I was the pain clinic today in the ED. I think every single one of my patients that I saw today was in the ED because of pain. I didn’t do much productive for any of them. Back pain, Tooth pain, Neck pain, Arm pain x 2 (one right, one left), scrotal pain. No one had any sympathy for my sciatic pain.

This morning I presented an M&M and all went well with discussion and didactic presentation untiil the last 2 minutes when the department head asked the (non-rhetorical) question…could this have been prevented? Gulp. He thought yes, but all cases suffer from hindsight bias. How many patients get sent home and never get adequate follow up but never have catastrophic outcomes? Far, far more than the ones that show back up on a gurney, I’m sure. Anyway, that kind of ruined the rest of my day.

Then the radiologist and I had a little “discussion” regarding a testicular ultrasound ordered after hours. Does anyone know if there is a “re-torsion” rate after surgical correction? This teenager presented with what he described as the same symptoms he had when he had a torsion about a year ago. Given that I wanted to prevent another future M&M conference, I decided to be a patient advocate and call in the ultrasound tech, even though he’d already had the surgery. Seeing as I have no personal experience with testicular pain, I had to believe what my patient was telling me.

During our radiology/emergency medicine monthly conference this morning, we discussed doing more pediatric ultrasounds as opposed to CTs for certain cases of belly pain. A point raised is that in our hospital, CT is available with techs in house 24 hours a day. Whereas the ultrasound techs go home at 4pm, and sometimes it’s like pulling teeth to get them to come back in. I even had one radiologist tell me to “make something else up” as a reason for my study. “The tech won’t think that’s a good reason for an emergency ultrasound.” I don’t know why the radiologists let the techs dictate when studies are done, but part of our daily challenge is “ordering” tests that we think are clinically necessary, and not “requesting” tests that the radiologist or technicians don’t think are necessary.