Doctors sometimes offering embarrassing advice

[thegenius]

A woman comes in saying she needed stitches for a finger lac. She already cleaned it and put on a bandaid. She called the advice nurse. SENT THE ADVICE NURSE PICTURES. The nurse then talked to a doctor, and ultimately said "you should go to the ER because you need stitches."

This was the smallest laceration ever! It was tiny! So f'ing embarrassing that a doctor and a nurse told her that. I legit said "I'm sorry you got bad advice. So embarrassing." She even showed me the picture she sent the advice nurse. I said...based on that they told you to go to the ER?

I was shocked. i wish I could post the picture. What the F are bandaids for it not to cover minor lacerations?!?!

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[namethatsmell]

Once had a pt sent in by urgent care midlevel for rabies tx…2/2 a dog bite that did not break the skin…

Patient probably got $1000 bill for crossing the threshold to the ER, though at least she could laugh about how absurd it was she was sent in

 

[thegenius]

I know we beat the same drum over and over
the kind of crap sent to the ER is sometimes just embarrassing. I rarely throw another "provider" under the bus, but I was happy to this time.

 

[Tiger26]

I had a patient show up last week where I had to ask her to point out the laceration on her finger that she was concerned about because I couldn't immediately identify it. Actually had to ask her twice to clarify. A bandaid was overkill in this case.

Actually my new favorite thing is telling patients freaking out about sutures that we can just put a bandaid on their wound.

 

[Janders]

I try not to throw anyone under the bus, but my poker face only goes so far and there are a couple GOOD urgent cares nearby I tell these people about…

 

[Angry Birds]

Once had a pt sent in by urgent care midlevel for rabies tx…2/2 a dog bite that did not break the skin…

Patient probably got $1000 bill for crossing the threshold to the ER, though at least she could laugh about how absurd it was she was sent in

Priceless

 

[Angry Birds]

I had a patient show up last week where I had to ask her to point out the laceration on her finger that she was concerned about because I couldn't immediately identify it. Actually had to ask her twice to clarify. A bandaid was overkill in this case.

Actually my new favorite thing is telling patients freaking out about sutures that we can just put a bandaid on their wound.

On a serious note, that’s what demabond exists. You can even put it on perfectly intact skin.

 

[thegenius]

I try not to throw anyone under the bus, but my poker face only goes so far and there are a couple GOOD urgent cares nearby I tell these people about…

I usually don't but I couldn't resist this time.

 

[DocEspana]

As an intern we had a trauma activation coming by helicopter for a pediatric finger amputation. We were told that "it's hanging off" and to "alert hand surgery" by the paramedics coming by helicopter (stressing because... you know where this is going). The helicopter arrives and the paramedics get off, as well as a mother who is cradling her daughter against her body, and daughter is holding a blanket that is not overtly blood soaked. Mother is openly weeping. Paramedics look scared. Child looks... actually.... fine. Obvious "this ain't right" moment.

Before they get to go in to the building I take the blanket out of the child's hand to look at the injury. And admittedly there is some blood on the blanket, but only some. This injury.... Its somewhere between a linear laceration of the fingerpad and a true papercut. The color drains out of the faces of the paramedics, with one of them saying 'I'm so sorry.... there was.... a lot of blood on the scene. We just.... we trusted the mom."

 

[WhatJobDoIPick]

As an intern we had a trauma activation coming by helicopter for a pediatric finger amputation. We were told that "it's hanging off" and to "alert hand surgery" by the paramedics coming by helicopter (stressing because... you know where this is going). The helicopter arrives and the paramedics get off, as well as a mother who is cradling her daughter against her body, and daughter is holding a blanket that is not overtly blood soaked. Mother is openly weeping. Paramedics look scared. Child looks... actually.... fine. Obvious "this ain't right" moment.

Before they get to go in to the building I take the blanket out of the child's hand to look at the injury. And admittedly there is some blood on the blanket, but only some. This injury.... Its somewhere between a linear laceration of the fingerpad and a true papercut. The color drains out of the faces of the paramedics, with one of them saying 'I'm so sorry.... there was.... a lot of blood on the scene. We just.... we trusted the mom."

