WhiteCoat

Healthcare Update Satellite — 04-02-2014

April 2nd, 2014

See other medical news on my other blog at DrWhiteCoat.com

Liberal use of blood transfusions may increase the incidence of serious infections. I don’t have access to the entire article, but wonder if the study also looked at overall mortality. In other words, is the increased risk of developing a serious infection outweighed by preventing more deaths from severe anemia (lower oxygen carrying capacity, increased cardiac demand, etc)

Traumaman … Traumaman goes wherever a trauma can. Sprayable nanofibers may soon replace sutures and may revolutionize trauma care. I imagine it’s only a matter of time until the idea is weaponized. One splat in the face and you’re through.

I’m with Skeptical Scalpel and SurgeryWatch on this one. If patient satisfaction and doctor ratings are of such value to the medical industry, we really need to expand the concept to other industries as well. Enter Airline Pilot Ratings. One of you flyboys hits turbulence and you’re ratings are through. If my ticket price is too high, you’ll be lucky if I give you a single “fair” rating on your whole report card. And if there are any delays, I mean ANY delays … I’ll give you friggin negative numbers. You hear me? NEGATIVE! Oh, by the way, I don’t like how your voice is muffled when you talk on the speaker. You get points off for that, too.
Yep. That’s how all enterprise should work.
Next up: Patient ratings.

Can charm be taught? Meet this generation’s version of (a female) Dale Carnegie and decide. The article is long, but well-written and enjoyable, so grab a cup of coffee before clicking on the link.

Another hospital closes its doors. Hospital board votes to close North Adams Regional Hospital in Massachusetts with only three days’ notice. The hospital had previously been open for 129 years. Nearby Berkshire Medical Center is going to attempt to preserve services at the hospital, but a source for funding has yet to be identified.

Give me the girl. Judge gives permanent custody of a Connecticut girl who is hospitalized in a Massachusetts hospital to the Massachusetts Department of Children and Families. “Closed-door juvenile court hearings late last year” allegedly proved that the parents were unfit to handle their child’s complex needs. It probably didn’t help that the girls dad was being a tool, failing to work with healthcare providers, threatening the social worker assigned to the girl’s case, and calling hospital personnel “Nazis.”
But if these types of things are sufficient to take custody of a child away from the parents, then we’re a few virtual reality computer programs and a holodeck away from the real life Hunger Games.
Another story on this case in the Boston Globe.

Association for Comprehensive Energy Psychology (the “other” ACEP) tries to get Wikipedia to open up its policies to encourage more articles about topics such as Emotional Freedom Techniques, Thought Field Therapy, and the Tapas Acupressure Technique. Wikipedia co-founder responds rather thoughtfully.
“If you can get your work published in respectable scientific journals—that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately. What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse.” It isn’t.”
Lunatic charlatans, eh? If advancing directives without having work published in reputable scientific journals and without those directives resulting form replicable scientific experiments is what defines the term, then the Joint Commission, Press Ganey, and most of the people who created Hospital Compare fit the definition.

Right on, brother. A leading neuroscientist asserts that ADHD is not a disease, it’s a label that is used to prescribe dangerous medications to children. The medications given to ADHD patients cause long-term changes in the brain and “their rewards systems change.”
Maybe that’s why some people call Ritalin and similar medications “kiddie cocaine.”

Another interesting article about the human microbiome. Certain bacteria in a woman’s vagina may protect against HIV infection. In the study, patients with bacterial vaginosis and taking an antiviral medication had significantly reduced antiviral activity while those patients with healthy vaginal bacteria and treated with the antiviral produced significantly less HIV.

High school teacher forced to resign after taking a 20 year old student (an adult capable of consenting to the actions) to the emergency department for an undisclosed problem and then paying for the cost of the student’s medical treatment.
Huh?

