WhiteCoat

Archive for the ‘Random Thoughts’ Category

Dragonisms

Sunday, June 30th, 2013

Surprised Morguefile.comI’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.

I suppose typing has its advantages sometimes.

 

I Can Hear You …

Wednesday, June 5th, 2013

EarI  think I’ve discovered what elderly patients feel like when everyone thinks that they’re too senile to understand the conversations around them and just talk about them as if they aren’t there. Like this …

In one emergency department, the nurses regularly talk about me in loud voices as if I’m either deaf or unable to comprehend.

Nurse 1 [to the ceiling]: This patient’s been ready to go for 6 milliseconds. Where are the discharge papers?
Nurse 2 [loudly, standing 3 feet behind me]: I don’t know. He’s still charting on the patient. I’m not sure why he can’t just print up the prescriptions and discharge instructions now and chart later.
Of course, the charting system doesn’t allow the nurses to print discharge instructions until the doctor finalizes the chart, but that’s only been the case for 4 years.

or

Nurse 1 [walking up to the desk directly in front of me]: Hey, has Dr. Whitecoat put in the admission orders on this patient yet?
Nurse 2 [standing right next to me and watching me enter the admission orders]: I think he’s trying. He’s not very good with computers, you know.

or

Nurse 1 [loudly behind me]: The patient down the hall and around the corner looks like he whimpered in pain like a minute ago. Is Dr. Whitecoat being stingy with the pain medications on your patients, too?
Nurse 2: Not yet
Dr. WhiteCoat [in crackly old voice]: Meeehhhhh. Can someone change my undergarments?

Both nurses then look at each other with furrowed brows, look at me strangely, and leave the nurse’s station.

Was someone talking about me?

Dear Diary

Friday, April 12th, 2013

VarmintSo much to rant about today.

The girls are doing a dance competition this weekend. I’m trapped in my own little version of Dance Moms. Aaaaauuuuuggghhh. Somebody help me. One daughter complains because she’s in the back of one dance the whole time. Another daughter is upset because people are mad at her because she’s in front during one of her dances. Glitter is all over our fricking kitchen and it doesn’t come up with wet wipes, either. We have to purchase hair extensions with curls for $25 for the girls, and we have to make SURE to purchase the color that most closely matches the girl’s hair. We can’t just curl the girls’ hair because judges can apparently tell the difference between real curled hair and fake curled hair and that makes a difference on how they grade the performance. Sounds like a Joint Commission inspection.
I just keep thinking that they couldn’t pay me enough to participate in a reality show based on this crap.

Junior WhiteCoat is ramping up lacrosse season. He’s loving it. Playing in a huge tournament at Notre Dame next weekend. Junior was also one of the main characters in a movie that won first place and multiple other awards at an indie film festival last week. He’s now getting requests for auditions with some bigger movies. Hear that, Adam Sandler? Pick him and your movie could grace the pages of WhiteCoat’s Call Room.

On the doggie chew list for the past week include a Jenga block, a decorative pillow from the couch, a garbage can in the office, the leg from a “Monster High” doll (since when did it become cool for young girls to go from modeling themselves after Barbies to modeling themselves after zombie high school kids, anyway?), and the middle of her doggie bed. The last one is most interesting. You see, she’s chewed half of the inside out of her own bed and now she no longer wants to sleep on the bed. So when it gets dark out, she runs upstairs to the bedroom and lays on the other dog’s bed before he gets there. That means that the innocent dog is stuck sleeping on a disaster of a dog bed that he had no part in creating. After the first couple of times that happened, I started moving the doggie garbage disposal off the good bed and letting our other dog lay on his bed. By the morning, though, there was more foam filling sitting on the floor, Chewmeister was laying on the good bed, and our other dog was laying on the floor. I’m getting to the point that I’m going to start making little Chewy sleep in a cage … on her own frigged up bed.
Then I thought to myself … those beds are a lot like, say California and Texas right about now. (more…)

Unnecessary Testing?

Thursday, April 4th, 2013

A patient was sent to the emergency department to have an ultrasound of her uterus performed.

She had been having abnormal bleeding which coincided with about the time her period was due – only it was a little heavier and lasted a little longer than usual. She decided the best course of action would be to make an emergency appointment with the gynecologist. She was seen the day before she was sent to the ED and the gynecologist performed an ultrasound in his office … which was normal.

The patient called the gynecologist the following day and said that the bleeding was still there, so the gynecologist told her to go to the emergency department for another ultrasound and some blood testing.

The patient arrived stating “I’m here for my ultrasound. Dr. Speculum sent me.” Since patients need orders for testing to be performed, the patient was given the choice of waiting to be seen in the ED or of getting a prescription from her doctor for the exam. She chose the former.

