WhiteCoat

Do Something!

They waited patiently while the emergency department staff was stabilizing several patients who had been involved in a motor vehicle accident.
“We’ll be with you as soon as we can.”

They waited patiently while the emergency department staff tended to the hypotensive nursing home patient, but were loudly telling everyone how the nursing home patient “got there after they did.”
“You’re next in line.”

When another ambulance rolled through the doors with a chest pain patient, they had enough and began demanding that their daughter be seen NOW.
So after the chest patient’s EKG was reviewed and showed neither signs of ischemia or sepsis, the doctor went into the room.

A rotund 9 year old was playing Angry Birds on her iPhone.
“What brought you here today?” the doctor asked.
“We just finished our meal at Burger King, were walking out to our car, and she got a stomach ache. When she sat down in the car, lights flashed before her eyes and she thought she was going to die, so we brought her here.”

Now the child’s vital signs were normal, which meant that she probably had two of the criteria for sepsis according to NY Times reporter Jim Dwyer’s logic (with NY Times editor Jill Abramson’s approval). It also looked like she had a pimple on her forehead, which caused a “suspicion” of a superficial skin “infection,” so according to Jim Dwyer’s logic, the medical staff should have put her into a sepsis pathway and drawn a lactate level and other labs, probably admitted her overnight, and started triple antibiotic therapy.

But, using his clinical judgment, the doctor did not perform any lab tests and examined the patient.
Symptoms gone.
Eyes normal. Visual acuity normal.
In fact, her whole examination was normal … except for the pimple, of course.

So, without so much as a blood glucose level, the patient was discharged with instructions to follow up with their family physician and/or an ophthalmologist if she continued to experience the light flashes and to return if any further problems occurred.

Ten minutes later, the family was back at the registration desk.

“She saw another flash of light in the parking lot and thought she was going to die again. AND THIS TIME THE DOCTOR BETTER DO SOMETHING!”
The patient’s vital signs were still normal, meaning that she met two criteria for sepsis under Jim Dwyer’s logic, and she still had that glaring pimple on her forehead. But she wasn’t seeing lights any more and her visions of death had subsided.
“We’ll get you into an examination room as soon as we can. Right now all the rooms are full.”
“WHAAAAT!?! We have to wait AGAIN!?!?”
“Unfortunately, all of the rooms are full. We’ll get you back into a room as soon as we can.”
“F___ THIS! We’re going somewhere else.”

And with that, the patient and her family left.

Patient and family were doing well the following day during their call to administration to complain about the lack of care and lack of blood testing during their visits to the emergency department.

———————–

This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.

5 Responses to “Do Something!”

  1. Chester T. says:

    I think we can drop this thing with Jim Dwyer.

    Also, did the parents think that maybe the child’s flashes were from her inadvertently looking at the SUN?

  2. TrueMD says:

    If we can somehow convince the public, our “customers,” that our 12 post-secondary education years are infact a little more authoritative than their “satisfaction;” maybe, just maybe the gauge of how good a physician is would turn from rating their “satisfaction” to rating their “understanding.” However, in the case presented here, I doubt any “understanding” would have ever been reached, as the parents are obviously not looking to understand, but to be treated as royalty. Another fall-out of consumerism adapted to rating of healthcare providers. Performance indeed.

    • Matt says:

      This is absolutely true. Of course, since 1) they don’t pay you; and 2) they have no way of differentiating you in terms of your skills; and 3) since you’re all paid pretty much the same regardless of skills, is it any wonder the public doesn’t value you since you don’t value yourselves?

      If people wanted to be treated as royalty, have the physician spend umpteen hours with them, then they ought to be billed by the hour for that. Obviously law and medicine are different, but I’ve found my clients who pay by the hour are much less verbose and demanding of my time when it costs them. Flat fee clients feel free to call any time. (The trick is learning how to price appropriately)

      And if Obamacare happens, you’re all looking at significant cuts in what you ARE paid.

      • defendUSA says:

        Matt…

        You are stating the obvious about docs being underpaid with O’care. And if a doc is willing to practice despite this, then I guess the damn government better ante up with more regs, hmm, because everything and anything will already be under scrutiny. O’care is an effing disaster.

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