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golghiapparatus

golghiapparatus

EM bound
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For which diagnoses do most EM physicians really strive for a 0% miss rate?
MI? SAH?
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Status Hystericus
 
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Oh, I already knew about those and have been utilizing the Modified Bull&@#@ Criteria Screening Tool to rule out all cases of lupus, FM and the dreaded ADD for years now...
 
golghiapparatus said:
For which diagnoses do most EM physicians really strive for a 0% miss rate?
MI? SAH?
Click to expand...
Sure, MI and SAH rank up there to ludicrous degrees. Although most SAH lawsuits result from doctors not wanting to finalized the SAH diagnosis, and instead relying on the CT.

That being said CT has made this list immensely longer. How many people refuse to d/c the kidney stone without confirmatory imaging. Or the abdominal pain that isn't peritoneal, and needs imaging. Or the neck pain after the parking lot fender bender. It's legal statement that as a society we would rather do a small amount of harm to a huge number of people rather than miss a real harm in an incredibly small subset of the population.
 
I like where this thread is going...

In my experience, when I ask a patient, "Where do you hurt?" and they respond "everywhere" or, "all over" the sensitivity for detecting Stage IV FM approaches 100%.
 
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I usually will send off a trollponin just to be sure I'm not missing badness.
 
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I think we are all a little quick to judge Fibro and other similar disorders. I worked with docs who do research on it and their pain is often real, it is sometimes overdiagnosed and used as a wastebasket dx. MS was called hysterical paralysis until they realized men got it too. A lot of disorders that primarily affect women are given a bad rap. I admit to falling prey to the judgement too but am trying to be more open minded. JMHO.
 
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Beth_W737 said:
I think we are all a little quick to judge Fibro and other similar disorders. I worked with docs who do research on it and their pain is often real, it is sometimes overdiagnosed and used as a wastebasket dx. MS was called hysterical paralysis until they realized men got it too. A lot of disorders that primarily affect women are given a bad rap. I admit to falling prey to the judgement too but am trying to be more open minded. JMHO.
Click to expand...
I have black mold in my lungs.
 
A while back, I had a patient tell me that her "fibromyologist" sent her into the emergency department for pain medication to control her advanced fibromyalgia. Naturally, I thought to myself "why couldn't I have been a fibromyologist?".
 
Greenbbs said:
A while back, I had a patient tell me that her "fibromyologist" sent her into the emergency department for pain medication to control her advanced fibromyalgia. Naturally, I thought to myself "why couldn't I have been a fibromyologist?".
Click to expand...
I had a similar one with fentanyl and oral dilaudid who had suspected fibro and was here for a pain crisis. Looked calm and relaxed the entire time. I wanted to find their pcp and smack them.
 
Bilateral, spontaneous lower extremity DVTS in the morbidly obese woman sent in by PCP, because we just gotta figure out what is causing that swelling today! (Answer: She's just getting fatter)
 
Beth_W737 said:
I think we are all a little quick to judge Fibro and other similar disorders. I worked with docs who do research on it and their pain is often real, it is sometimes overdiagnosed and used as a wastebasket dx. MS was called hysterical paralysis until they realized men got it too. A lot of disorders that primarily affect women are given a bad rap. I admit to falling prey to the judgement too but am trying to be more open minded. JMHO.
Click to expand...

I believe that Fibromyalgia is real. I just like to call it by its other name: Depression
 
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Beth_W737 said:
I think we are all a little quick to judge Fibro and other similar disorders. I worked with docs who do research on it and their pain is often real, it is sometimes overdiagnosed and used as a wastebasket dx. MS was called hysterical paralysis until they realized men got it too. A lot of disorders that primarily affect women are given a bad rap. I admit to falling prey to the judgement too but am trying to be more open minded. JMHO.
Click to expand...

I'm not sure about that - "hysterical paralysis" is an outmoded term for conversion disorder. Alternately, "hysteria" in women was treated with "therapeutic massage" (manual genital manipulation by the physician in the office) over 100 years ago. Recalcitrant cases could get hysterectomy.

Personally, I do NOT think that "we are all a little quick to judge Fibro". What has been studied to have been shown to be most effective, bar none, bar fistfuls of opiates enough to lethally inject 5 people, bar trigger point injections, bar Neurontin, bar Lyrica - is exercise. If I asked someone to describe the average fibro patient, it would be "a fat woman" (who isn't exercising).

