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Open Mic Weekend

Saturday, August 13th, 2011

Away for the weekend and into Monday (actually posting this from my phone).
Take over the comments section with any medically-related questions or comments you have.
Just remember — no personal attacks.
Will try to answer any questions on Monday.
Have a great weekend!

Differences in Opinion

Thursday, August 11th, 2011

There’s a relatively new radiologist on staff at our hospital. He and I just don’t seem to see eye-to-eye.

The radiologists like to do real-time readings of xray studies from the emergency department during business hours. Then the radiology tech brings us a report. I tend to look at most of the radiology studies I order regardless of who reads them or when. Many times I have picked up abnormalities that the radiologists have missed … and vice versa.

The new guy doesn’t seem to like the ED physicians very much. Once he called me and berated me for ordering a CT scan of the lumbar spine to rule out a fracture on a patient instead of just doing an MRI. I told him “Fine, change the order.” He couldn’t change the order, though, because he had waited until the CT scan was completed and after he read the study before calling to “discuss” the matter with me. His preliminary interpretations – which are made part of the medical record – include written statements such as “sinus CTs are never an emergency procedure.”

One report I got this week really got me ticked.

A patient comes in with severe dyspnea. She had trouble finishing her sentences without gasping for air. Her blood pressure was good and her heart rate was a little fast. I ordered labs and a portable chest x-ray. I went and looked at the xray and it was fairly normal. Maybe a little CHF, but otherwise good. The report comes back saying “Limited study. Why did you order a portable exam?”

I grabbed the report and walked over to his lair.

Sooo … I got your report. Just wondering … did you examine the patient?
“Did I examine the patient? No.”
“Did you take a history from her?”
“No.”
“Do you know anything about her condition?”
[Cocking his head to the side as if he is now getting annoyed with me] “She’s short of breath.”
“Anything else?”
“No.”
“Then why would you write something like this on the chart?”
He just looked at me.
“Does the reason for a portable film have any bearing whatsoever on your interpretation of the film?”
“Yes. Portable films are more difficult to interpret.”
“Listen to the question. Does the REASON for a portable versus PA/Upright film have any bearing on the interpretation?”
“No.”
“Then please leave the commentary to yourself. OK?”
He just looked at me.
I have him a half smile. “Thanks.”

Next time, I’m going in there with a Rey Mysterio mask on.

 

 

 

 

Google Plus

Tuesday, August 2nd, 2011

The Happy Hospitalist was kind enough to invite me to join Google Plus. I haven’t done much with it yet. but I now have a bunch of invites to give out.

If you don’t have one and you want an invite to Google Plus, drop me an e-mail. whitecoat at epmonthly dot com.

Healthcare Update 07-11-2011

Monday, July 11th, 2011

Wicky sticks making a comeback? Kids ingesting enbalming fluid with marijuana to enhance their “high.” Bad news is that formaldehyde can cause headaches and psychosis and who knows what the hell other symptoms. Remember: The only controlled studies on the effects of formaldehyde on human beings have been on DEAD PEOPLE.

Ten Texas patients called EMS 831 times in a one year time frame. So how do we address EMS frequent flyers? One Texas EMS service is using paramedics to troubleshoot patient needs and get patients plugged into the system. As a result of one paramedic’s efforts, EMS calls by ten frequent flyers fell by 79 percent. With 367 frequent flyers costing taxpayers more than $1 million in EMS charges alone, these paramedics may be on to something …

High risk insurance pool in Colorado running out of money and may have to “raise premiums, lower benefits and add waiting lists.” You don’t say. One analyst commenting in the article stated that those who created the plan “don’t have a clue about health care, and they don’t have good solutions.” You don’t say. Welcome to health care of the future.

More patients gone wild. Nineteen year old intoxicated patient drinks himself into oblivion, passes out, then wakes up in the emergency department, starts disturbance, tries to leave. Po po called and patient has an “electrifying” experience.

