriptions for your coughs and nasal congestion. CRKP is already resistant to those. The only thing that will cure it is colistin which, in one study, caused renal failure in 27% of patients who took it.
Violence against women increases by 10% on days in which an underdog beats the home team in NFL football. The logical response: Have JCAHO ban the NFL as a patient safety violation. Look at all those “never events” we could prevent.
If you build it, will they come? Cayman Islands looking to increase medical tourism by decreasing prices, limiting medical malpractice awards, changing doctor registration laws and changing organ donation laws.
Posted in Healthcare Update | 41 Comments »
Saturday, March 26th, 2011
[Originally posted September 2007]
WARNING: THIS IS GROSS
In keeping with the “Most” theme, this is probably one of the most funny moments I have had at work. I have one other one that I’ll use on another day off when I’m bored and don’t have much to write about. You’ve been warned that this is gross, so read at your own discretion.
One of the nurses with whom I used to work was always giving the docs a hard time. Sometimes it was deserved, sometimes it wasn’t. Either way, it was all in good fun and helped make the ED a fun place to work.
When I first started working there, she used to make a lot of smart-Alec comments towards me. One night a patient came in with a discharge that was presumably a yeast infection. After examining the patient, I asked her whether the lab would do wet mounts and cultures at night. Her reply was “Why – didn’t they teach you what yeast looks like in medical school?” Everybody laughed, thinking she was quite funny. Har harr.
I went back in the lounge to get something to eat out of the refrigerator. Seeing some of the leftovers in the refrigerator, an idea was hatched. I put a small amount of cottage cheese and a little bit of pineapple juice into a specimen container and shook it up really well. Then I put the container into a bag, put a patient label on it, and put it out on the counter.
After a little while I asked the nurse whether or not she was going to send the specimen to the lab. She looked at me and said “what isthat?” I told her it was the discharge from the patient that had left. She asked why we had to send it to the lab if I already discharged the patient. I said “Fine, if you don’t want to send it to the lab, I’ll get rid of it . . .” I then opened the container and tipped it upside down over my mouth, tapped the contents into my mouth, and started chewing.
It was as if someone pulled the drain plug out of her oil pan. Her ruddy complexion turned white and she ran out of the room. Later she said that she went straight to the bathroom and vomicked.
From that night forward, we grew to be good friends.
Here’s to you, Sue!
Posted in Funny | 14 Comments »
Friday, March 25th, 2011
[Originally posted February 2008]
When someone kicks at the locked door between the waiting room and the triage room, it usually isn’t a good thing. Most often it is someone who has been shot, someone who is being dragged in by any available body appendage as a drug overdose, or someone with a bad asthma attack.
So my heart sank when we heard kicks at the door and heard a frantic mother screaming “My baby! My BAAABY!”
“Go grab the peds crash cart,” I told the tech standing next to me.
Then the door opened and I had to do everything I could to keep from laughing. A rather large mother busted through the door holding her two year old son. The son was holding on for dear life with one hand as the mom shuffled back and forth looking frantically for … ME. The mom would start walking one direction, abruptly stop, and then start walking faster the other direction. The kid’s body would sway back and forth, but he kept his grip on mom’s shirt with one hand. On the kid’s other hand was the source of the commotion … a can of green beans.
Seems that mom used a can opener to open then can of beans, but didn’t completely detach the lid. She drained the water out using the can lid and then left the can on the counter. Junior then put his hand into the can, pushing the lid down and catching his wrist between the bent-down can lid and the side of the can. Every time the mom tried to pull the kid’s hand out, he would scream because she was pinching his wrist against the inside of the can.
So kid is being yanked all around the ED by mom, he’s holding onto mom’s shirt for dear life with his good hand while his entrapped hand is flailing in the air – banging on random objects while mom is running through the ED.
All I could think of was the kid in a cowboy hat riding a bull at the rodeo.
The nurses got mom settled in a bed with Junior. I went up to the kid, pushed his arm into the can a little more, bent the lid in a little further, and out popped his hand – along with a bunch of squished green beans. There was a little scrape on the inner part of his wrist, but he was none the worse for the wear.
The ironic part is that the mom then grabbed the kid out of the bed, muttered “it’s about time you doctors did something right around here” and walked out of the room.
Um … you’re welcome?
Posted in Patient Encounters | 6 Comments »
Thursday, March 24th, 2011
From an eMedHome.com “Clinical Pearl”
Medications which, when taken even in small amounts, can have significant adverse effects on young children.
- Camphor, which is contained in many OTC products such as vapor rubs and Tiger Balm
- Quinine, such as in some cardiac medications and in Placquenil which is used to treat lupus.
- TriCyclic Antidepressants such as Elavil
- Oral Hypoglycemics, such as diabetic medications glipizide and gluburide
- Calcium Channel Blockers, which are fairly common blood pressure medications
- Methyl Salicylate, found in limaments such as Ben-Gay and as an artificial flavoring in peppermint, spearmint, wintergreeen (think of Life Savers and Altoids)
- Theophylline, an asthma medication which has fallen out of favor in the US.
- Imidazolines, which are contained in the blood pressure medicine clonidine, but which can also be found in over the counter medications such as Visine and Afrin
- Lomotil, a medicine for severe persistent diarrhea.
- Toxic Alcohols – such as methanol which is found in many paint removers/varnishes and which is metabolized to fomraldehyde and formic acid in the system. Ethylene glycol is also another toxic alcohol found in antifreeze and de-icing products.
If Poison Control Centers close under nationwide budget cuts, information like this (including treatment options) will be less availble.
Posted in Medical Studies | 14 Comments »
Wednesday, March 23rd, 2011
Sometimes karma works in strange ways.