And I agree with Mr. Hat - fibro is real, but it is not something new or unrecognized or different. When I had my period of depression, I had those point aches and pains, and I said "fibro is bull****, and I'll be damned if I have it!", and my doc said that, as my depression improved, my aches and pains would go away, and, you know what? They did! So I am, literally, empathetic, because I HAVE felt it.
 
Apollyon said:
I'm not sure about that - "hysterical paralysis" is an outmoded term for conversion disorder. Alternately, "hysteria" in women was treated with "therapeutic massage" (manual genital manipulation by the physician in the office) over 100 years ago. Recalcitrant cases could get hysterectomy.

Personally, I do NOT think that "we are all a little quick to judge Fibro". What has been studied to have been shown to be most effective, bar none, bar fistfuls of opiates enough to lethally inject 5 people, bar trigger point injections, bar Neurontin, bar Lyrica - is exercise. If I asked someone to describe the average fibro patient, it would be "a fat woman" (who isn't exercising).

And I agree with Mr. Hat - fibro is real, but it is not something new or unrecognized or different. When I had my period of depression, I had those point aches and pains, and I said "fibro is bullcrap, and I'll be damned if I have it!", and my doc said that, as my depression improved, my aches and pains would go away, and, you know what? They did! So I am, literally, empathetic, because I HAVE felt it.
Click to expand...

:thumbup::thumbup:

Just think how much less depressed you would have been (or mor accurately, how little you would have cared) if he had just put you on 120MED of oral dilaudid...

Also, aren't opioids a violation of the standard of care in FMS since they have not been shown to have any benefit?
 
sanityonleave said:
:thumbup::thumbup:

Just think how much less depressed you would have been (or mor accurately, how little you would have cared) if he had just put you on 120MED of oral dilaudid...

Also, aren't opioids a violation of the standard of care in FMS since they have not been shown to have any benefit?
Click to expand...

You might be surprised that many (good) Pain specialists and Rheumatologists have a policy of "no opiates for fibromyalgia." Take five minutes to peruse these abstracts.


Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study.Fitzcharles MA, Faregh N, Ste-Marie PA, Shir Y.
Pain Res Treat. 2013;2013:898493. doi: 10.1155/2013/898493. Epub 2013 Mar 18.


Chronic opioid use in fibromyalgia syndrome: a clinical review.
Painter JT, Crofford LJ.
J Clin Rheumatol. 2013 Mar;19(2):72-7. doi: 10.1097/RHU.0b013e3182863447.
PMID: 23364665 [PubMed - in process]


Opioid use, misuse, and abuse in patients labeled as fibromyalgia.
Fitzcharles MA, Ste-Marie PA, Gamsa A, Ware MA, Shir Y.
Am J Med. 2011 Oct;124(10):955-60. doi: 10.1016/j.amjmed.2011.05.031.


The use of opioids in fibromyalgia.Ngian GS, Guymer EK, Littlejohn GO.
Int J Rheum Dis. 2011 Feb;14(1):6-11. doi: 10.1111/j.1756-185X.2010.01567.x. Epub 2010 Aug 23. Review
 
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Greenbbs said:
A while back, I had a patient tell me that her "fibromyologist" sent her into the emergency department for pain medication to control her advanced fibromyalgia. Naturally, I thought to myself "why couldn't I have been a fibromyologist?".
Click to expand...

I hope you asked for that doctor's contact information (so you ask them what is needed to move from EM to fibromyologist sub-specialty. As EM is the specialty that sees fibromyalgia the most, I can only assume that you could be a "fibromyologist" in a year or two with the right training.)

GL to all you aspiring fibromyologists!
 
Birdstrike said:
You might be surprised that many (good) Pain specialists and Rheumatologists have a policy of "no opiates for fibromyalgia." Take five minutes to peruse these abstracts.


Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study.Fitzcharles MA, Faregh N, Ste-Marie PA, Shir Y.
Pain Res Treat. 2013;2013:898493. doi: 10.1155/2013/898493. Epub 2013 Mar 18.


Chronic opioid use in fibromyalgia syndrome: a clinical review.
Painter JT, Crofford LJ.
J Clin Rheumatol. 2013 Mar;19(2):72-7. doi: 10.1097/RHU.0b013e3182863447.
PMID: 23364665 [PubMed - in process]


Opioid use, misuse, and abuse in patients labeled as fibromyalgia.
Fitzcharles MA, Ste-Marie PA, Gamsa A, Ware MA, Shir Y.
Am J Med. 2011 Oct;124(10):955-60. doi: 10.1016/j.amjmed.2011.05.031.