After examining her, we performed a pregnancy test which was negative and a CBC which was normal. So I told the patient she was likely just having a heavy period and that she could follow up with her gynecologist as an outpatient.
The patient demanded an ultrasound. After all, Dr. Speculum sent her to the ED specifically to have an ultrasound done.

So I called Dr. Speculum.

“Hey, it’s WhiteCoat here. Your patient is here with metrorrhagia and I’m trying to discharge her, but she insists that you want her pelvic ultrasound repeated.”
“Yeah. Can you do it?”
“Well what are we doing it to look for?”
“Fibroids”
“OK, well if she does have fibroids, are you going to admit her? Her hemoglobin is fine.”
“Noooooo. Discharge her after the ultrasound.”
“So then why … nevermind. If all you’re looking for is fibroids, weren’t you able to see that she didn’t have any fibroids on the ultrasound you did on her in the office yesterday?”
He must have really wanted that ultrasound by his response.
“Naaaaaaah. The ultrasounds I do in my office aren’t accurate.”
Allrightey, then.

The repeat ultrasound was still normal. I guess he was more accurate than he gave himself credit for.

Wonder if she’ll be referred back to the ED tomorrow for repeat pregnancy testing.

———————–

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.

Dear Diary

Sunday, March 31st, 2013

My gosh. I actually get angst when I haven’t posted for a few days.
Actually, I have angst for other reasons, but not posting just adds to the angst.

So what’s been happening lately?

First, the poor WhiteCoat children are having trying times in their love lives.
Oldest daughter WhiteCoat found out from a member of her track team that her boyfriend of 6 months was cheating on her. Another member of her track team was apparently going around and telling everyone that she had a “secret boyfriend” and was also telling everyone the sordid details of the interactions she was having with her “secret boyfriend.” So daughter WhiteCoat dumped Mr. Two-Timer. Mrs. WhiteCoat called his parents to let them know what was up. Papa Two Time said that he didn’t know what we were so upset about because the other woman “pushed herself” on Daughter WhiteCoat’s ex and that the other woman was a “two bit whore” anyway. I’m kind of thinking that this breakup was a good thing.
The next day, Junior WhiteCoat’s girlfriend texts him and says she “wants to be single.” The text gets posted to Instagram. Then about 60 comments later, there are accusations flying back and forth that she’s been dating someone else and that he deserves better. When I was 12 years old, I was climbing up trees with a bag of tomatoes and tossing them at cars. Now my kid is 12 and he’s in need of relationship counseling.

Health hasn’t been great lately. Pretty much every person in the family has had vomicking and/or diarrhea in the past week. Zofran is our friend. But it gets a little frustrating when you’re working in the ED and patients who puked once or who have had a couple of loose stools want work notes to be off for the rest of the week.
Got kind of a kick out of one patient walking into the emergency department as I was leaving work. He was heading toward his car in the parking lot and I saw him suddenly turn around and head back toward the hospital. He was walking like he had a load in his pants. He gets closer to me and he starts shaking his head.
“Ya try to do the right thing and what happens? It bites you in the ass. I’m holding in my gas in the ER and I waited until I get outside to pass it … then I crapped my drawers.”
He did have a load in his pants.
Although if he passed gas in the ED, it probably would have been just as embarrassing.

Grandma and Grandpa WhiteCoat have been having issues. Their health has deteriorated to the point that they were unable to stay independent, so they moved in with my brother. The only problem is that Grandma WhiteCoat has a few cats … like 10 … and that Grandpa WhiteCoat has a book collection … like about 30,000 … all in boxes. He also has a good thousand or so small plastic boxes of pictures that he has taken through the years. All categorized, but none of them ever seen by anyone but the person at the photo lab who initially developed them. And if you want to look at one of them, you can’t take it out of the house because you may copy it and the pictures are copyrighted. Fortunately, he converted to digital pictures about 7-8 years ago, so now it’s just a matter of storage on his computer drive and no additional plastic boxes. But then he sends pictures to you and the pictures have copyright marks all over them.
Well things came to a head when the grandparents wanted to move their things into my brother’s house. My brother had a bad experience with a cat and a muzzle loader once and doesn’t really want any cats near his house. There was a lot of arguing and hand wringing. Finally, Grandma WhiteCoat talked a friend of hers into keeping the cats in her basement. Grandpa WhiteCoat is upset because he has to rent out a storage facility to keep his prized book collection and all of his pictures.
I get caught in the middle with all of the phone calls. Brother WhiteCoat is at his wit’s end. Grandma WhiteCoat says that the cats are the only thing in her life that keeps her happy and that Brother WhiteCoat is just trying to keep her from being happy. Grandpa WhiteCoat just walks around the house in his tighty whities (which are reportedly still white but not quite as tight in certain places) complaining about how these schlubbs at the storage facility better not ruin his book collection.
If you ever wondered whether your family was dysfunctional, it isn’t. Trust me.

