Is gastroenteritis that difficult to diagnose clinically....or does EVERYONE need a CT abd/pel?

[Ho0v-man]

It’s not 20 years ago where an ER doc can just treat symptoms and watch the patient. Most ERs have had 2 patients waiting on every currently occupied bed for years. I’d much rather interpret the BS study than deal with the patient who came in for this BS in the first place.

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[vm26]

It’s not 20 years ago where an ER doc can just treat symptoms and watch the patient. Most ERs have had 2 patients waiting on every currently occupied bed for years. I’d much rather interpret the BS study than deal with the patient who came in for this BS in the first place.

Most definitely. I get many rads are burnt-out (as are other physicians), but as long as we have fee-for-service in place, still think we have it pretty good. Image-overload does play a role in fatigue/misses (thousands of images in pan-scan trauma which now often includes CTA head/neck) but just part of the gig.

 

[RustedFox]

Until. We. Have. Tort. Reform. Nothing. Will. Change.

 

[thegenius]

Everything

Until. We. Have. Tort. Reform. Nothing. Will. Change.

Just get rid of the periods it's easier to read.

 

[RustedFox]

Everything


Just get rid of the periods it's easier to read.

They're. For. Emphasis?

 

[southerndoc]

Just get rid of the periods it's easier to read.

I gotta slow down with the speed reading. Initially I thought your comment was directed at females.

 

[thegenius]

They're. For. Emphasis?

TRY THIS ON FOR EMPHASIS.

 

[RustedFox]

TRY THIS ON FOR EMPHASIS.

I tried your mom on for emphasis.

 

[Apollyon]

I tried your mom on for emphasis.

Ouch! Need some Silvadene for that burn?

 

[thegenius]

I tried your mom on for emphasis.

Yup...She. Told. Me. You. Had. Too. Many. Periods.
she was bored.

 

[RustedFox]

Yup...She. Told. Me. You. Had. Too. Many. Periods.
she was bored.

AHHAAAAHAHAHAAA!

Dude, you absolutely got me to laugh out loud there.
Touche'.

 

[TooMuchResearch]

Everyone is citing high EM malpractice risk as a reason for ordering tests that are not really indicated if going by guidelines, or admitting patients that probably could be reasonably discharged. In reality, according to this study EM malpractice risk is similar to that as the average physician when compared to other specialties (Malpractice Risk According to Physician Specialty); it's the surgical specialties that have the highest malpractice risk. Also, studies have shown that the probability of losing personal assets in a malpractice lawsuit (ie someone successfully sues above your malpractice insurance coverage limits), while not zero, is extremely rare and probably almost as low as winning the lottery.

Okay, now tell the hospital peer review/witch hunt committee that you didn't order the tests because they weren't indicated or because the patient actually didn't want to do the low probability testing.

I'm on a peer review committee that I can't quit because someone has to stay who thinks that most of what gets sent to us is reasonable care that doesn't need intervention/education/reprimand. But someone still tallies all the cases for ammunition later.

 

[bougiecric]

We say "malpractice," but I think it's used as shorthand similar to how nurses will say, "I don't want to lose my license."

Malpractice concerns me, but there are many more avenues for people to retrospectively judge your care. Medical board, peer review, QI/QA, M&M, clipboard nurse emails, trauma/STEMI/stroke committees, patient complaints. Much of my practice is based around avoiding being contacted by any of the above.

 

[RustedFox]

We say "malpractice," but I think it's used as shorthand similar to how nurses will say, "I don't want to lose my license."

Malpractice concerns me, but there are many more avenues for people to retrospectively judge your care. Medical board, peer review, QI/QA, M&M, clipboard nurse emails, trauma/STEMI/stroke committees, patient complaints. Much of my practice is based around avoiding being contacted by any of the above.

So much this.
Fortunately, I've found that my very direct and easy-to-read style of charting (which has changed as of about a year ago) does a pretty good job of keeping me out of said situations.

 

[MechEDoc]

So much this.
Fortunately, I've found that my very direct and easy-to-read style of charting (which has changed as of about a year ago) does a pretty good job of keeping me out of said situations.

It's much easier to order a test, chart something about needing it, rather than having to provide a long justification as to why you missed something when a simple test (TSH, d-dimer, CT) would have caught it. We have the tools in our toolbox, why not use them?

 

[RustedFox]

It's much easier to order a test, chart something about needing it, rather than having to provide a long justification as to why you missed something when a simple test (TSH, d-dimer, CT) would have caught it. We have the tools in our toolbox, why not use them?

Good question, and I don't disagree.

I nearly always include language about shared decision making and risk/benefit analysis. I love to include the phrase "patient makes clear their desire in both word and in gesture."

 

[Mount Asclepius]

Good question, and I don't disagree.

I nearly always include language about shared decision making and risk/benefit analysis. I love to include the phrase "patient makes clear their desire in both word and in gesture."

I try to imagine what you mean by patients gesturing as they decline testing.

Very few of my patients ever decline testing if offered. They usually gesture when they don’t get testing. Not typically a middle finger, but it’s more so along those lines if I refuse or don’t recommend testing.

So, not so much treat and street as it is gest and test… then street.

 

[RustedFox]

I try to imagine what you mean by patients gesturing as they decline testing.

Very few of my patients ever decline testing if offered. They usually gesture when they don’t get testing. Not typically a middle finger, but it’s more so along those lines if I refuse or don’t recommend testing.

So, not so much treat and street as it is gest and test… then street.

So, this is the subtle suggestion/mirroring thing. I learned this somewhere in a behavioral health book or something.

I ask the question: "So, to be clear; we've talked this thru and you DON'T want me to CAT scan your (head/chest/whatever)" and I shake my head side-to-side and hold my hand up, palm towards them in the "STOP!" gesture that a traffic cop makes.

They then do the same.

 

[Mount Asclepius]

So, this is the subtle suggestion/mirroring thing. I learned this somewhere in a behavioral health book or something.

I ask the question: "So, to be clear; we've talked this thru and you DON'T want me to CAT scan your (head/chest/whatever)" and I shake my head side-to-side and hold my hand up, palm towards them in the "STOP!" gesture that a traffic cop makes.

They then do the same.

Jedi mind tricks. Brilliant.

 

[RustedFox]

Jedi mind tricks. Brilliant.

Thanks; but really - it's not out of line. People (admins, peer review committees, scumbag attorneys) need to recognize just how dumb the average muggle is and why we do what we do. This makes it clear to them that I did "the reasonable thing", which was discuss risks/benefits/alternatives and made the decision along with the patient who understood and made themselves clear.