Working in the Zone

As has been the case for the past year or two, the individual cases I see are not all that exciting for me anymore.  Rather, its the interaction with my patients and their families that makes or breaks my day.

At the moment, I can’t recall a single diagnosis from any of the patients I saw today, but I do recall the blue man in his 90s who requested a pillow just as I was about to intubate him (I didn’t intubate him).  He was one of a dozen or so patients with whom I chatted and joked, trying to ease their time in the Emergency Room.

While I frequently get little feedback from my sick patients at the time, my easy-going nature usually pays off.

Just yesterday I was buying shoes and a sales person from the other side of the store flew over and said, “I know you! You took care of my father last year when he was in a car accident!”  She told me I did a good job.

I always wonder what people think of me when they see their emergency room doctor, sometimes the doctor that saved their or a loved one’s life, outside the hospital setting…buying shoes for example wearing a t-shirt and bike grease stained jeans.

Best line from the nursing staff…

Setting: 2:13 AM, Saturday, Halloween Weekend. Nursing Station of a busy inner-city emergency room. The department is spookily quiet. Jodi & Sonya, both nurses in their mid 50s, sit side by side filling out paperwork.

JODI: Do you realize, Sonya, that we have been working together for over seventeen years. And we still get along!

And the award for best line from a nurse goes to Sonya…

SONYA: Thats only because sex isnt involved!

Doc Shazam Mountain Bikes on 3 Day weekend

This weekend Doc Shazam is going mountain biking with 3 friends for a 3 day weekend. The week has been filled with cleaning, shopping and gathering supplies to make sure we have a fantastic weekend of riding.

More fun filled tales of gore from the ER next week.

Maybe even some gore filled photos from the weekend. One can only hope. 😉

A little Rant on needless ER visits

OK, I’ve been trying to be really positive today, but I wanted to share 3 cases that didn’t need to come to the ER today.

1)  12 year old with a sore throat.  The school nurse said, “Go to the Emergency Room”

2)  An 80ish year old lady who was IN her doctor’s office, had a Normal EKG taken, lab panels drawn, outpatient scripts written for a heart monitor and some vascular studies. She passed out when her blood was drawn.  So the doctors office sent her to the ER.  Umm…so you’ve already got her EKG, her labs, she’s scheduled for some great outpatient tests, and then she had a vagal reaction IN your office WHILE DRAWING BLOOD.  Umm…what do you want me to do exactly?

For the record, I had to draw more blood since I had no access to the PCP offices bloodwork…and she passed out again.  When she woke up I sent her home.   I did nothing for her except give her a “check up”.  Isn’t the doctors office for “check ups”?

A 60ish year old guy with DVTs (blood clots in his legs) on Coumadin, a blood thinner.  The coumadin was not therapeutic.  So his PCP sent him to the Emergency Room to get a shot of Lovenox and some prescriptions for lovenox.  Sigh.  The PCP can WRITE her own prescriptions for the Lovenox and send a home health nurse to the house to help teach him to administer them.

For anyone who doesn’t understand why the above scenarios are needless ER visits… the Emergency room includes ALL of the following, none of them are optional:

1)  Registration for demographic & insurance information & creating a  permanent written record of the patient’s care

2)  Evaluation by a triage nurse, including initial vital signs and coordinating getting the patient to the right part of the ER as timely as possible

3)  An evaluation by the patient’s assigned nurse

4)  A physician’s evaluation.

Between numbers 2, 3 & 4, we are required by federal mandate to ascertain that no emergency medical condition exists.  This means that every single patient who shows up at the ER is seen by at least 2 practitioners (nurse and physician).  If a patient is on the hospital premises and requests an evalation, I am personally responsible for that patient, even if I never actually see him for whatever odd reasons.

Add to the above any medically recommended blood tests, imaging & other testing to help diagnose the said emergency medical condition, and then obviously to treat any conditions that exist.

So in the case of a patient who has already been seen & examined by his physician and needs only a prescription for Lovenox, the ER doctor’s involvement only complicates the patient’s care, exposes the ER to further liability, is a waste of money for the patient and/or his insurance company and/or you and I in the form of increased premiums to cover this visit.

In the case of the patient who was at her physician’s office,  and had a vaso-vagal reaction to drawing blood…Well, the trip to the ER was just to appease the daughter.  It was a “really bad fainting spell” according ot the nurse practictioner who saw her in the office.  OK, when you faint, you faint.  Blood flow to the head is decreased when you have a vaso-vagal reaction, you pass out, blood flow returns ot your head and you wake up.  During this process you are goofy or unconscious.  Some people have “myclonic” jerks which are small muscle twitches like the ones you have as you are about to fall asleep at night.  A vaso-vagal fainting episode is not a siezure, and any practictioner who has ever seen either knows the difference.

Since the patient arrived in my ER, I was obligated to ensure that no emergency medical condition existed, for example, a severe anemia that would limit the patient’s abilty to respond to a vaso-vagal reaction … all of this had been checked at the PCP’s office, but I had no access to teh data so it all had to be performed again, resulting in a 2nd identical episode.

What really aggrevated me is that after this entire episode, the patient tells me, “Oh, I always faint when my blood is drawn.”

Wouldn’t it have been funny if we needed to admit the patient and watched her faint every morning at 6AM when labs were drawn?

And the 12 year old?  Well if a school nurse can’t tell the difference between a student that needs to go to teh ER and a student that just needs to stay home from school for a day…she might need to take a little nursing refresher.

OK, rant over, only positive stuff for awhile.

Have you noticed the Ads?

Mr. Hassle’s Long Underpants recently underwent a complete make-over. (And I only got a handful of comments on it…love it or hate it, let me know!)

Part of the makeover was the addition of two different sources of ad revenue that hopefully do little to interfere with your enjoyment of the site.

Why did I decide to use ads?

I realized that I had quite a bit of traffic to this website after over three years of (somewhat) regular posting on real stuff…not just random drivel. I get several dozen search engine hits a day on just about every topic I’ve ever written about (and yes, even ‘underpants’).

I also realized that my enthusiasm for the site was flagging as you may have picked up in posts a few months ago…not so much for the site, as it has meant an awful lot to me, but rather for my job. Well, I won’t go into that now.

So with nothing to lose, I figured that I would give two sources for ad revenue a shot.

The old Standby, Adsense, which you see below each post and probably don’t need explaining as they are fairly ubiquitous on the net.

The second is a little more interesting, a company called “Text Link Ads”. You see the text link ads in the upper right under “sponsors”. Pretty unobtrusive, right? I have the ability to screen whose ads appear so that they match my blog theme. For example, I’d be unlikely to accept ads from a medical malpractice law firm.

If you’re having trouble seeing the ads, for example “EMR Software”, try going back to the main page of my site, instead of the post page of my site…just click on the title bar, MR. Hassle’s Long Underpants.

So how much have I made? About $20 so far, which is better than $0. I figure it will pay for site hosting and give me just enough incentive to continue posting new stuff…which is what you come here for in the first place, right?

BTW, if you are interested in hosting ads on your site, use the Text Link Ads button in the right hand column (below the archives) to sign up for a free publishers account. If you are accepted (not all sites are), and install the script on your website for 7 days, I’ll get a $25 commission. The script is as unobtrusive as what you see under “sponsored links” in my right sidebar. Only the first one is an ad, EMR Software. (BTW, feel free to visit them so that they keep renewing their ad each month). The second two links I added myself.

So there you go…the WHY of my ads, the WHAT of my ads, and the HOW MUCH of my ads.