The biggest source of my angst lately is a change for me. I’m changing my blog site. I registered a new site at DrWhiteCoat.com and have been working to get it up and running for months. Over the past week, I put a lot of my non-ED time into trying to finish it and it’s almost there. But that was at the expense of posting. As a result, I have a stack of notes on my desk about all the things I want to write about. Literally. There are 11 pieces of paper. Several of them have more than one topic on them. So I’ve got a lot of writing to do.
I’m not leaving EP Monthly, but I’m planning to expand this blog beyond just emergency medicine and I don’t want to keep straying from EP Monthly’s mission, so I’m going to split my time between the sites.
I want to try to do a more regular posting of Healthcare Updates perhaps 3-4 days a week rather than doing them once a week. I don’t like pushing out stale news.
Also planning to do a hospital administrator/hospital rating page within the site – a health care worker satisfaction page. Still need to come up with some cash for that project, but it is already planned out and I obtained a list of all the hospitals in the US to populate the site.
Planning to write some more articles with information to help patients.
Also planning to reincarnate Grand Rounds. Creating a separate page just to promote other medical blog posts.
And I’ve got a few guests who are going to help me with the blogging.
Hoping that it will be a win-win-win for readers, EP Monthly, and me. One way or another the site will be up this week. If you want to be notified when it is up and running, click over to the site and enter your e-mail – you’ll get a notification when there’s new material.

The past couple of days have been spent hanging out with family. Lots of the Rock kind of things. After the kids got sugared up on Peeps and jelly beans, we went out to the park and flew kites. Then we came back, had a great dinner and laughed. Mrs. WhiteCoat opened a bottle of wine, and we are getting ready to watch a movie.

Now I’ve at least gotten my blogging fix and am not in need of intravenous benzodiazepines.

Time to go have a glass of wine and relax.

Back to blogging as usual in the morning.

Grand Rounds Snoop Dog Style

Sunday, March 24th, 2013

I happened to catch on Twitter a web site where people could search up their Twitter names and get their tweets translated into gangsta talk. Probably not something you should read at work or in church, tho … yo.

So I tried it with some other sites. I can’t decide which is more amusing.

A newspaper story about a crime?

A court opinion?

A medical article?

Press Ganey’s web site? Note at the bottom of the page the type of “Regionizzle Symposium” they have in 2013.

Or a WhiteCoat post?

Wanna be an instant YouTube sensation? Have someone video you doing a grand rounds translated by Gizoogle.

Legislative Comparison

Wednesday, March 20th, 2013

Another factoid about the UnAffordable Care Act sparked by an e-mail link from DefendUSA (thanks!).

Number of pages in the document that formed the basis for creating our nation: FOUR. Well, five if you include the Bill of Rights

Number of pages in the document that purports to provide affordable “care” for everyone by requiring that people have “insurance” (which likely won’t be accepted by many medical personnel providing care), increasing the costs to purchase said insurance, encouraging companies to reduce their workforces so they don’t have to provide such insurance, and imposing taxes on people if they don’t purchase said insurance from third parties: 20,000 and counting according to Senator Mitch McConnell

UnAffordable Care ActUS Constitution

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Cavity Pain

Tuesday, March 19th, 2013

oxycodoneYou’ll probably consider this post non-medical, but I consider it a discussion of anatomy which IS medical.

A New York newspaper article caught my eye. Two New York City miscreants were arrested for drug trafficking. Big deal, right?

The thing that caught my eye was how police found the drugs, the amount of drugs, and where the drugs were located.

First, Ebony Howard and William Waters need to choose their friends better because someone narcked on them.

OK stop there. English majors … what is the proper spelling of “narcked”? “Traffic” adds a “k” to make it “trafficking” (see above). Does “narc” add a “k” to make it “narcked”? Doesn’t look right. Should it be “narced”? That doesn’t look right, either. Or should I just change it to “tattled”? The American Heritage Dictionary doesn’t help much. It only contains the definition of a “narc” being a law enforcement officer who deals with narcotics violations. Now I am getting off track.

So Ebony and William travel to the quaint little Upstate New York town of Waterville to see the sights. But police arrested the couple as they filled up at a Waterville gas station based on a tip that the couple would be traveling to the town to deal drugs.

When police searched the couple, they found 645 oxycodone pills with a street value of $20,000 … packed in to Ms. Howard’s body cavities.