Bwaaaaaaah. District Court Judge Carter Schildknecht has open and closed door meetings with hospital administrators after her husband had a heart attack in the emergency department at Medical Arts Hospital. Ellis Schildknecht apparently had a gag order imposed by his wife as he remained silent during the meeting … and because of HIPAA laws, the hospital can’t respond publicly to the Judge’s complaint, leaving District Court Judge Schildknecht’s vague question “Is this the reputation that you want our hospital to have in this community?” out there for debate.
Saving the life of a patient suffering from a heart attack? Yes. That’s the reputation we want.
Perhaps you could order that your husbands files be released to the public so everyone could review the care that you deem so deficient and worthy of contempt.

Happy Doctors’ Day

March 30th, 2014

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According to the Southern Medical Association,

Doctors’ Day was first observed in 1933 as a way to honor the profession. Initially, it involved mailing cards to physicians and their wives and placing flowers on the graves of deceased physicians.
It wasn’t until 1958 that the US House of Representatives adopted a resolution commemorating Doctors’ Day.
In 1990 several Mississippi legislators drafted a bill to make March 30 National Doctors’ Day.  George Bush signed this bill into law later that year.

A red carnation has traditionally been used as the symbol of Doctors’ Day.

Give your doctor a fist bump today.

Excuses

March 27th, 2014

ekg-jiggle

I recently got into a rather … shall we say “colorful” … discussion with another doctor about lawsuits. I’m involved in another one. This one is even more screwy than the one I wrote about before. But this lawsuit isn’t finished yet. I expect that it will be over with in the next few months, but I’ll have to wait and see about that.

The discussion centered around medical records, which were one of the issues in my lawsuit.

The other doctor believed that what people write in the chart plays a big part in whether a doctor is successfully sued. In other words, the doctor believed that medical providers largely have the ability to document themselves out of a lawsuit.

I, on the other hand, asserted that charting generally does more harm than good. Sure, a well documented chart may make a doctor look more thorough and conscientious, but in the end if a diagnosis is missed, experts and jurors will work backwards from the diagnosis to determine all of the things that a doctor should have done to arrive at the diagnosis. If it’s a difficult diagnosis, documentation *may* save you. But if it is a disease where a patient manifested a couple of symptoms – even if those symptoms were nonspecific – documentation won’t do much. Electronic charting also provides a LOT more information, so it gives plaintiff attorneys more opportunity to show inconsistencies within a patient’s complaints, review of systems, and physical examination. Create an inconsistency by checking the wrong box or accidentally clicking “yes” instead of “no” and you look like either a careless schlubb who couldn’t be bothered to do an accurate exam or you look like someone who’s documenting an exam you didn’t perform in order to bill more money.

Then I started thinking. You know where that leads.

Suppose that a patient came to the emergency department with chest pain. He has a couple of risk factors for heart disease. His chest pain wasn’t classic cardiac pain, but he had chest pain. His EKG didn’t show any acute changes, but sometimes they don’t when someone has angina. His blood tests were normal, but again, blood tests often are normal when someone has angina. The pain gets better, so the emergency physician sends the patient home with a diagnosis of “chest pain” and instructs the patient to follow up with his doctor. But the patient doesn’t live that long. He dies that night from a heart attack.

Of course there’s going to be a lawsuit because a patient died from a heart attack after going to the emergency department with chest pain. I’m not going to argue whether or not the physician should have been sued. I didn’t give enough information in this example for anyone to make that determination.

My question is this: Given this scenario, is there anything about the chest pain patient’s history or physical exam that the physician could write in the chart to lessen the likelihood that he would be sued? If you were jurors, what types of things would sway your opinion (if anything) and make you decide that the doctor shouldn’t be liable for missing a heart attack in a patient complaining of chest pain? If the medical professionals were acting as expert witnesses, what documentation (if any) would make it more likely for you to conclude that the doctor complied with the standard of care?

I’ll let you know my thoughts once I read some comments.

Healthcare Update Satellite — 03-25-2014

March 25th, 2014

Patients gone wild. Really wild. 70 year old Brookdale Hospital nurse Evelyn Lynch gets knocked to the ground by patient Kwincii Jones and has her head stomped. She was knocked unconscious and suffered severe facial fractures. Also underwent brain surgery, so it is likely she suffered a brain bleed or has brain swelling as well.