(more…)

WhiteCoat Challenge #7 Winners

Thursday, June 30th, 2011

The competition was tough, the voting was close, and half of you have your minds in the gutter. After careful consideration, EP Monthly’s editors have chosen the following comments as winners of WhiteCoat Challenge #7:

#3 Ed’s observation that “they have the ‘sickness and health’ clause covered.”

#13 joebob’s morning after question – “Have you passed gas yet?”

#24 ER Jedi’s comment that the bridal party will be catching C.Diff instead of bouquets and that the best man accidentally removed the bride’s catheter instead of her garter belt

Honorable mentions also go to:

# 10 BinkRN’s Reception Menu

# 12 Christopher’s Time Out clause

Winners send your contact information to lplaster -at- epmonthly dot com to get your prizes. Check out www.zazzle.com/epmonthly for your list.

Thanks to everyone for playing along!

WhiteCoat Challenge #7

Wednesday, June 22nd, 2011

I was going to add this story to next week’s Health Care Update, but as I was thinking about it, there were too many smart-alec comments that can be made about this scenario.  See what you can come up with …

Bride gets married in hospital when appendix ruptures on her wedding day.

Here are a couple off the top of my head to get you started:
And you thought the reception hall was going to be expensive …
Hey – they needed something to do while they were waiting to see the doctor …

Top three choices as chosen by EP Monthly editors get either a travel coffee mug or a t-shirt from the EP Monthly store.

Winners chosen next Tuesday.

Open Mic Weekend

Friday, June 17th, 2011

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

 

Unusual Coincidence

Thursday, June 16th, 2011

Any time that I discuss patients on this blog, I randomly change around the gender, the age, the complaints, and any names involved – both to protect the patients’ privacy and to comply with privacy laws. As I have stated in my “About” link:

“If you think there is any similarity between you and a patient I write about, it isn’t you. I may or may not change the age, sex, injuries, or complaints of the patients I write about. The 70 year old grandma with a hip fracture may really be a 16 year old star high school football player who skinned his knee. I may change some of the things that patients say or do for entertainment value. I repeat: It isn’t you.”

One of the patients I have written about in the past came back to the ED for a different issue the other day. The previous post was a funny scenario and I made up names for each of  the other people involved.

The last visit, the patient was alone. This time his family was with him. When I walk in the room, I usually introduce myself to everyone and shake everyone’s hand. When I got to the patient’s father, he introduced himself and told me his name. His name just happened to be the same one that I created out of thin air for the previous post.

I happened to remember the patient and the name I made up for his dad. I did a double take and must have given the dad a strange look when he told me his name, because he then gave me a funny look and tilted his head.

“Sorry, you look just like someone else I know with that same name. You don’t have a twin, do you?”
“No, but if I did, he probably wouldn’t have my name …”

Another reason why from this point forward, all patients will hereby be named Joanne Doroshow.

Emergency Physicians International

Tuesday, June 14th, 2011

A quick shout out to a new venture from Emergency Physicians Monthly

Logan Plaster and company have started a new magazine called Emergency Physicians International. They just put out Issue #3 and there are a lot of good articles inside, including articles about laryngoscopy and emergency medicine in Croatia, Japan, and South America, to name a few countries. I found it very interesting reading.

There are over 1000 registered members on the site from 60 different countries.

If international medicine is your thing, you can read all the issues online and join the forum discussions at this link:
http://epinternational.ning.com/

Update

Thursday, May 26th, 2011

I’m still around.

Unfortunately, the past couple of weeks have been very busy at work and filled with some not so nice things. Dealing with a lot of death – both at work and at home. Death is part of life, but sometimes circumstances make it a little harder to accept.

Have a lot to write about, but just need to set aside some time to do it.

Also, please excuse the breaks within the posts. I added Google ads to the ends of the posts to try to earn “take Mrs. WhiteCoat out to dinner” money from ad clicks, but Google only allows three ads to be shown on a single web page, so ads in older posts at the bottom of the blog cause ads in newer posts not to show up.

Will be back to regular blogging soon.

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