I’m not sure if I’ve had a stroke and am slurring my speech or if the Dragon NaturallySpeaking voice recognition engine is just messing with me, but lately I’ve had to triple check my charts to make sure some bad transcriptions don’t get finalized into the record.
Earlier this month, I tweeted about one case where part of my discharge instructions to a patient suffering from GERD symptoms included: “Bland Diet.”
The Dragon NaturallySpeaking program translated that to: “Plan to die”.I could only imagine those instructions hitting the front page of our local newspaper if I hadn’t caught them.
The latest Dragonism was during a recent physical exam of a patient who fell.
He fell down some stairs and injured his ankle. I examined the rest of his body to make sure that there were no other injuries.
I dictated: “Left lower extremity with no pain to the hip or knee …”
Dragon transcribed: “Unfortunately with no pain to the hip or knee …”
Another one that probably wouldn’t look too good while blown up on a courtroom exhibit or in front of a state medical board.
Not quite a case medical student’s disease, but close. Have to love it.
The thing is that when I was a medical student, there wasn’t an internet and there definitely wasn’t a Dr. Google. So we were a lot more stressed out because we had to rely on the advice of our professors – who weren’t always that well versed in the diseases.
Stool impactions probably aren’t what most people would consider an “emergency” … until they actually have a stool impaction. Personally, I wouldn’t wish a stool impaction on someone. In chronic constipation, more and more stool collects in the colon until size of the ball of stool is too big to pass through the opening to the outside world. The major function of the colon is to absorb water from the stool, so the longer the stool sits in the colon, the larger the amount of water that gets absorbed, and the harder the blob of stool gets. By the way – the whole water absorbing function of the colon is why it is important to keep well hydrated to maintain good bowel habits.
There are a lot of ways that you can try to get rid of a stool impaction, but when the stool gets hard enough, pretty much the only way to remove the impaction is by having someone use their fingers to perform a “disimpaction.” There’s just no good way to get a big hunk of stool the consistency of clay soft enough for it to pass through the rectum. It has to be dug out.
Disimpactions aren’t fun for the doctor or the patient. They’re painful and obviously messy. I’m probably more willing than most docs to perform disimpactions because I can see how much the patients are suffering. Although unpleasant, disimpactions are an easy fix to the patients’ problem. Like I said, you probably can’t appreciate how bad impactions are until you’ve been on the other side of the gloved finger.
As I donned my mask, gown, and multiple layers of gloves to commence the procedure on one patient, one of the nurses sent a nursing student in the room with me to observe. The student said that she had seen “many” disimpactions in the past, but the nurse wanted her to observe this one, so she reluctantly came in the room with me.
One of our registration clerks thinks she’s pretty slick.
We play little practical jokes on each other every once in a while. One day she’ll unplug the keyboard to my computer when I’m in a room with a patient. I’ll come out to try to enter orders and start pounding the keyboard. Another day I’ll squirt a syringe of saline onto her chair so her butt gets wet when she sits down. And on and on and on.
Recently, she tried to scare me. My desk sits across the station from hers and my back is to her. She thinks I can’t see her, but I can see everything that goes on behind me by the reflection off of the x-ray computer screen. While I was looking at an old chart on the screen, I saw her get up out of her desk, put her finger up to her lips to tell everyone to be quiet, and try to sneak up behind me. She was trying to tip-toe, but I could hear her little clown sneakers squeak as she walked. When she got close enough to me, she dug her fingers into my sides and yelled. I saw it all coming.
I acted like I was sleeping and I stretched my arms up in the air, yawning.
[Yawwwwwwn] “Is it time for me to go home already?”
“You think you’re funny, don’t you WhiteCoat? Just wait. I’ll get you yet.”
When my shift was over, I decided to make a pre-emptive strike.
The registration clerk sits in a little cubby hole of sorts. There’s a line of several windows – one for each registration clerk – with a ledge and two chairs in front of each one. There’s a wall right next to the window where she was sitting. The clerks can’t see around the wall from that seat, so there is a mirror across the hall that the clerks use to see if patients are coming. Due to several slow nights at work, we discovered that shadows in the waiting room created a few blind spots in the mirror.
I said goodnight to everyone, got my coat on, and acted like I was leaving for the night.
I waited a few minutes and watched the clerk in the mirror. Soon she settled into reading a book on her Kindle which she rests on the computer keyboard.
I then pulled my hood over my face, ran up to her window, slammed one of my hands on the desk and in the best Jacob Marley voice I could muster, I yelled “Hellllp!” Then I fell over onto one of the chairs and fell on the floor.
The clerk jumped out of her skin, then screamed.
“Aaaaaah! Where the hell did you come from?!?! Aaaaaaahhhh Get a nurrrrrrse Get a dooooctorrrrrr!”
There were a couple seconds of silence, then her little head poked through the open window over the ledge to look at me on the floor.
I was laughing so hard I had trouble catching my breath.