Congratulations to the antivaccination movement for increasing the worldwide incidence of pertussis and measles. Measles and mumps are now “crushing” the UK. Patients with “religious exemptions” to receiving vaccinations were reportedly the source of one recent California pertussis outbreak.

Rise of the machines. I thought I was pretty good at spotting patients in fake pain. Turns out that most observers are only slightly better than chance at picking out fakers from the real deal. This computer program can achieve 85% accuracy in picking out patients who are truly in pain just by analyzing their facial expressions. Of course, watching the surveillance video of people skipping in the parking lot, then limping into the ED hunched over in “pain” is also a dead giveaway.

Machines are also pretty darn good at sniffing out cancer. A device called BreathLink can detect changes in a woman’s breath that suggest breast cancer and has a diagnostic power similar to mammograms. The device may also be able to test for tuberculosis.
The article also has a neat table about the odors different disease processes cause. Did you know that rubella may cause your sweat to smell like freshly plucked feathers or that schizophrenia may cause your sweat to smell like vinegar? Typhoid fever may cause your skin to smell like fresh-baked bread.

Wrapping that rascal is more and more important lately. The CDC is warning that gonorrhea may soon become untreatable. The “love dart” – otherwise known as an injection of Rocephin – has been a stalwart of treatment and now gonorrhea is showing resistance to this class of medications as well. Another article on the topic in The Verge here.
By the way, do you know what you get when you kiss a parakeet? Chirpes … fortunately that’s still tweetable.
Stop groaning. That thar’s funny and you know it.

What do you do if you’ve been diagnosed with cancer? Take a deep breath. Own it. Don’t run to consult Dr. Google. Dr. Peter Edelstein has some more suggestions here.

Utah Senate passes bill allowing doctors to prescribe Narcan to third parties to administer to patients who may be suffering from opiate overdose.
Initially, I had problems with this idea. Would people be able to inject it IM or assemble the intranasal administration assembly? How would the lay public deal with patients who are suddenly thrown into withdrawals?
Then I thought that it would be better to at least attempt to reverse an opiate overdose and deal with the consequences rather than having a patient die.
So why require a prescription? Shouldn’t Narcan just be made over the counter?

Rhode Island emergency department becomes first in nation to incorporate Google Glass into patient care.

Call of Duty – Dialysis Edition. 14-year-old Norwegian kid drinks 4 LITERS of an energy drink over 16 hours so he could stay awake playing Call of Duty. Ends up in a coma in a hospital for two weeks with “kidney failure” but is expected to respawn and live to fight another day.

Many people in New York contracting rare skin infection called Mycobacterium marinum. All of the 30 cases diagnosed were in people who were handling seafood.

Trying to change the message again. Obamacare architect Dr. Ezekiel Emanuel asserts that “you don’t need a doctor for every part of your health care.” If you like your high school sophomore with a 16 hour course in basic first aid, you can keep your high school sophomore with a 16 hour course in basic first aid.

The “Punch” Line

March 19th, 2014

BoilerQ: How do you get a room full of little old ladies to all use obscene language at the same time?
A: Yell “BINGO!”

When elderly patients blurt out obscenities, most of the time it takes everything I can do not to laugh out loud. No offense intended. I just get flashbacks of my mom sitting and putting her fingers in her ears while watching scenes in certain movies or seeing her gasp in shock if an F-bomb catches her off guard. I don’t expect to hear obscenities from someone who just rolled by me with a walker. For example, a while ago I posted a story about one lady from a nursing home who caught me off guard with an MF-bomb.

But this post came about from another patient encounter that made me reflect about how the things that doctors say to patients can affect a patient’s perception.

Enter the elderly patient who hobbled past the nursing station and into a treatment room with the help of her walker. As soon as we saw the chief complaint of “rectal pain” pop up on the tracker, everyone hoped it was a hemorrhoid and not a stool impaction. The other doc pretended he didn’t see the patient go by and headed into another room to see a different patient. I put my name under the “assign doctor” tab and went into the room to see her.