In Emergency Medicine, one of the primary tasks in any patient encounter is to deduce "who is lying, and why?"

 

[emergentmd]

A woman comes in saying she needed stitches for a finger lac. She already cleaned it and put on a bandaid. She called the advice nurse. SENT THE ADVICE NURSE PICTURES. The nurse then talked to a doctor, and ultimately said "you should go to the ER because you need stitches."

This was the smallest laceration ever! It was tiny! So f'ing embarrassing that a doctor and a nurse told her that. I legit said "I'm sorry you got bad advice. So embarrassing." She even showed me the picture she sent the advice nurse. I said...based on that they told you to go to the ER?

I was shocked. i wish I could post the picture. What the F are bandaids for it not to cover minor lacerations?!?!

The nurse may have said she did but prob did t show the doc or the doc was so lazy who didn’t even look and just told them to go.

 

[Apollyon]

As an intern we had a trauma activation coming by helicopter for a pediatric finger amputation. We were told that "it's hanging off" and to "alert hand surgery" by the paramedics coming by helicopter (stressing because... you know where this is going). The helicopter arrives and the paramedics get off, as well as a mother who is cradling her daughter against her body, and daughter is holding a blanket that is not overtly blood soaked. Mother is openly weeping. Paramedics look scared. Child looks... actually.... fine. Obvious "this ain't right" moment.

Before they get to go in to the building I take the blanket out of the child's hand to look at the injury. And admittedly there is some blood on the blanket, but only some. This injury.... Its somewhere between a linear laceration of the fingerpad and a true papercut. The color drains out of the faces of the paramedics, with one of them saying 'I'm so sorry.... there was.... a lot of blood on the scene. We just.... we trusted the mom."

I had a woman with an open fracture of the 5th toe. On the weekend, so no ortho. I call Ortho at the big house, and he says, "splint it". I told him, maybe, you might want look at the X-ray. The distal middle phalanx is inline - just completely lateral to the medial part. This was the literal "hanging off". He had me send her.

 

[Saddleshoes]

Rule #1 in ALL of healthcare...

When you have no idea what is going on, Refer to the Emergency Department.

 

[thegenius]

Once again...34M with cough and fatigue for many weeks, has had three xrays that all show mild atelectasis or maybe a tinge of developing PNA.
Normal Vitals.

The PCP notes are littered with "Strict Precautions to the ED" in every stupid note. "I'm directing you to the ER for worsening symptoms."


This guy is totally stable. Why can't this be taken care of by other doctors in the outpatient world?!?!?!?!?!?!?!?!

 

[greatnt249]

A woman comes in saying she needed stitches for a finger lac. She already cleaned it and put on a bandaid. She called the advice nurse. SENT THE ADVICE NURSE PICTURES. The nurse then talked to a doctor, and ultimately said "you should go to the ER because you need stitches."

This was the smallest laceration ever! It was tiny! So f'ing embarrassing that a doctor and a nurse told her that. I legit said "I'm sorry you got bad advice. So embarrassing." She even showed me the picture she sent the advice nurse. I said...based on that they told you to go to the ER?

I was shocked. i wish I could post the picture. What the F are bandaids for it not to cover minor lacerations?!?!

Clearly it turned out to be an inappropriate referral, though my question for the patient would be, for what reason do you need to call anyone for what to do about a simple laceration?

 

[emergentmd]

We all get this b/c some Americans are just dumb as rocks with no common sense. No biggie. See, bill, discharge, 10 minutes, charge a level 3.

 

[CajunMedic]

This guy is totally stable. Why can't this be taken care of by other doctors in the outpatient world?!?!?!?!?!?!?!?!

If it’s like some of the ones I’ve seen recently. They’re a complete and total PITA, and it’s easier to foist them on me to tell them the same thing in a different voice; than it is to tell them to suck it up, here’s a prescription for 2 testicles, respiratory viruses suck and you’re going to feel bad for a while, here’s your inhaler, prednisone, and tessalon perles.

