WhiteCoat

Open Mic Weekend

Leaving for a two day lacrosse tournament, so won’t be online this weekend.

May add a couple of tweets from my phone.

The comments section is hereby open for anyone to post any medically-related questions, comments, or other esoterica. Just remember, no personal attacks.

I’ll try to answer posted questions/comments on Monday. Have a safe and enjoyable weekend … and wear sunscreen.

WC

 

35 Responses to “Open Mic Weekend”

  1. Melissa says:

    How long does it take for your blood count to come back up after a surgery? I had blood count barely above necessitating a transfusion around March 25th. Trying to eat leafy greens and beef and taking iron tab each day but still feeling tired.

    • Tracey H says:

      I’m not a doctor, but I was at a very low level from heavy periods years ago (my doctor didn’t know how I was walking around with such low ferritin and hemoglobin levels). I took Slow Fe daily (everything else bugged my bowels), ate cereal for breakfast (most of them have about 40% of your daily requirement of iron), red meat, and drank orange juice (vitamin C helps you absorb iron). I was better within 3-6 months.

    • WhiteCoat says:

      Assuming that there are no other issues, and depending upon how low your blood count dropped during surgery, my guesstimate would be 4-6 weeks.
      Keep in mind that persistent anemia may be due to a problem with losing blood in other areas (GI losses or menstruation) or with decreased production (dietary insufficiency, malabsorption, bone marrow issues). Persistent anemia should be investigated.
      Anemia isn’t the only thing that causes fatigue, either. Talk to your doctor about other potential causes.

  2. Hueydoc says:

    Our small rural hospital just announced surgery will be on call until 7 PM and not after that.
    When did surgery become an 8 to 7 job ? We already lost our after hours ultrasound.
    I’m giving up- after 30 years in the ER I just signed a contract for an 8 to 5 clinic job. Being in the ER now is like being on the Titanic. I have seen a lot of changes in the last 30 years, and very few have been for the better.
    Maybe some administrator can work my job for a change………… HAH !

    • Hueydoc says:

      And I have to ask if anyone else has noticed this problem- Why do you come to our ER for a problem you have had for 4 days, when both you and your doctor live in another town that also has a hospital ?????
      This is NOT an occasional problem but one that happens numerous times a day .
      Any thoughts?

      • WhiteCoat says:

        This scenario happened at another hospital where I used to work. One doctor who did this told a nurse that he sent certain patients to a different hospital on purpose so that if they were admitted, he wouldn’t have to take care of them.
        Nice guy, huh?

  3. Teresa says:

    I read an article today about the use of the ED. They were giving numbers on how many patients were treated and sent home vs. being admitted. The clear implication was that those who were treated and sent home should not have been at the ED at all.

    I broke my tibia completely in two, and it was at night. All the regular orthopedics offices were closed. So I went to the ED. My leg was splinted and I was sent home. I am curious to know if that constituted an emergency or not. Not sure how I would have dealt with the problem if I had waited until the next day.

    On the other hand, my life was not in danger, and probably there were no serious consequences to waiting until the next day. So by that definition, I suppose it does not constitute an emergency.

    Was this an emergency, or an abuse of the ED?

    The other experience I have with the ED is I cut a 3 inch gash about an inch deep into my arm one night at work. A supervisor drove me to the ED, where it was stitched up, and I returned to work. Clearly not an emergency, right? So what is the alternative to ED in a situation like this? All I can think of is wait until the next morning–kind of a miserable wait.

    In your opinion, if the patient is not admitted to the hospital, does that make their complaint non-emergent?

    • Hueydoc says:

      Broken legs and lacerations are an emergency. A Rash for 6 months is not. A Toothache is not. Back pain for 6 years is not. A baby who has vomited once, is not, nor does it need to come in by ambulance. The people who abuse it are usually well known to us.

    • Meghan says:

      Of course those are legit reasons to be in the emergency room. We’re talking threat to life or LIMB. If you have a broken bone, it may be compromising neurovascular status (needs to be assessed by a doctor at the very least), besides the fact that it’s incredibly painful, and needs to be stabilized. As far as stitches go- it’s something that needs to be taken care of. You can’t do it yourself, so you need a doctor. Frequently, it should be done within 12-24 hrs to prevent against infection (but the sooner the better). There are good reasons to be in the ER that might not get you admitted.

      • Teresa says:

        If you have a broken bone, it may be compromising neurovascular status

        Lay person cannot possibly know that is a potential problem. That does not help me to distinguish between a genuine emergency and a non-emergency. The only criteria available to me are those that I can absorb without getting a medical education.

        the fact that it’s incredibly painful

        Indeed, I found it to be so. However, the EM bloggers have repeatedly said that pain is not something that is an emergency unless it is chest pain.

