WhiteCoat

Archive for December, 2011

Akismet Rocks

Wednesday, December 7th, 2011

Are any of you other bloggers getting blasted with spam comments lately?

Last month, I had an uptick toward the middle of the month. November ended with 84,000 spam comments.

This month, I’m on track to have well more than 100,000 spam comments.

I can guarantee that without Akismet, I wouldn’t allow comments on the blog. There is no way I could read through and delete 4000 comments a day.

If you’re having comment spam problems, Akismet gets my unconditional endorsement.

And I didn’t get paid anything for this post. It was the least I could do for this great service.

Miscellaneous Pain Histories

Tuesday, December 6th, 2011

Had several notable histories from patients in pain lately.

One patient with chronic back pain hobbled into a room and said “I better not be waiting here 8 hours like I did last time.”
We looked through her old chart out of curiosity to find out what caused the extended eight hour wait on her previous visit. The longest that she had waited in her prior seven visits before getting her shot of Dilaudid so she could go home and sleep was 2 hours and 15 minutes.
Of course, making comments like that to the staff has no effect on anyone’s passive-aggressive behavior. Really, it doesn’t.

Another patient with chronic back pain had an acute exacerbation and needed pain medication. When he took off his coat, he was wearing a T-shirt that had a logo on the back. At the top was “Stoner Steve’s.” Underneath was a big circle with a line through it. Inside the circle was written “Motrin, Klonopin, Ultram”. The line through the circle was a marijuana joint. Why in this world Stoner Steve decided to advertise his aversion to these three specific medications is beyond me.
Of course, wearing a shirt like that to a hospital emergency department and asking for pain medication has no effect on the doctor’s tendency to prescribe you Motrin, Klonopin, and Ultram. Really, it doesn’t.

Finally, there was a patient with a chronic toothache. He tried taking some Vicodin that he had in a cabinet, but it didn’t taste right and, more importantly, it didn’t work. Then he looked at the bottle and it was a year out of date. And he stored the bottle above his refrigerator, so the heat probably degraded the medication even more. So he dumped the rest of the bottle into the toilet and flushed them. He needs another prescription to replace those pills. And he didn’t bring the bottle, either. He threw that out.
First of all, medications don’t all turn into arsenic the millisecond after their expiration date. Few medications lose much potency after expiration, either. See WSJ article here (full text here).
More importantly, most states have a database that tracks when patients fill prescriptions for controlled substances. Presenting with a history like this doesn’t affect the tendency for a doctor to look up your name on the state database. Really, it doesn’t.
It does make things a little uncomfortable when a patient hasn’t filled an opiate prescription for more than a year and I show them a printout that they have filled five opiate prescriptions from different doctors in the past month.
What? Wait. Where are you going? Why are you leaving? I was going to write you a prescription for Motrin … or Klonopin.

This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

Healthcare Update — 12-05-2011

Monday, December 5th, 2011

Also see more medical news from around the web over at the Satellite Edition of this week’s update at ER Stories.

Whooping cough resurgence in New York. More than double the number of cases than occurred in the next-largest outbreak in 2006.
I renew my assertion that vaccinations should not be mandatory, but that parents who fail to vaccinate their children should be charged with endangering the welfare of a child and should incur civil liability if their children contract preventable communicable diseases or transmit those diseases to others.

Now from the “how else can we justify our existence” department. JCAHO is considering whether to regulate “overuse” of health care treatments, procedures, and tests. That’s right, boys and girls, soon the clipboard brigade will descend upon hospitals and start throwing out citations if too many CT scans or surgeries are performed.
You’ll have to click on the “read more” link at the above site to read about it. I avoided pasting into the story the unique URL that the link generates.
That got me thinking. When is someone going to do a study showing how JCAHO is a threat to patient safety?

Patients gone wild. Illinois man gets a twofer. First he’s arrested for breaking a car door at a bowling alley parking lot. Then he is arrested again after going to the emergency department and attempting to punch out a female emergency physician, hitting her in the ribs.

Who are you freaks and what did you do with Bullwinkle? Flying squirrel gets loose in emergency department, repeatedly jumps from light head-on into glass window.
In other news, PETA is now considering whether to pursue an EMTALA action against the hospital for failing to perform a proper screening exam before releasing the animal into the wild.
And in still other news, JCAHO is considering whether to declare glass windows a threat to patient safety because patients *could* make the same mistake and run head-on into glass, killing or seriously injuring themselves.
Hat tip to hashmd for the story.

(more…)

Dear Diary

Saturday, December 3rd, 2011

This week was rather rough.

Things in the ol’ emergency department have been busy lately. Lots of people seem to have minor problems that don’t need “emergency” care, but they have nowhere else to turn. I’ve had several patients come in just asking for medicine refills or asking to have their medications switched to something on WalMart’s $4 list. Kind of a difficult position to be in. On one hand, several people have a sentiment not to “feed the bears” because then the “bears” will keep coming back for more prescriptions. On the other hand, what are the patients supposed to do? Sometimes, I wish we could put legislators into the shoes of these patients.