“Hi! I’m Dr. WhiteCoat. How can I help you today?”
“I’m having pain in my rectal region, doctor.”
Then her husband jumps in “She had surgery to fix a fissure a few days …”
Esther got upset. “You let ME tell him, Herb. It’s MY rectum.”
Herb shut up.
“I had surgery to fix an anal fissure a few days ago and I’m still having pain in the area – especially when I go to the bathroom.”
I got some more history and then had her get undressed so I could look at the area. While she described what had taken place over the past few days, she was obviously upset about her outcome.
Esther wasn’t a petite woman and she wasn’t quite as mobile as most patients. The nurse had to help her get into a gown and then helped pull down Esther’s pants. I could immediately see why Esther was having pain. There was extensive bruising to the inner aspects of both buttocks.
“Have you told your surgeon about this?” I asked.
Despite having a spine contorted from years of progressive osteoarthritis, Esther managed to twist herself sideways to give me a stern look and resolutely state “I am never talking to that goddamn sonofabitch again in my LIFE!” She then flopped back onto her stomach on the bed.
Herb started to chime in. “We went to Dr. Rectum’s office yesterday and …”
Esther’s voice, muffled from the pillow, still cut him off. “Herb, it’s MY body. Shut up.”
Herb shut up.
“I saw the bruising yesterday, so we went to Dr. Rectum’s office yesterday to ask him about it.” She explained. “That sonofabitch told me that my butt was so big he had to have two fat guys from the hospital boiler room come and pull my butt cheeks apart so he could finish doing the surgery.”
Herb grinned.
I raised my eyebrows at him and softly shook my head.
“OK, Esther, we’ll get you some medicine for the pain and I’ll give one of our other surgeons a call.”

The other surgeon who covers for Dr. Rectum was out of town, so I ended up talking to Dr. Rectum himself.
“Bruising is normal after surgery like this.” He said. “Hers was a little more than usual, but she’ll be fine. Part of it is because of her size. We had a little difficulty retracting her buttocks. Tell her to take it easy on the opiate pain medications and continue the Sitz baths and cool compresses like we discussed. She can see me in a few days if she’s still having pain.”
“She’s pretty upset with you,” I told him. “She said you told her that her butt was so big that you needed two men from the hospital boiler room to come and hold her butt cheeks apart.”
“I told her that the traction from the tape we use is what probably caused the bruising. I jokingly told her that it wasn’t like two men came in from the boiler room had to hold her buttocks apart. And I never said anything about the size of her rear end.”
“That’s not how she remembers it. She’s refusing to ever see you again.”
“I’ll call her to apologize. My gosh. That didn’t go very well, did it?”

I told Esther what Dr. Rectum had said.
More profanities. No change of heart. She remembered what she heard, she didn’t think it was funny, and she was NOT ever seeing Dr. Rectum again.

Dr. Rectum is a good doc, but his misguided attempt at humor torpedoed the care he provided … and he was lucky that the patient didn’t complain to the administrators about her perception of a statement that men from the boiler room came into a surgical suite while she was under anesthesia.

So Esther was discharged with some stool softeners and a few pain pills.

As she was getting dressed, Herb nudged me and whispered “I thought it was pretty damn funny when she told me.”
I smirked a little and whispered back “Any good comedian knows his audience.”

Making cracks about the posteriors of hearing impaired little old ladies – definitely not doctor’s office material.

———————–

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.

Healthcare Update Satellite — 03-04-2014

March 4th, 2014

Science reporter Miles O’Brien suffers a freak accident while packing equipment after a reporting trip. Case falls onto his arm and causes bruise/injury. The following day, pain and swelling in his arm got worse. The day after that, he was being rushed to the operating room for compartment syndrome. His blood pressure dropped during surgery and the surgeon had to amputate his arm.
Best wishes for a speedy recovery, Miles.

Patients who have had strokes are 50% more likely to have iron deficiency anemia as are control populations. Authors suggest a couple of possible mechanisms for the correlation including decreased oxygen delivery and a secondary thrombocytosis, but no one is quite sure why the risk increases.

Eastern Ontario Children’s Hospital asks patients to stay away unless they have a “true emergency”. The hospital is just too busy.