        Frequently, it should be done within 12-24 hrs to prevent against infection

        So does that mean it is not an emergency unless it occurs between 5 PM on Friday and 8 AM on Sunday? I guess that is what you are saying—I could just leave a gaping wound 1 inch deep in my arm until the morning, which is less than 24 hours away.

        Such a laceration, if it occurred during business hours, could be stitched up by the primary care provider, could it not? If so, then how could it be considered a reason to visit the ED at night, other than the fact that primary care is not available at night?

        Don’t you guys see that you complain about providing primary care, yet patients might really need primary care when it is not available.

        For the record, I have never been to the emergency department for a rash, toothache, back pain, or vomiting, even though I have had all of those problems. ;) And I have never been to any doctor, EM or otherwise, for a cold.

        Back to the point–the point of the article was that people who are treated in the ED and sent home do not have a reason to be seen in the ED. No one seems to be willing to refute that, but none of you seem to be willing to agree to it, either.

      • KT says:

        I have to point this out – most EM bloggers say CHRONIC pain is not an emergency, not any pain except for chest pain.

      • Savage Henry says:

        Teresa said:

        the point of the article was that people who are treated in the ED and sent home do not have a reason to be seen in the ED. No one seems to be willing to refute that, but none of you seem to be willing to agree to it, either.

        Meghan said:

        There are good reasons to be in the ER that might not get you admitted.

        I’ll say it again, too:

        There are lots of legit reasons to come in, and many of them won’t get you admitted.

        In addition to stuff like bone breaks and lacs, there’s stuff that might be Badness but turns out not to be:

        -chest pain from indigestion
        -severe flank/back pain that turns out to be a kidney stone (especially in someone who’s never had a stone before)
        -woman, smoker, recent air-traveler, mid-thirties, on hormonal birth control with a painful swollen posterior calf that turns out to be cellulitis

        All those are from my last shift. None of them got admitted. In my humble opinion (and everybody I worked with that day, I’d imagine)all of those pts were in the right to come in. Just because it doesn’t turn out to be Bad, doesn’t mean the patient is wrong.

        On the other hand, one aphthous ulcer on your tonsil for four hours is not a reason to come in. Not even if you’re going to Disney Land next week, and you need “zeepack” to make sure you don’t get the strep. I know “zeepack” is the “only thing that works” for you because of your totally unique biology. I know Dr. Smith your PCP is an idiot, because he doesn’t have a deep and fundamental understanding of pharmacology like you do. I understand that you love saying “zeepack”, but I’m going to keep calling it azithromycin because every time I do, you tell me that one doesn’t help either – only zeepack helps.

        That lady came in (again) on my last shift, and she’s a time waster par excellence. Keep paying your taxes, kids – that lady loves spendin’ ‘em.

        Teresa, are you asking a legitimate question or are you trying to prove some goofy point?

    • ThorMD says:

      There are plenty of conditions that we treat that are emergencies and the patients are discharged home, like fractures are lacerations. Others that come to mind are anaphaylaxis, and SVT. Agree with Hueydoc – if your kid vomits once or has a decreased appetite today, you don’t need to come in. Likewise conditions that have been going on for weeks to months. I always love when patients tell me they’ve seen 5 doctors for their condition already and “no one can figure it out”. That usually means I’m not going to either. And certainly it’s not an emergency.

    • WhiteCoat says:

      I think this “you shouldn’t be here” mentality stems from two issues.

      First, medical personnel often assume that patients have their level of medical knowledge. Patients don’t. That’s why they are coming to see you. Imagine how a doctor would feel if an electrician laughed at him for asking about the repair of a simple switch problem in his house. Then, the whole knowledge thing wouldn’t be so funny.
      That doesn’t mean that every person with a hangnail or a runny nose is justified in seeking emergency care, but I think that there is a tendency for everyone to overestimate the medical knowledge of an average layperson.

      Second, there is an issue of hindsight bias. It’s easy to look at a kid’s sore throat, call it a virus and send the kid home saying they never should have come to the ER. But what about the kid with a sore throat who ends up having a peritonsillar abscess or a retropharyngeal abscess? Minor complaint doesn’t always equal a minor problem.
      Even if a patient has a minor problem and I reassure them that nothing serious is wrong, I usually tell people that it’s “better safe than sorry.”

      Acute pain is absolutely a reason to come to the emergency department. I’ve seen and treated plenty of people who are in agony over “toothaches” and “back pain”. I’m happy to help them. When the complaints are recurrent and the patient is visiting multiple practitioners and getting multiple prescriptions for the same pain complaint, though, you have to question the patient’s intent in repeatedly coming to the emergency department.

    • Teresa says:

      Thanks for your comments, Dr. Whitecoat.

