"Things I learn" & "Medicine Sucks" discussion thread

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Originally Posted by VELOv

Dude, a lot of hospitals won't let you see any doctor, even with another doctor referring you, if you don't have insurance--the only option is to go to the ED where they aren't allowed to turn you away, which is what I had to do when I started having simple partial seizures as an adult. It wasn't emergent in that I hadn't lost consciousness, but by rights, I should have been able to see a doctor within a month of presentation, just because of the horrible things that could have been causing the seizures. . . ED was my only option.

But anyway, pregnancy test wands cost like $15 for a three-pack at the drugstore, whereas the ER has much lower expectations with billing. My downstairs neighbor owes something like $40,000 between his recurrent "kidney stones," some busted teeth and the time he punched his wall.

In any case, "possibly pregnant" is not an emergency. If she's really so poor she can't pay, there's probably a charity clinic she could go to, instead of wasting the ER's time.

Originally Posted by VELOv

But anyway, pregnancy test wands cost like $15 for a three-pack at the drugstore, whereas the ER has much lower expectations with billing.

According to the Superstars over at Vagina_Pagina, the test sticks from the Dollar Store are some of the most reliable ones on the market.

No, seriously!

.

I love you people in the ER so much for all you do for your patients. I made sure to bring in some muffins for the folks in the ER where my mom works; sounded like they were a hit.

If a patient can afford the time to go to the university's psychologist to see if S.O.B. and fatigue is caused by stress or something, then said patient doesn't need the ambulance to go to the ER!
Though at least the ER docs figured out what was wrong... Labyrinthitis, of all things I haven't heard of.

Also, if you can't figure out what's wrong with the girl who has had heart problems for years and no one has figured out what was wrong so far, don't decide that the diagnosis is "panic attacks.'
If her cardiologist can't figure out the heart problem and the girl is one of the most laid back people in the world, it seems extremely unlikely that panic attacks are the problem.
[edit] I know that they were just trying to get her out of there with some sort of diagnosis rather than just going "I don't know" because I'm fairly sure that makes the ER docs feel worse about their job...

Originally Posted by FTWBrass

I love you people in the ER so much for all you do for your patients. I made sure to bring in some muffins for the folks in the ER where my mom works; sounded like they were a hit.

Good for you. I have a box of chocolates and a card I'm playing to send to the A&E in my area, they've treated both myself & my husband recently & they were wonderful about it, couldn't have asked for better treatment.

Hello. I'm another of these people who aren't doctors, attracted like cyber-flies to the internet-pervading odour of the famous ER thread. Good to see you have created a separate thread where people like me can post without interfering with the "proper" one.

I have an interest in most things with a scientific/technical aspect, and since my mum is a doctor, I have learnt the odd thing from her. (Favourite reading material around ages 5-8 was the Heart section of "Anatomy" by Gardner/Gray/O'Rahilly, and Wolff's "Diseases of the Eye"...) I therefore have a level of knowledge which could be described as "enough to be dangerous but not enough to be useful", and indeed have given serious consideration to the idea of using razor blade, soldering iron, superglue and purified street cocaine to perform a DIY vasectomy. I'm not posting to report the results of actually having done it, though; rather I am posting because the question quoted below is one that has been asked of me...

Originally Posted by gutonc

I actually got so fed up w/ a patient the other night who wanted to leave AMA that I finally asked the question I've wanted to since I started this..."if you don't want to be in the hospital, why did you come to the hospital?"

Situation: I had been feeling like crap for some days with something resembling flu but not flu. Fever (or so it felt, I do not have a thermometer to check), delirium, lethargy, dyspnoea on exertion to the point of near syncope after climbing one flight of stairs, and enough clear, fluid mucus in my respiratory system to run a mucus-powered car for a week. Parents emailed me to ask how I was getting on, and I replied with a summary of the last couple of days which included a mention of difficulty sleeping because whichever lung was on the lower side would start bubbling after a few minutes of lying that way and it was an annoying sound and sensation. That has happened on quite a few previous occasions when I've had a horrible snot disease, so I'd always thought of it as a normal symptom caused by excessive mucus and nothing more than an annoyance.

Three hours after sending that email, someone comes banging on my door. It's my dad. He has come to take me to A&E. I protest that I am not an emergency. He says that mum is freaking out thinking I might have pneumonia. I say no I don't, I always get bubbling lungs when I lie down if I've got this much mucus going on. He says mum won't be satisfied with that and she wants me to go to hospital. Eventually I agree to go purely to calm her down.

Now, the time is approaching midnight... on New Year's Eve. So it's a pretty safe bet that A&E is going to be full of people suffering what I believe is known as "trauma secondary to EtOH intoxication" who do actually need to be seen urgently. Hardly an auspicious time for this sort of caper... So I take pains to explain the circumstances of my visit, point out that I'm there for my mum's benefit rather than my own, state that I do not consider myself to be an emergency and that furthermore I feel like a knob being there at all. I repeat this explanation to everyone I get to see, from admissions through triage and having my temperature taken (normal, much to my surprise) followed by various other tests all the way up to a chest X-ray.