Got behind in some work I needed to do because of emergency department shifts. Planned to catch up on everything yesterday. Woke up and had to drive two kids to school because they missed the bus. Then got home and the house smelled like someone hadn’t flushed the toilet. Went to check the toilets and they were clean. Then went to the basement to check the toilet. Someone had flushed. Unfortunately, the pump in the ejector pit had burned out, causing toilet contents to back up into the basement. Oh, and as a cherry on the top of this sewage sundae, someone also threw out a half-eaten apple in the bathroom garbage can. That apple had turned brown, had partially liquefied, and the non-liquefied portion had grown a white beard. I was going to post a picture, but between the smell in the basement and the looks of that apple, I damn near barfed.
Fortunately, I had a hand pump that I purchased a few months ago the last time that the ejector pump failed. I was able to pump about three gallons of sewage out of the pit and then the ever expanding smelly puddle started to recede.
Removed the old pump. Went to Home Depot to get a new pump and some PVC pipe. Got home. Damn. Forgot a plastic connector to reattach the pump to the sewer line. Drove all the way back to Home Depot for a 83 cent piece of plastic. Bought two of them just in case. Got home and got the new pump installed and working. Took most of the day to do all the cleaning and disinfecting.
So much for getting work done.
Oh, and if one more person says anything similar to “sh*t happens” and then laughs about it thinking they’re witty, they’ll be coughing up teeth … or maybe coughing up a brown bearded apple. I think I’m going to put that into a garbage can in the garage and see if it grows into a Tim Burton character.

The two youngest girls finally got to be in their stage play. They happened to be the best two performers in the show – not that I’m biased or anything. It did my heart good watching them enjoy themselves on stage … all three shows.

Oldest daughter is still having trouble with the bullies at school. In the past few weeks, not only have they gotten her last friend to turn on her, they also spread rumors about a teacher who has been helping her and now the teacher had to go to a private school board meeting to defend herself. I get frustrated watching her get depressed, but I also let her know we’re all there for her. May be filing legal papers against these miscreants.

Son goes to his first wrestling tournament tomorrow. He’s nervous because he gained 5 pounds from last year. Still, he can do 75 pull-ups and 100 pushups a night, so I think he’s ready to put some shoulders to the mat.

While decorating for Christmas, found out that the puppy doesn’t like any type of Christmas decorations. Stuffed animals are violently unstuffed. Garland vomit spots are in several areas of the house.

Found out I’m probably going to need more surgery. Running out of things to cut on in this body. Sucks getting old.

My wife and I try to go out of our way to help others. Over the past month, we both helped a family whose mother was dying from cancer. My wife went to their home and did home medical visits. I helped them fill out medical paperwork and power of attorney papers. The patient died this past week. We got a wonderful thank you note from the family. Totally unexpected, but much appreciated. Little things like that make such a big difference in our lives.

Finally, we went to our kid’s school for a Santa Workshop today. Kids go around to a bunch of tables and pick out all kinds of “low priced” gifts that they can wrap and give to their family members. Low price as in $10 for ratty stuffed animals or cheap costume jewelry. It was like an overpriced rummage sale. And it kind of ticked me off because it had a table just for gifts to “aunts and uncles” with $6 plastic screwdrivers that say “greatest uncle” and $8 ratty reminder boards that say “greatest aunt” on them. All the kids felt obligated to purchase gifts for everyone. Did get to have a lot of fun wrapping everything, though. Not one of them can keep a secret, either. My wife knew all of her gifts within about 10 minutes of our arrival home.

Gotta go, diary. Weigh-ins end at 7AM tomorrow morning, which means I’ll need to stop for an extra large coffee before we get on the road.

 

Revenge Best Served with Hot Lead

Friday, December 2nd, 2011

A young guy gets brought in with a non-life-threatening gunshot wound to his arm.

The police were called and the patient had no idea who shot him.

After the police left, the patient admitted that his own friend shot him. He was sent home that night.

Not 45 minutes after my shift started the next day, the patient’s “friend” comes in with a GSW to the leg.

Guess who the perp was.

Can’t you just smell Jack Daniels and hear someone yelling “How do YOU like it” in the background?

 

This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

Meet Babs Bunny

Thursday, December 1st, 2011

A dad brought his 15 year old daughter in because she had missed her menstrual period the past week. He kept her home from school for three days because he wanted to see if the period had just decided to show up late.

Alas, after 5 extra days, no period was forthcoming.

The young girl’s pregnancy test was …. positive.

When the nurse told the father that his daughter was pregnant, he wigged out.

“You mean she’s having a baby NOW!?!?”

No, sir, the gestation in humans is 9 months not 35 days. You’re thinking of rabbits.

This and all posts about patients may be my experiences or may be submitted by readers for publication here. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

 

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