(Can’t you tell I’m sick of whatever URI and GI bug is going around in my area. Meanwhile, I’m double-fisting pepto and Imodium, chased with Gatorade and cough drops, but still managing to work)

 

[thegenius]

Clearly it turned out to be an inappropriate referral, though my question for the patient would be, for what reason do you need to call anyone for what to do about a simple laceration?

We did talk about that a little bit. She just wanted some advice from the nurse and was surprised when the nurse said "go in" after looking at the picture. I kind you not it was < 1 cm long and not deep.

 

[BoardingDoc]

Local PCP just sent me someone last night.

Patient sees PCP for multiple chronic things. One of those things is 6 months of diarrhea. ~3x a day. Doc gets a KUB. KUB is later read by rads as "No air fluid levels. Focal thickened area of small bowel, possibly due to focal ileus or obstruction."

PCP tries to calls patient TWELVE times (per documentation and confirmed by patient) to say he urgently needs to go to the ER.

Me: Does your belly hurt?
Him: No.
Me: You still having diarrhea and passing gas like you have been for 6 months?
Him: Yeah
Me: <abd exam done. is normal>. You don't have an obstruction. Obviously. Wanna go home?

Just bananas stupid.

 

[WhatJobDoIPick]

It's gotten so bad from some of these idiot PCPs that because you hear "But Noctor Mackenzie sent me in to rule out an obstruction!" so many times per shift, and thus, just reflexively order the CT, it is a profound breath of fresh air when you encounter a patient who is easily reassured with a clinical exam and agree that their PCP is just as much of an idiot as you think.

 

[pkwraith]

Local PCP just sent me someone last night.

Patient sees PCP for multiple chronic things. One of those things is 6 months of diarrhea. ~3x a day. Doc gets a KUB. KUB is later read by rads as "No air fluid levels. Focal thickened area of small bowel, possibly due to focal ileus or obstruction."

PCP tries to calls patient TWELVE times (per documentation and confirmed by patient) to say he urgently needs to go to the ER.

Me: Does your belly hurt?
Him: No.
Me: You still having diarrhea and passing gas like you have been for 6 months?
Him: Yeah
Me: <abd exam done. is normal>. You don't have an obstruction. Obviously. Wanna go home?

Just bananas stupid.

Him: So what's causing my diarrhea, are you going to figure that out? I waited 5 hours for this? Also what are you going to do about my 10/10 pain.

 

[BoardingDoc]

Him: So what's causing my diarrhea, are you going to figure that out? I waited 5 hours for this? Also what are you going to do about my 10/10 pain.

He was actually quite reasonable. Our interaction verbatim was
Him: "So I'm ok? I'm not dying?"
Me: "Yeah. You're fine."
Him: "Ok. If I die though, I'm totally gonna haunt your ass."
Me: "I'm ok with that."

 

[CoolDoc1729]

He was actually quite reasonable. Our interaction verbatim was
Him: "So I'm ok? I'm not dying?"
Me: "Yeah. You're fine."
Him: "Ok. If I die though, I'm totally gonna haunt your ass."
Me: "I'm ok with that."

“You’re going to die someday, but not this day!”

 

[comp1]

I get when something doesn't perfectly fit an algorithm, but you'd really think the medicolegal liability would be quite low if they had an issue and the advice nurse advised someone to seek urgent care as opposed to going to an emergency department. For example, a laceration, if it's cleaned and no longer bleeding, I can't see why anyone would recommend ED over an urgent care. From 9 AM to 9 PM there are very, very few things that you should be able to call someone about and then drive yourself to the ED for. Maybe we just need to build urgent cares into our RN algorithms more aggressively? It seems like insurance companies, which run most of the advice nurse lines, would be strongly in favor of this. The only options in the algorithm shouldn't be: "you're fine," "call your PCP tomorrow" and "go to ED now."

 

[Mount Asclepius]

Urgent cares. Where medicine goes to die.

We all will die someday. Just hopefully not from diarrhea, and certainly hope not at an urgent care.

 

[thegenius]

Local PCP just sent me someone last night.

Patient sees PCP for multiple chronic things. One of those things is 6 months of diarrhea. ~3x a day. Doc gets a KUB. KUB is later read by rads as "No air fluid levels. Focal thickened area of small bowel, possibly due to focal ileus or obstruction."