I thought about this. I have a bottle of 500 Tylenol pills that is pretty full and it measures 3 inches in diameter and 5 inches in height. Think of two tennis balls next to each other. I’m having trouble imagining how it would be comfortable taking a several hour car trip and then walking around a gas station with more than two tennis balls worth of contraband in one’s body cavities.

Then there’s the value of the pills. One can get 30mg oxycodone pills (I’m presuming that was the strength of the pills found in Ms. Howard’s cavities) at a pharmacy for about $6 each. According to police reports, the street value of the pills is more than $30 each. Even if someone faking pain in the ED only received 20 Oxys from the visit and then sells the pills, that’s a $500 profit in a few hours — a lot more than most doctors make.

Finally, there’s the manner in which the drugs were found. I need some help from police officers here. If one’s friend is found with a small amount of marijuana and another unknown substance (assumed to be ecstasy) on his person, does that give police sufficient cause to perform a pelvic exam and rectal exam on everyone in the same vehicle?

I’m not condoning what these people did, but just thinking that if police can do body cavity searches based upon an anonymous tip and some drugs found on a traveling companion, “SWATTING” is soon going to take a back seat to “NARCKING” … or “NARCING” – however the hell you spell it.

High School Science Class Fail

Wednesday, March 6th, 2013

Daughter WhiteCoat doesn’t have the stomach for her science class.

They were dissecting a sheep heart in her class not too long ago and she was becoming increasingly queasy. Apparently the sheep had been recently slaughtered because she said that there was still blood in the heart. She was more skeeved because the science teacher was manipulating and dissecting the muscle without using gloves.

She went up to the table where the dissection was taking place, but had to leave the class at one point because she thought she was going to throw up. Mrs. WhiteCoat and I? We can watch surgery while eating a plate of spaghetti and meatballs. Or eggs and sausage.

After the class, several “concerned” classmates came up to my daughter. Instead of consoling her, they said “Eeeeewwww. You have heart juice on your sleeve” or “Gross. There’s heart juice on your notebook.”

Heart juice?

Heart juice?

What the hell is heart juice? It’s called “blood” people. You all fricking fail.

I gave her a bottle of disappearing ink and told her to squirt it on those people’s notebooks, saying that they had crab heart juice on their notebooks (yes, horseshoe crab blood is blue and it contributes to modern medicine), but she wouldn’t do it.

Can’t wait for them to start discussing reproductive system. I’m going to have to send the teacher some smelling salts for use on my daughter.

Dear Diary

Sunday, March 3rd, 2013

Lets see. What’s new recently?

Wrestling is officially over for the year. I happened to be the “trainer” for junior’s regional wrestling meet. Was busy most of the day. It seems as if the coaches give kids Coumadin before the meets. I haven’t seen so many nosebleeds in a long time … except maybe last year when I was the “trainer” for a wrestling meet. Not only nosebleeds, but there were also head injuries, an eye injury, and a broken arm. Nothing some 3 inch tape and gauze pads can’t handle, though.

During the match, I had a firsthand experience of why the UnAffordable Care Act isn’t going to help as much as many people believe. Again, it boils down to the fact that healthcare insurance doesn’t equal healthcare access.
A dad walked into the meet and from a distance I could tell he was having difficulty breathing. He was stopping every so often while he was walking so that he could lean on the wall or sit down and catch his breath. He made his way over to me and asked for a favor. Could I write him a prescription for ciprofloxacin? He had these same symptoms with pneumonia in the past and that is what his doctor prescribed to clear it up. This dad is a great guy, but he doesn’t live the healthiest lifestyle. He smokes. He’s heavy. He drinks quite a bit. I also knew from previous discussions that he had a history of anemia. There were literally 10 diseases that popped into my head that could have been causing his trouble breathing – besides pneumonia.
“You really have to go to the hospital. You need blood work and a chest x-ray, not a prescription for antibiotics. Besides, even if this is pneumonia, ciprofloxacin probably isn’t going to help. And if the pneumonia is bad enough to be causing you trouble breathing, you’ll need to be admitted anyway. This is serious.”
“I can’t afford it. The doctor’s visit will be $75, the chest x-ray will be $250, and my insurance won’t pay for any of it. I am having trouble paying my bills as it is.”
“But this is your life. I would rather see you have to pay a couple extra bills and be around for your kids.”
“I’ll be okay.”
I kept an eye on him during the meet, and he ended up leaving early.
I even texted him later in the day. He wrote back that he was okay as long as he was laying on the couch. I told them that I could call some people at the hospital to see if we could get him discounted testing performed. He said that he still couldn’t afford it.
I hope I don’t read about him in the obituaries.
It just sickens me that our government provides no-cost “insurance” for poverty-stricken people who earn no money, but many of the working poor get nothing but a mandate. If we’re going to make the system better, why can’t the government provide access to health care for everyone?

(more…)

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