New Hampshire hospital employee makes “offhanded” comment about strangling and shooting man who was divorcing her daughter. “Antagonistic” co-workers notify police that she was making homicidal threats. Police then come and arrest her and take her to hospital emergency department … where she waits six days before a bed in a psychiatric hospital opens up. She is discharged from the psychiatric hospital the following day. Now she’s suing for false imprisonment and wrongful discharge … from her job, not from the hospital.

The good news is that we have these tests to give us a better idea of your medical “frailty.” The bad news is that if the tests are abnormal, you’re substantially likely to die sooner. Tests include alpha-1-acid glycoprotein, albumin,  very-low-density lipoprotein particle size, and citrate. Those whose tests were in the highest 20% were 19 times more likely to die in the following 5 years than those whose tests were in the lowest 20%. Patients whose tests were in the 99th percentile had a 23% likelihood of dying in the next 12 months and 49% likelihood of dying within the following 5 years.
So … do you still want to have the testing done?

78 year old farmer takes a nap, then wakes up with a bunch of people at a funeral home trying to embalm him. Coroner was called to the house, said the patient had no pulse, and declared him dead. Family surmises that the patient’s pacemaker stopped working.
I’ll say.

Maybe a better title to this article would be “The Way We DON’T Pay Primary-Care Doctors Is Insane”. Some people commenting on the article are advocating use of NPs and PAs to replace the primary care physicians.

Paul Hsieh writes a nice article in Forbes about whether you can trust what’s in your medical records. Uses the case of a Dragonism where “DKA” was transcribed to “BKA” to illustrate the point that sometimes erroneous information can be unintentionally propagated in future medical record entries. Also gives some good advice on patients can minimize errors in their records. Best suggestion: Obtain copies of your medical records and request copies of all testing performed on you.

Louisiana patient sues cardiologist for failure to stent which allegedly resulted in permanent disability when the patient suffered a heart attack a few weeks later.

Should Zohydro be removed from the market? Ten milligrams of hydrocodone in one pill. Opponents are concerned that it will cause further addiction and deaths from drug overdoses. Proponents say that patients may need it for proper pain relief.
Another important issue is whether many doctors will even be willing to prescribe it with the increasing number of criminal actions against physicians whose patients die from drug overdoses.

Unprofessional Act or Political Mudslinging?

February 26th, 2014

Milton Wolf Facebook

US Senate candidate Milton Wolf (@miltonwolfmd), who also happens to be a radiologist, is catching heat because he had previously posted patient x-rays on his Facebook account … and then made what some people would consider as inappropriate comments about the patients who were depicted in the x-rays.

Articles in the Topeka Capital Journal are here, here, and here. Note the repeatedly recycled content.
The story was also picked up in Talking Points Memo and on Breitbart.com

For example, in the comments to the right, he commented that the positioning of a dead patient’s head on CT scan wasn’t going to cause the patient to complain.

A spokesman for the doctor’s opponent, Senator Pat Roberts, said that Dr. Wolf’s posts raised “legal and professional responsibilities to maintain privacy of patient medical information.”

It appears that Dr. Wolf anonymized the pictures before posting them. If that was the case, HIPAA doesn’t apply to deidentified health information, so there was no “legal responsibility” to maintain privacy of medical information that could not be traced back to the patient. Professional responsibility is a separate issue.

John Carney, president of the Center for Practical Bioethics, reportedly stated that Dr. Wolf’s posts would be “beyond alarming for a professional in the field of medicine.” An “array” of other medical ethicists who viewed the images or were provided a description of Dr. Wolf’s materials also reportedly “condemned” Dr. Wolf’s publication of this information “outside confines of a doctor-to-doctor consultation or for the purpose of formal medical research or textbook instruction.”

This last point is an important one. If a picture is used for teaching purposes, why is publishing it “beyond alarming” or worthy of condemnation?

Milton Wolf Ankle Post

Look at the post above. There are two fractures present. Dr. Wolf makes the comments “Sledding accident. Look closely. It’s kinda subtle.” How is such a post “beyond alarming”? Aside from the fact that people can comment in real-time on the content of the picture (which would seem to enhance learning), how is an anonymized Facebook post of this picture ethically any different from the same picture contained in a textbook? And why are unnamed ethicists judging the appropriateness of published material based solely on the medium in which that material is published?