PCP tries to calls patient TWELVE times (per documentation and confirmed by patient) to say he urgently needs to go to the ER.

Me: Does your belly hurt?
Him: No.
Me: You still having diarrhea and passing gas like you have been for 6 months?
Him: Yeah
Me: <abd exam done. is normal>. You don't have an obstruction. Obviously. Wanna go home?

Just bananas stupid.

This is it. This is exactly what I'm talking about. This is not the pt's fault. There is no reason ever to get a KUB for 6 months of (painless) diarrhea, and the doctor doesn't even know what to do with a read that goes against the top 20 entries on his differential diagnosis. Both obstruction, and for that matter ileus, do not account for 6 months of diarrhea. So sad.

 

[cyanide12345678]

Had a real (not NP) doctor send in a patient with a laceration. She saw the guy in clinic for a area of bleeding from the hand. She states on the phone that she couldn’t get it to stop bleeding, and says that she’s sending it my way - starts talking about how she thinks it’s an arterial bleeding and asks if I’ll have to transfer the patient for vascular surgery.

Patient arrives - paper cut sized laceration. Granted it was oozing enough that i had to apply pressure for a few minutes and then do dermabond.

But this pcp was having a very very serious conversation with me about how i might have to transfer this patient for vascular 🤣

 

[emergentmd]

Had a real (not NP) doctor send in a patient with a laceration. She saw the guy in clinic for a area of bleeding from the hand. She states on the phone that she couldn’t get it to stop bleeding, and says that she’s sending it my way - starts talking about how she thinks it’s an arterial bleeding and asks if I’ll have to transfer the patient for vascular surgery.

Patient arrives - paper cut sized laceration. Granted it was oozing enough that i had to apply pressure for a few minutes and then do dermabond.

But this pcp was having a very very serious conversation with me about how i might have to transfer this patient for vascular 🤣

Some docs are dumb as rocks. I get transfers from outside all the time. All I need is diagnosis, and why. Getting into an in depth diagnosis is a crazy waste of time.

 

[MechEDoc]

I had a woman with an open fracture of the 5th toe. On the weekend, so no ortho. I call Ortho at the big house, and he says, "splint it". I told him, maybe, you might want look at the X-ray. The distal middle phalanx is inline - just completely lateral to the medial part. This was the literal "hanging off". He had me send her.

My final med flight as a resident (we flew in residency) was a scene flight for a arterial bleed wrist laceration with a tourniquet in place! Lots of drama landing a parking lot so that the patient could get to a hand and vascular surgeon in a timely manner! It didn't seem so bad so I took the tourniquet off on scene. It was an isolated laceration of the palmaris longus with venous oozing. $30-40k transport costs for a superfluous tendon.

 

[Apollyon]

My final med flight as a resident (we flew in residency) was a scene flight for a arterial bleed wrist laceration with a tourniquet in place! Lots of drama landing a parking lot so that the patient could get to a hand and vascular surgeon in a timely manner! It didn't seem so bad so I took the tourniquet off on scene. It was an isolated laceration of the palmaris longus with venous oozing. $30-40k transport costs for a superfluous tendon.

Reminds me of a guy I saw in Hawai'i. Left handed, chopping something with a chef's knife, and stabbed himself right in the radial artery on the Right. Like, legit arterial bleeding. He got it.

I called Vascular downtown at the big house, and they were HAPPY to take him. The med director was in the office, and he asks me, "are you going to oversew that?", and I gave him the look like I gave the manager at Longhorn Steakhouse when he asked if I wanted A-1. I tell the director, "no, this needs OR repair".

The med director did two years of surgical residency in the 80s. The management of the department was...suspect.

Most of my career, I was the "sender", not the "sendee".

 

[Janders]

Reminds me of a guy I saw in Hawai'i. Left handed, chopping something with a chef's knife, and stabbed himself right in the radial artery on the Right. Like, legit arterial bleeding. He got it.