The use of opioids in fibromyalgia.Ngian GS, Guymer EK, Littlejohn GO.
Int J Rheum Dis. 2011 Feb;14(1):6-11. doi: 10.1111/j.1756-185X.2010.01567.x. Epub 2010 Aug 23. Review
Click to expand...
+1 It's not just in fibromyalgia though. Chronic opiate use for non-cancer pain may be second only to putting dinosaur bones in the ground as the devil's most damaging prank on mankind.
 
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Given the jewish population here we have a 0% miss policy for the diagnosis of VD in the females of this cohort

The "Veak and Dizzies"
 
As someone who has friends and family with it, some who were children at diagnosis, it is not depression. It occurs more often with autoimmune disorders, they have increased levels of substance p. As a diagnosis of exclusion some people will be inappropriately diagnosed. And try living with chronic pain, any disorder with chronic pain can cause depression. If it was just depression don't you think the SSRIs would cure the majority of patients? But they don't. I'm not saying to prescribe dilaudid to people, I'm saying don't be so quick to judge. And yes, hysterical paralysis was used to describe MS. Plus many cases of FM occur in people with prior autoimmune disorders like Lupus, RA etc. I know it's easy to get jaded but try to keep an open mind. And FM is often far more than myalgias depression patients get.
 
Beth_W737 said:
As someone who has friends and family with it, some who were children at diagnosis, it is not depression. It occurs more often with autoimmune disorders, they have increased levels of substance p. As a diagnosis of exclusion some people will be inappropriately diagnosed. And try living with chronic pain, any disorder with chronic pain can cause depression. If it was just depression don't you think the SSRIs would cure the majority of patients? But they don't. I'm not saying to prescribe dilaudid to people, I'm saying don't be so quick to judge. And yes, hysterical paralysis was used to describe MS. Plus many cases of FM occur in people with prior autoimmune disorders like Lupus, RA etc. I know it's easy to get jaded but try to keep an open mind. And FM is often far more than myalgias depression patients get.
Click to expand...
Ok sure there are syndromes like this but I am sorry if a patient comes in who had been to multiple pain clinics and had been told not to take narcotics and comes in sitting playing on her cell phone and saying she is having a pain crisis and her pain is a 10. I call that BS.
Somebody was smart enough to give her dilaudid and Fentanyl at home and it didn't work. I know it's nice to go well in the past we couldn't find a cause so we probably aren't looking hard enough to find a cause. Sometimes there isn't a cause and people to have factious disorders. Which reminds me I just had a black mold flare up.
 
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MDRAP (multi-drug resistant abdominal pain)*

Chronic Lyme Infection**

*coined by Arcan, I believe
**to be distinguished from post-Lyme syndrome in that Chronic Lyme Infection is treated with high-dose, long-term IV antibiotics administered through indwelling catheters at high cost and with significant side effects . Disease course, duration and outcomes, however, are indistinguishable. Oh yeah, and the doctors who treat CLI charge A LOT more money.
 
Beth_W737 said:
And yes, hysterical paralysis was used to describe MS.
Click to expand...

You got a dog in this fight somewhere, so I'm leaving that alone. However, educate me - I researched this, and no one online has written about MS being called "hysterical paralysis", although there were other things called "hysterical paralysis". Show me something that supports your point, because I can prove that I am right - but what I am not saying is that you are wrong. 100 years ago, many things that looked alike were grouped together (like a panda and a raccoon and a bear - actually, by genetics, the panda is actually closer to a bear now, whereas the red panda is closer to a raccoon).
 
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Beth_W737 said:
As someone who has friends and family with it, some who were children at diagnosis, it is not depression. It occurs more often with autoimmune disorders, they have increased levels of substance p. As a diagnosis of exclusion some people will be inappropriately diagnosed. And try living with chronic pain, any disorder with chronic pain can cause depression. If it was just depression don't you think the SSRIs would cure the majority of patients? But they don't. I'm not saying to prescribe dilaudid to people, I'm saying don't be so quick to judge. And yes, hysterical paralysis was used to describe MS. Plus many cases of FM occur in people with prior autoimmune disorders like Lupus, RA etc. I know it's easy to get jaded but try to keep an open mind. And FM is often far more than myalgias depression patients get.
Click to expand...

I don't think SSRIs would cure the majority of patients simply because SSRIs have about the same efficacy as placebo; and both are pretty crappy.
 
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