There is a spectrum of online activity in which medical providers can engage. At one extreme is a hospital employee from a “staffing agency” who posted a patient’s name on Facebook and commented “Funny but this patient came in to cure her VD and get birth control.” At the other extreme are the many educational medical sites such as Dermatlas. In the middle is a large grey area. Overreaching “ethical expert opinions” condemning any online medical posts outside the extreme of “formal medical research or textbook instruction” should be carefully questioned. Unfortunately, the Topeka Capital Journal and reporter Tim Carpenter don’t really mention the names of the “array” of other ethicists with whom they presented this information, so it’s difficult to determine how much weight to give Mr. Carpenter’s assertions. Good job on the editorial work, there Capital-Journal. The array of writers involved in editing articles who reviewed this article condemned your work.

The responsibilities of a medical provider who posts patient information online depend on how the information is presented. If we prevented any posting of x-rays or patient pictures, then medical knowledge would advance at a much slower rate – regardless of the medium. I know for a fact that many x-rays and EKGs in medical textbooks are reprinted without the permission of the patient. I see pictures of patient body parts, x-rays, CT scans, and EKGs used in lectures without patient permission. These actions are hardly worthy of condemnation or “beyond alarming.” Conversely, using pictures to belittle patients who have little control over their conditions may be pushing the envelope on professionalism. Remarking that a patient who died from a gunshot wound “got what he deserved” may initially seem harsh, but would it be as inflammatory if the patient was in the process of brutally raping a young child?

Dr. Wolf’s humor may have been a little off-color. Off-color humor may be offensive to some. Should a doctor be labeled as “unprofessional” because that off-color humor offends a minority of people who read it … along with the president of the Center for Practical Bioethics (who probably wouldn’t have been quoted in the news had he not derided Dr. Wolf’s comments), a few unnamed “ethicists”, and a political opponent behind in the polls who stands to gain if the campaign of “unprofessionalism” gains steam?

I’m not condoning Dr. Wolf’s comments, but I think we need to look at the motivations of those publishing information and at the implications of whatever societal rule we want to create. Should off-color commentary render someone unfit for political office?

And by the way, has anyone looked into Tim Carpenter‘s background lately?

Hat tip to a @movinmeat tweet for the initial story. If you want to read his blog, you can go here, but he’s turned into a Twitter bug for the past year or so.

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Healthcare Update Satellite — 02-24-2014

February 24th, 2014

More medical posts from around the web over on my other blog at DrWhiteCoat.com

Another Pennsylvania hospital closes its obstetrics department, citing clinical and financial viability of the department with only one obstetrician on staff. Interesting point in the article is that in 14 years, more than 40 obstetrics units have closed in Pennsylvania. One site lists about 240 hospitals in the state total. Why all the closures? How does that affect care provided to the pregnant patients?
The article notes that the emergency department is trained to handle emergency births, but if a baby is breach or needs emergent delivery, the outcome is likely not going to be good. Emergency physicians can’t do emergency Caesarian sections and we don’t specialize in high-risk maternity care.

Paramedics frustrated at having to provide care to patients for hours in parking lot at University Hospital Limerick before being able to move patients onto a bed inside the hospital. During that time, the paramedics are unavailable to make other runs to other hospitals.

More and more Kentucky patients dying from heroin overdoses, but benzodiazepines still cause most emergency department visits for overdoses in Kentucky. According to the CDC, the number of patients using heroin nationwide has increased by 80% between 2007 and 2012 and much of that increase is attributed to a clampdown on pain medication prescriptions.

Interesting arguments for NOT treating a child’s fever. Fevers won’t fry a child’s brain. That whole egg on a frying pan comparison only works for drugs. The magnitude of fever is not related to seizure risk. I always believed that high fevers made additional febrile seizures more likely, but was unable to find any literature to support that belief. Fevers may help your body fight infection better. And lowering a fever increases transmissibility of influenza.