I called Vascular downtown at the big house, and they were HAPPY to take him. The med director was in the office, and he asks me, "are you going to oversew that?", and I gave him the look like I gave the manager at Longhorn Steakhouse when he asked if I wanted A-1. I tell the director, "no, this needs OR repair".

The med director did two years of surgical residency in the 80s. The management of the department was...suspect.

Most of my career, I was the "sender", not the "sendee".

As a resident on an OSH rotation I had a guy do similar while working in a fish canning factory. Smelled like fish guts and was spraying radial blood everywhere.
I put a BP cuff up as a tourniquet and called the hand surgeon
HS— it’s not arterial. It’s venous. (On the phone)
Me— ma’am I know the radial artery. And his in in two pieces.
HS— oversew it an send it to clinic
Me— ma’am I’m also close enough to graduation to tell you I’m not gonna follow that plan. He’s got rusty knife fish guts smeared between his radial artery and nerve…
HS- ok repair the artery
Me— um I missed that part of my training
HS— I’ll come down and show you how to suture it, because only the skin needs suturing. You people always think the arteries are injured. *hangs up*

Act II, 5min later. 5’1’’ Hand surgeon arrives, angry.
HS— watch, I’m going to take this stupid cuff down and..
*Firehouse of arterial blood soaks her scrubs while she tries to get a thumb on it*
*blood is now on her face. In her hair. The patient begins to scream*
*HS grabs a pair of needle drivers out of the suture kit, digs in the wound a moment, clamps the unanesthetized proximal radial artery with said needle drivers. Patient howls. Needle drivers rhythmically pulsate*

HS- 1gm ancef on call to OR for radial artery and nerve repair and wound washout call the OR to book it *stomps off*

I’m not sure the moral of the story, but I remember the smell…

 

[MechEDoc]

I’m not sure the moral of the story, but I remember the smell…

Something like, "hah! F-you and your attitude!" comes to mind. Or perhaps, pride goes before the fall?

 

[alpinism]

To be fair the vast majority of "arterial bleeds" I've seen transferred were nothing but some mild capillary oozing.

I'll also mention that unless there is a total loss of extremity perfusion there really isn't any need for emergency operative intervention.

Not to hate on anyone's training but these cases really just need a figure of eight stitch then washout at the bedside. I'll see these pretty regularly when I'm overseas from machete wounds and they all do just fine without any specialists. In most of these places there aren't even any on call vascular surgeons in the entire country and it's not like these people are doomed to have their limbs amputated. To be honest it's a great example for residents about why managing traumas during residency is actually important so that you can get comfortable with managing bleeding and not have to do all these unnecessary specialist transfers when you're out working in community hospitals.

 

[GassYous]

To be fair the vast majority of "arterial bleeds" I've seen transferred were nothing but some mild capillary oozing.

I'll also mention that unless there is a total loss of extremity perfusion there really isn't any need for emergency operative intervention.

Not to hate on anyone's training but these cases really just need a figure of eight stitch then washout at the bedside. I'll see these pretty regularly when I'm overseas from machete wounds and they all do just fine without any specialists. In most of these places there aren't even any on call vascular surgeons in the entire country and it's not like these people are doomed to have their limbs amputated. To be honest it's a great example for residents about why managing traumas during residency is actually important so that you can get comfortable with managing bleeding and not have to do all these unnecessary specialist transfers when you're out working in community hospitals.

Just hold pressure. All bleeding stops eventually

 

[WhatJobDoIPick]

To be fair the vast majority of "arterial bleeds" I've seen transferred were nothing but some mild capillary oozing.

I'll also mention that unless there is a total loss of extremity perfusion there really isn't any need for emergency operative intervention.

Not to hate on anyone's training but these cases really just need a figure of eight stitch then washout at the bedside. I'll see these pretty regularly when I'm overseas from machete wounds and they all do just fine without any specialists. In most of these places there aren't even any on call vascular surgeons in the entire country and it's not like these people are doomed to have their limbs amputated. To be honest it's a great example for residents about why managing traumas during residency is actually important so that you can get comfortable with managing bleeding and not have to do all these unnecessary specialist transfers when you're out working in community hospitals.

The standard of care in the US is a bit different than in a 3rd world machete fight.