After the X-ray I get to sit in some room which has been temporarily repurposed as a holding area for patients who aren't actually leaking, and wait there for some time until another doctor arrives - it is the first time I have seen this particular doctor. She says that they basically don't know what's wrong with me. My white cell count is slightly elevated so there has been something, but every other test came back normal. It's not pneumonia, whatever it is. It's not flu either, but what it is, they can't say. She then says they want to keep me in overnight for observation and for them to have more time to ponder over what it might be.

At this point I figure enough is enough. What they do know by now is enough to convince my mum that I do not have one foot and most of the leg in the grave, and for myself I never thought I did anyway, so as far as I'm concerned the desired result has been achieved. I've been stuck in here for several hours feeling like a knob for wasting their time and resources on one of the busiest nights of the year. Now they want me to waste a bed as well... I never have spent the night in a hospital ward, and never been in one for more than a couple of hours, but that is enough to know that the only way I would spend the night in one is if I was either physically incapable of not spending the night in one, or so ill that I neither knew nor cared where I was. I'd rather spend the night in a prison cell, and I do know what that's like... behind the safety of a locked door, with no other people, your own toilet and the freedom to use it, and better food

So I said no, not happening, I'm going home. At which point she asked the same question I've quoted above To which I replied by once again explaining that I was only there because my mum was worried, that their reassurance that I was not in fact about to die would be enough to stop her worrying, and that from my own point of view it had been a waste of everyone's time and I was just as annoyed about it as she was and embarrassed to boot.

So... not everyone who comes into A&E/ER being a knob necessarily wants to be a knob, it may just be that the alternative was being a bigger knob to their mum

(Whatever it was didn't get any worse, and passed off by itself in a couple of weeks.)

Originally Posted by emtcsmith

Never question the crazy patient trying to 302 herself how she scores free weed on the street.

I do not know what "trying to 302 herself" means but I would love it if it happened to mean "trying to obtain some kind of temporary transfer", and so would anyone else reading who is familiar with HTTP status response codes

Or How to almost kill your patient.

Woman not known for going to bother doctors starts get very sore neck muscles. So sore that her neck retracts, jaw goes into spasm, walking and sitting are agony, and eating is impossible. When she finally come to see you, at your busy GP practice and has waited patiently for 3 hours, glance up, take her chin and twist the neck from side to side, grunt, and then tell her it's just a pulled neck muscle and she's to take some panadol, have a hot shower, rest, and "stop thinking about yourself. It's nothing."

When this doesn't work, and a week later she is back in the surgery, now with very sore throat, not having eaten for 3 days, neck muscles almost completely and permenantly tight, and a new symptom of waking every morning at 1am, sweating so hard her clothes are drenched but shivering uncontrolably and so hard and violently it feels like her tendons are about to rip, once again grunt, poke and prod her neck, take a cursory look in her throat, and then tell her its still probably a pulled musle. Apply heat gel, have hot showers, and rest.

5 days later, when the woman has had an attack at work, frightening her staff and lasting for 40 minutes before she could finally swallow down some panadiene forte, and her partner has dragged her into the clinic and demmanded she see another doctor.

Who takes one look at her throat and recoils in shock, diagnosing massive strep/staph infection that has left only a tiny hole for breathing and swallowing. Listen to the patient and go pale at the video of the early morning convulsions. And then start writing a test sheet for every blood test known to mankind to find out what's really wrong. Start the patient on massive amounts of Amoxy until the results come back, to try and control the throat infections.

When the results come back, and frighten the daylights out of you, call the patient and order them to get down to the clinic. When they do, tell them that they have had a massive glandular fever attack, with they resulting liver and kidney issues. When the patient asks if the first doctor could have prevented some of it by diagnosing it earlier, admit it might have helped, but not made a lot of difference.

Result: Patient recovered and has all liver and kidney function returned, but it was a very close call.

Originally Posted by Perentie

When the patient asks if the first doctor could have prevented some of it by diagnosing it earlier, admit it might have helped, but not made a lot of difference.

So, in other words, lie.

Originally Posted by Kittenmommy

So, in other words, lie.

It's rather poor form to throw colleagues under the bus, especially if you don't entirely know the story behind their management decisions.

Originally Posted by Kittenmommy

Stuff like this always baffles me. I just don't understand how someone could be pregnant and not know it. If anything, didn't she wonder why she was suddenly gaining so much weight?

Yeah, yeah, yeah, I know it's old.

My sister is actually one who totally missed that she was pregnant until 7 months with her first kid. Her cycles were (and still are) always pretty light and she skips months randomly anyway. Never had morning sickness, never was tender or anything, bra size never changed. Really didn't gain much weight, but when she gained I think 8 pounds, it was over Thanksgiving/Christmas so she just figured that's what it was from, and that's why her jeans didn't button.

It was middle of January, she had a routine dr visit and she goes "Why haven't you been in for prenatal care?"

Yup. My nephew was born March 19th.

My sister is all of 5'1" and 110 pounds. Kid was 8 pounds, 15 ounces. I have NO idea where he was hiding for 7 months because she sure didn't look pregnant and on March 18th, she maybe looked 5-6 months pregnant.