      First, medical personnel often assume that patients have their level of medical knowledge. Patients don’t.

      Hammer, meet nail. It’s too bad most medical personnel don’t understand this point better. My perception is that doctors expect me to bring only appropriate problems to them. Consequently, I often wait longer than I should to seek treatment. I have several friends and family members who are the same way. Some quality of life issues for me don’t get treatment at all. There is such a thing as patients erring on the other side.

      Second, there is an issue of hindsight bias.

      You’ve nailed it yet again. Even *I* can often tell when someone didn’t need to go to the doctor after we find out what is wrong with them.

  4. MamaOnABudget says:

    So what’s the proper recourse if you had a bad experience at a hospital? I was encouraged by the nursing staff and my midwife to say something about the OB that was present during my daughter’s birth – his inappropriate behavior (nothing sexual, just comments he made, saying one thing and doing another, treating us like we were three year olds, lying about things to us and then writing something completely different in the records, etc.). He was a regular employee of the hospital, he was a new OB hospitalist (they call them deck docs here), none of the nurses had ever worked with him.

    This isn’t an “I want restitution” kind of thing. He didn’t carve his initials into me or anything. But he made me extremely uncomfortable, he did something that could have (though thankfully it appears did not) hurt my newborn. I don’t want the hospital thinking I’m sue happy or looking for a payout – I’m not. I just want to make sure that was happened is brought to the attention of someone that matters a little bit and might actually care.

    The hospital doesn’t do PG surveys. They do phone surveys a few days after the fact. I answered those questions truthfully… but they never asked anything about the doctor – just the nurses (who were incredible, wonderful, cannot say enough good things about them) and my pain relief (which was also great – the main reason I ended up there at all).

    Long question short: To whom do I write and what should I say to be heard for what I’m saying rather than feared for what I could possible cost the hospital (which is nothing because, again, I’m not litigious)?

    • Rachedy says:

      If there was no harm to your newborn, what is the problem? What exactly did he do that you think could have hurt the newborn? Rudeness is subjective, a lot of doctors have uh hum, an usual sense of humor, doesn’t make them a bad doctor.

      Do you want this doctor punished? I seriously doubt he will be. I suggest you get over it.

      • MamaOnABudget says:

        No, I do not want the doctor punished. What I would like is for someone to share my feelings with him so that he hopefully won’t do what he did to me and my daughter to another mom/baby pair. We are very lucky that the outcome was as good as it was, though it did require a lot more interventions than it should have. I discussed this procedure with him ahead of the birth, he agreed to do it, then lied about why he didn’t (he said one thing to me, my husband, sister and midwife and the nurses present – and wrote something completely different in the labor notes). I don’t feel the need to discuss the exact nature of what he did on an internet forum, but it was my midwife (not affiliated with the hospital) and the nurses present (who did work for the hospital, obviously) who encouraged me to make known what happened.

        As I said, we’re very blessed that my daughter was okay – and I pray that what happened won’t have long term effects on her health and development. Just because she was able to leave the hospital a couple days after she was born doesn’t mean his lies should be covered up!

        (And one correction to what I typed before. It should have said he was NOT a regular employee of the hospital.)

    • WhiteCoat says:

      Most hospitals have a director of patient care. Call the operator and ask who that person is, then make an appointment.
      If it is a smaller hospital, you may need to make an appointment with the CEO or the COO.
      I encourage everyone to also contact administrators if they have a good experience at the hospital. Positive feedback makes a world of difference to doctors and nurses.

      • MamaOnABudget says:

        Thank you. I plan on including how incredible the nurses and anesthesiologist were doing the whole process, and I talked them up (some specifically by name) during my PG phone call. I also plan to go back when my daughter is about 6 months old to bring a fruit plate or something and some thank yous. We didn’t plan to be there, but they made the transition much better than I could have hoped. But then again… nurses rock =)

  5. Linda says:

    Not a medic of any sort, but I think you should complain in writing, more precisely, not as vaguely as you have here, to the doctor and copy the hospital administration.

  6. Evelyn says:

    I had what the ED physician told me was a rare allergic reaction recently, erythema multiforme, and she recommended I follow up with my allergist. He said this could be caused by a vascular disease that women my age (46) commonly get. He said he’d do a blood test to find out; it would either be positive or negative, and I’d have the results the next day. It took him two weeks to get the results back, and all he will tell me is that my test was positive, and the numbers were “off the charts high”. He said he’s referring me to a rheumatologist, but he won’t tell me why. Any ideas what’s going on? I’m obviously not looking for a specific diagnosis, just some opinions as to what it might be. Thanks!