More of the Obamacare Chronicles.
Patients who are happy to have “insurance” then overcome with shock when they can’t find a doctor who takes their insurance. “Covered California” leaves many Californians “uncovered” for medical care and the doctor directories that it posts on its web sites are often inaccurate. Consumer fraud, anyone?
Remember my prior post about how doctors would be vilified for refusing to participate in low-paying insurance plans? This article is just one of what I’m sure will be many more to come.
Another article on the same topic is here.
And another.
Receiving healthcare insurance doesn’t guarantee you medical care any more than receiving automobile insurance guarantees you a car.
And California is getting close to Florida as one of the states in which doctors should NEVER consider practicing medicine.

Topeka, Kansas VA Hospital is converting its emergency department into an urgent care clinic. As a result, the hospital no longer has to take ambulance runs. Hospital cites staffing shortages. Kansas Senator Jerry Moran alleges that the VA’s failure to hire appropriate staffing is “causing a … backlog of our nation’s heroes who are not receiving the heath care they need.”

Do doctors need to lie to patients? Is it ethical to tell a patient that everything will be alright when the doctor knows that is not the case?

Another example of selective government “transparency.” Feds want to release payment numbers to physicians for providing medical care, but refused to disclose how much money grocery stores were earning from government food stamps. Government attorneys argued that the data was privileged and exempted from the Freedom of Information Act. The 8th Circuit Court of Appeals shot down that argument.

Just Checking

February 22nd, 2014

CT BB NoseIn one of the hospitals where I work, when we order certain tests in the computer, we have to write the indications for the test on the order sheet. I suppose this isn’t a bad idea in some cases. For example, if an ultrasound might be better than a CT scan to look for the suspected diagnosis, writing the indication may help to provide the most useful test.

The problem that has popped up recently is that the typewritten indications have now turned into a full scale interrogation by the radiology techs. What symptoms is the patient having? For how long? What is the patient’s medical history? What medications?
Apparently this all has to be written on the order form for some patient safety protocols.

I’m even getting regular calls to ask if I “really want the test” and then ask why I am ordering the test – even though the indication for the test is written on the order.
Just double checking, of course.
It isn’t uncommon for two techs to ask me if I really want a test in some cases.

The director of the radiology department approves of all the questioning. After all, it improves patient safety. I’m not sure how repeated questioning improves patient care and I haven’t been persuaded to change or cancel any of the tests I have ordered, but I am now beginning to see how the pre-authorization process would dissuade some doctors from ordering certain tests. Some doctors just get tired of dealing with the hassles involved in ordering the tests.
I’m not one of those doctors, though.

Initially, I planned to just start typing “yes I really want the test” in the order comments. Then, my better judgment got the best of me. A statement like that probably wouldn’t look too good if the charts were sent to outside hospitals or other third parties.

Although the actions of the techs are frustrating, they are just doing the job assigned to them by their boss. Not really fair to give them a hard time.

How would you address the situation? Is it even worth complaining about? Let me know what you think.

Problem Found

February 17th, 2014

Stuffed Cat

An 8 year old girl was brought in for a psychiatric evaluation.

The child’s mother had a laundry list of abnormal behavior in which the child was engaging. The child allegedly scratched the eyes out of all her dolls – except her stuffed cat, of course. The patient breaks glass on the bathroom floor so no one can use the bathroom. She also screams incessantly. Oh, and today she threatened to burn down the house.

According to the patient’s mother, she was suffering from post-traumatic stress disorder after being beaten by her stepfather as an infant. Then, a couple of years ago, her pet kitten was found dead on the road. Ever since that time, the girl acts out and carries around a stuffed cat with her wherever she goes. And sometimes she carries a blanket, too.
All of this has to be discussed out in the hallway so that the patient doesn’t overhear these conversations and become more upset.

The child hadn’t said a word since she arrived in the emergency department. she just watched TV in the room as she clutched her stuffed kitten. She was still dressed in her coat and gloves as she went to sit on the bed.

“You’re going to have to take off your coat and sweatshirt so we can examine you,” the nurse told her.

The mother interjected “Yeah, well that will probably just get her sexually aroused, but what-ever.”

At that moment, the staff realized that the source of the patient’s psychiatric issues was likely neither the girl’s reported neonatal beatings nor her deceased cat.

———————–

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.

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