Parents bring their child in for evaluation of the child’s cough and runny nose. About the tenth such case of the day and no one wants to get their kids flu shots.
The child’s dad is standing next to the bed holding the child’s hands and talking baby talk to the child – which is already grating on my nerves.
“We dunna find out what’s wrong wif you.”
“Sir, I’m going to need to get in there so that I can examine him.”
He kind of scooted up to the head of the bed, but wouldn’t leg go of the child. He was kneeling down, still holding his child’s hand, and still doing the baby talk.
I listened to the child’s heart, listened to the lungs, pressed on the belly, felt for lymph nodes, looked in the ears, looked in the nose, then looked in the mouth with a tongue depressor. Lots of postnasal drip … blaaaaaaaaaa. Ooops. Got the gag reflex.
With a violent retch, the child hurled a column of partially digested macaroni and cheese mixed with varying colors of phlegm. I jumped back, but the kid turned his head … directly toward his dad. Dad turned his head to avoid a direct facial hit, but still got sprayed with Kraft Macaroni and Phlegm – all down his neck.
Then I was in the difficult position of trying to look concerned while trying to avoid laughing while keeping my inner voice from blurting out “I told you so.”
Instead, I just excused myself from the room to go get some towels.
Posted in Patient Encounters | 3 Comments »
Tuesday, March 22nd, 2011
By the time you read this, I’ll be having a gas … literally. As in Sandman, Great Z’s, and Anesthesioboist kind of gas.
I’m having surgery done to fix some issues that have been giving me trouble for quite some time. According to the surgeons, I’m expected to be in the hospital for about a week and then another 2-3 weeks recuperation at home. That means I’ll be out of the hospital in a few days and back at work in about a week.
Just kidding. I promised that I would be a good patient.
A couple of people are hopefully going to guest post in my absence, so looking forward to reading their stuff when I return.
I also scheduled a few “blast from the past” posts from my old blog for the rest of the week so you don’t get bored.
If you’re thinking good thoughts, thanks.
Hopefully I’ll be back next week. May even try to post a couple of short posts while in the hospital once the anesthesia wears off.
Posted in Uncategorized | No Comments »
Monday, March 21st, 2011
See more medical related news stories from around the web at the Satellite Edition of this week’s update over at ER Stories.net.
More patients gone wild. Florida woman being abusive to staff in emergency department, then punches and kicks several nurses and technicians. After getting a nice matching sets of leather bracelets, then then bit an EMT who was helping insert an IV. When a nurse administered medications to her, she bit him and took a chunk of his skin off.
Notice that there was no mention of using less restrictive measures to calm this poor woman. Look for the whole hospital to be written up by JCAHO. After all, it is probably a patient satisfaction hazard not to wash your forearms when a patient is foreseeably likely to bite you there.
Later, the patient was taken to jail and pepper sprayed. See, police don’t have ridiculous agencies governing their actions that make it an offense to defend yourself.
Now it’s hospital workers gone wild. Woman accuses male hospital attendant of repeatedly raping her in the emergency department as she lay “defenseless, altered and inebriated” in her hospital bed. Reporters get an “anonymous e-mail” detailing the event. Authorities charge the worker with four felonies, including administering an anesthetic so that the woman could not resist the man’s advances.
More hospital workers gone wild. Chicago area hospital employee steals wedding rings off of dead patient, sells them to pay for cable bill. Now he is facing 5 years in the Greybar Motel where cable TV will be provided for free.
Alabama’s Randolph Medical Center abruptly closes due to cuts in payments from Medicare, Medicaid, Blue-Cross Blue Shield and a high indigent-care loss. Now the closest emergency care for city residents is 25-30 miles further away.
Alabama jury awards $3 million to family of man who bled to death after ulcer surgery.
Jury awards family $1 million when patient dies from problem with bowel movement after being discharged from the hospital with enlarged gallbladder. Emergency physician admits not checking patient’s vital signs during visit. Family sues because hospital won’t give them answers to what happened.
Veteran’s Affairs Office of Healthcare Inspections cites an Illinois VA Hospital for lapses in appropriate medical care. Amongh the violations include delay in diagnosis of lung cancer for several months, failure to coordinate a patient’s home health schedule, and failure to give pain medication to a patient who rated her pain as 10 on a 1-10 scale.
Connecticut’s safe harbor laws changing. Apparently, so is the willingness of physicians to provide medical care in Connecticut. Before, physicians had safe-harbor protection from malpractice lawsuits when the care they provide is within accepted guidelines. If physicians practice within established guidelines, they can’t be sued if there is a bad patient outcome. Now those protections are being removed in Connecticut House Bill 6305. Instead of having a prospective standard that everyone should be able to agree upon, Connecticut wants to go to a retrospective standard so that lawyers can engage in Monday morning quarterbacking for multimillion dollar verdicts.
Part of Long Island, NY emergency department cordoned off by police after patient’s family member leaves portable EEG machine in emergency department and no one can figure out what the hell it is.
Funding for Poison Control centers to be cut by 20%. Not good news for emergency medical staff who need immediate information on drug overdoses.
For example … do police officers exposed to a mobile meth lab really require hazmat decontamination at the emergency department? Darned if I know.
Paul Levy looks at CT/MRI use in Israel versus the United States, noting that flat-rate payments in Israel may serve to limit the use of MRIs from the emergency department whereas the amount of CT and MRI use in the US has tripled in the past 10 years. Why the difference? One issue I would want to address in that debate is a comparison of the medicolegal climate in Israel versus the medicolegal climate in the US.
Posted in Healthcare Update | 5 Comments »
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