    • WhiteCoat says:

      Not enough information to give you an idea of what’s causing the problem or what’s concerning your allergist.
      EM can be caused by multiple things – most commonly infections and medications. Not sure where your allergist is going with the blood test issues. Minor cases of EM are usually not cause for concern.
      Here’s one link with more information about EM:
      http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001854/

  7. min says:

    Hey did I get fired?
    Played what the heck is wrong with me in addition to trying to actually live my crazy busy life for about 6 years. After my third nasty bout of iritis and an inability to basically eat or digest food with food with any nutritional content, my internist and my eye guy both said get to a GI who sent cameras and measuring things up, down through and up again. Called it colitis tossed me steroid and sent me to a rheumy. Expensive steroid was great until it truly was horrid after like 10 days. Rheumy said RA probably ankylosing spondylitis and treated with sulfasalzine which was great for 8 months until the biopsy said its killing me so like stop taking it. Rheumy was like damn that sucks but I got nothing else for you so can’t schedule another appointment cause well I gotta think of some thing else but hey call me? Oh and about the perpetual colitis flare for the last 2 unmedicated months? Call your old GI guy eh?
    Soo when I check out with (pay) the receptionist says EXACTLY the same thing no appointment but call if you need to kiss kiss. Did I just get like booted very nicely from the practice or what?
    I feverishly await your thoughts and the next 25 days until my GI appointment.

    • bubba says:

      I’m not a dr, min, but it sounds like RA + GI issues + iritis = IBD, and none of the above are going to be happy until the IBD is under control.

      I don’t know if you got kicked out of the Rheum. practice or not, maybe the “call” you could make to the Rheum. is “Is there any way you can help me get into this GI in less than 25 days??” because sometimes there are urgent appointments available in less time than that.

    • Teresa says:

      If the doctor can’t help you, then you are on your own. Have you tried The Specific Carbohydrate Diet?

    • WarmSocks says:

      If that rheum won’t prescribe anything other than ssz for AS, maybe he did you a favor so you’d know to find a doctor who’s kept up with current treatment options. Biologics can be used to treat AS. Go shopping for a new rheumatologist. Have you looked at the Spondylitis Association’s website? Good luck!

    • Marilyn says:

      I am not a medical professional, but a person with great interest in autoimmune disease because I have one (maybe two). So this is just a suggestion and connection to information, that seems to have helped some other people; do not consider this medical advice.

      I would second what Teresa said. The Specific Carbohydrate Diet might be helpful for your GI discomforts.

      You might want to get checked for celiac disease. Get the genetic test, not just the blood tests. Very easy to check it out without doctors by going gluten free, which is not as easy as it seems but if a lot of your symptoms abate on the diet, you have a no cost answer.

      AS is an autoimmune disease, and generally people with one end up with one or two others. Celiac is a frequent companion of other conditions and while eating gluten-free won’t cure, it can reduce symptoms greatly in some people.

  8. *** says:

    Our ED hired an incompetent administrator who bullied multiple people to cover up her stupidity. When will she be fired?

  9. *** says:

    Why would the hospital’s relationship with tobacco be a security issue? Why is the pilot project a security issue so that my phone is being tapped (Yes I can tell)? To be blunt: I initially liked the ED because I thought I was helping people have access to care. Dr. Lewis doesn’t like the survey because it casts doubt on his claims. The demonstration/pilot project deal may raise questions about STARK or other laws any attorney could issue spot. The pilot proposal right now may fail to meet the objectives; that’s a lot of money to waste. When I have mentioned these concerns the response was “How would anyone know?”… Patty bullied out Tara and Denice and I filed reports with HR, so she attacked me. Patty’s incompetence caused her to screw up the ACTION grant form and I went back and corrected it. Why did someone let an incompetent fool attack my research coordinators? Of course I am defensive. I have no stocks or way to profit from this. If I am supposed to keep my mouth shut, then get me out of here.

    • *** says:

      If there was a different vision, it should have been communicated. Of course I defended the research coordinators and reported it to HR — would you have me react a different way? If my immediate superiors are threatened, don’t you want me to try to help them? Of course I care that they are being attacked?

  10. Hueydoc says:

    An Open Letter to Administrators:

    If you add 8 extra exam rooms to the ER and do NOT increase the satff; yes, your length of stay times will worsen.

    If you actually DECREASE the number of staff in the ER, your times will greatly worsen.

    Rewarding bad behavior of patients will only worsen their behavior. Any parent knows this.

    When will we see satisfaction surveys of administrators by the staff ?

    If a patient is drunk, violent, threatening to us- can we give them your home phone number and address ? And give them a cab voucher to your house at 3 AM ?

    And just how are we to get 100% satisfaction scores when you take away basic services like ultrasound ?

Leave a Reply


+ six = 13

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Earn CME Credit