“Damn you, WhiteCoat! You just made me wet myself.”
And I didn’t even need a syringe of saline to do it.
Courtesy of Mednificent Comics. Lots of funny comics about med school over there.
Of course now that I’ve linked to the site, I won’t be able to re-post any of her other comics. Well … maybe a few.
P.S. For those of you who don’t know what “medical” clubbing is, click here.
I was taking a history on a patient, and, in order to receive appropriate compensation from the government, one of the things that doctors are required to ask about (regardless of whether it has any impact on the patient’s condition or care) is a patient’s social history.
“Do you smoke?”
“Do you drink alcohol?”
“A little … once in a while.”
At that point, the patient’s wife interrupted. “Sam, be truthful now.”
Then to me, the wife says “Doctor, he has two or three drinks every day.”
The patient got irritated and yells “Marge, will you shut up? For Christsakes! I used to spill more than that when I was younger.”
Then I was talking to one of the maxillofacial surgeons about a patient in his 20s with a tooth abscess that had progressed to Ludwig’s Angina. The surgeon was apparently frustrated because he had recently been taking care of multiple patients with the same diagnosis.
“His airway looks good, but he’ll need to be admitted for IV antibiotics.”
“Let me guess, the guy has about 10 teeth left in his mouth.”
“More than that, but they’re not in very good shape.”
“When are people going to learn that we’re not sharks? Our teeth don’t spontaneously regrow! Toothbrushes, people! Toothbrushes!”
“And floss, too.”
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.
My wife and I don’t watch TV that much. Maybe the news in the evening and that’s about it.
Our kids, on the other hand, not only watch TV, but they download video clips on their iPods.
Daughter WhiteCoat showed us this excerpt from Family Guy where Peter gets all buzzed up on Red Bull. If the video below gets pulled down, just do a search on YouTube for “Family Guy Red Bull.” I have to admit that it made both my wife and me laugh pretty hard.
The problem was that our daughter was laughing at one part and we couldn’t figure out why it was *that* funny. In the clip, Peter starts milking a cow, then milks the cow too fast and the cow’s udders catch on fire. The cow runs away. A few seconds later, Peter’s son comes running through the screen with his crotch on fire. We were sitting there thinking “Did he just ride the cow and catch on fire, too?” “Did the cow come and attack him?” So we asked Daughter WhiteCoat why she thought it was so funny.
“Umm … because the Red Bull made things catch on fire when you pulled on them too fast … duh!”
Here I was thinking I had to have the “sex talk” with my daughter and she’s the one schooling me.
As more and more state databases come on line, those “patients” who feign pain seeking narcotic pain medications are finding it more and more difficult to find prescribers willing to oblige them. As a result, the patients are adapting by suffering acute injuries for which they need immediate narcotic pain medications to relieve their suffering.
Reality check: One or two falls is one thing. When you call around to other hospitals and to the physicians listed on the state databases and find that the patient has “fallen” a half dozen times in the past 10 days, it is quite another.
One such unsteady patient was brought by ambulance after falling on the ice. His feet slipped out from under him and he fell flat on his back “like one of those Dudley Doo-Right cartoons.” At least his description was colorful.
When the paramedics arrived on the scene, he gave them a hard time. First mistake. Dropping F-bombs, yelling at them, telling them he was hurt all over and not to move him. Well, they decided to look for injuries in the field, and in doing so cut off his clothing – including his down coat.
When he arrived, it looked like the Incredible Hulk had been attacked by Angry Birds. There was a trail of goose down wafting to the floor as the stretcher was wheeled into a room.
Immediately, the patient began demanding pain medication for his 10 out of 10 pain all over. He stated that he could not move because the pain was so severe. We stated that we needed to assess him for injuries, first. He then threatened to leave the hospital. We told him that was his choice, but he would have to sign out against medical advice. Then he said that his pain was too severe for him to move. He settled on repeatedly demanding that we call the ambulance back to take him to the hospital across town. Sorry, sir, but that isn’t happening.
We dutifully began trying to undress him when then the emergency department tech came into the room and asked with a smirk …
That comment must have triggered a release of endorphins from the patient’s pituitary gland. Suddenly he sat up in bed with rage in his eyes.
“F–k YOU!” The patient yelled.
The tech then walked back out of the room and could be heard down the hall asking …
Yet another release of endorphins. The patient was suddenly able to get up off the cart and rip off his cervical collar. Seeing that he was able to spread goose down with each and every movement of his arms, the patient then stormed out of the emergency department cursing, shrugging his shoulders, and flapping his arms as if he were a reincarnation of some extinct dodo bird attempting his virgin flight. I have to admit that I was laughing while watching him walk out the door flapping his arms. You can’t appreciate it without seeing it.
The nursing supervisor happened to witness the patient’s display and his miraculous recovery from whole body pain so severe that he couldn’t move merely minutes before.
She casually turned to one of the nurses at the desk and asked …