New Year's Resolution: Broken.

Discussion in 'Emergency Medicine' started by RustedFox, Jan 2, 2019.

  1. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO.
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    This just happened.

    Working at a freestanding.
    Its snowbird season.
    Wife drags her husband to the ER for flu-like symptoms x 1-2 days. He doesn't wanna come, but she won't shut the hell up. Nuuuu Yawwwwk.

    He is a reasonable enough guy, but she brought the Encyclopedia Dramatica with her, and is reading it out loud, starting with "A". She looks like one of those other women from the scene in "Goodfellas" where Lorraine Bracco is at the party with all the mob wives getting their nails done and such.

    "Sure, I'll swab you for the flu. I'd also like to get a chest x-ray to see if there are other factors at play.
    CXR normal. Flu B+.

    "Your chest x-ray is normal, thankfully. Your flu swab is positive for influenza B. If you'd like, I can write a prescription for a drug called Tamiflu. Its not a very good drug, though. It might help you feel just slightly better; but its no guarantee. It may do nothing at all."

    Husband says Thank You. Is rather appreciative. Wife is too busy dialing the cellphone to say anything, which I was initially thankful for.

    I proceed to next room to look at kid with lac to forehead. No big. I can hear that woman from the other room yapping into the phone... Her freaking volume knob needs to be turned down.

    "Yeeeah. Yeeeeeeeah. Uh-huh. Well, the dawktahh says that dis here medicine will cure his flu."


    I was done looking at the kid anyways.

    I walked right back into Statin [sic... see what I did there] Island Sweetheart's room.

    "Stop. Don't say that. I didn't say that at all."

    She stops talking, phone still at her ear, in its designated fixed position. It probably just hovers there at all times, even when she's not holding onto it. Mouth open. Gum looking back at me.

    "The medicine does not cure the flu. Nothing cures the flu. What I said was that it might help improve his symptoms. I also said it might do absolutely nothing. What you're doing here is setting your own expectation, and not actually telling the truth about what I said. You didn't listen to me at all. You just wanted to think that this is what I would say, and now you're telling other people things that aren't true."

    She looks at me like she doesn't understand English.

    Husband says - "I understand what you said, Doc. Dun listen to her. She never listens to nothin' anyways."



    Resolution broken.



    The number one cause behind burnout is... the patient.
     
    #1 RustedFox, Jan 2, 2019
    Last edited: Jan 2, 2019
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  2. petegriffin

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    Uhm, I think it's new york and everything within the 50 mile radius. Tough working there...ppl (docs, pts, nurses, techs) are abrasive
     
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  3. Perfect Hair Day

    Perfect Hair Day Grapes of Wrath, Chocolate Ice Cream, Johnny Cash.
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    Husband of the year though.
     
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  4. bravotwozero

    bravotwozero Chronically ambitious
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    What did I tell you about keeping New Years resolutions?


    Sent from my iPhone using Tapatalk
     
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  5. d2305

    d2305 SDN Gold Donor
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    Patients are anxious after Bre Payton's death. Sounds like the 1918 flu, healthy yesterday and dead today.
     
  6. GonnaBeADoc2222

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    Should be universal ED policy of no "visitors" unless dying, can't give history for yourself, or are a minor. So over trying to speak directly to my patient and having 7 interjections, "they have more questions" after I've left the room, "oh room 9's aunt just showed up and has questions," and "you're not keeping him?!?!" after discharge order placed.
     
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  7. Psai

    Psai Snitches get zero vicryl
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    Sounds like the patient was just fine, it's the family that's the issue
     
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  8. OP
    OP
    RustedFox

    RustedFox We're all stars now. In the GOAT RODEO.
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    You're absolutely correct.

    I guess what drove me nuts about this vacant prole was directly spreading misconceptions in front of me is that I knew that it would eventually come back to bite me in the form of a patient asking for "the medicine that cures the flu".

    I wanted to punch her in the mouth in some spiritual form that wouldn't actually result in charges.
     
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  9. Perfect Hair Day

    Perfect Hair Day Grapes of Wrath, Chocolate Ice Cream, Johnny Cash.
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    "Here, take this - it's called Thalidomide - it'll prevent you from getting flu from your husband. It only works if you're sexually active though, so saddle up!"
     
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  10. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    That's odd. Nobody has mentioned her to me.
    They have ALL mentioned that poor little Guatemalan kid though.
     
  11. thegenius

    thegenius Senior Wharf Rat
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    I hear ya man. I don't think there is a job out there that completely avoids the crazies.

    I used to think it was always easier to take care of poor people than rich people. I'm beginning to think that is not the case.

    (I'm not saying your hubby couple above are rich or poor..just making a general observation)
     
  12. thegenius

    thegenius Senior Wharf Rat
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    I haven't heard of any of these.....wait
    was the guatemalan kid did he come across the border, saw a doctor, dx with the flu, then saw the doctor again a few days later and soon died?
     
  13. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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  14. OP
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    RustedFox

    RustedFox We're all stars now. In the GOAT RODEO.
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    Yep.
    If you ask the average *******, the child died not because he had the flu (which sometimes is fatal), but because Trump killed him with his policies.
     
  15. Birdstrike

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    Ah...The joys of dealing with the public.
     
  16. Alvarez13

    Alvarez13 PGEEE2 mediates FEEEVER
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    Had a guy come in after trying to circumcise himself. Ask him what he was thinking and states that he was just tired of dealing with it so he bought a new pair of scissors at Walmart because they would be sterile but had to stop because he was bleeding too much. I miss Darwinism.
     
  17. Old_Mil

    Old_Mil Senior Member
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    I'm not sure how one ends up living or working in the dystopian future predicted by the movie "Escape From New York" back in the 20th century...but consider that a significant portion of that state already has. They call it Florida.
     
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  18. Vandalia

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    The rich and the poor have their own eccentricities which in some strange way seem to complement each other.

    The only population that has, generally speaking, been a pleasure to treat are farmers and their immediate families.

    Several of us have fantasized about starting a "Farmer's Only" FSED.
     
  19. Groove

    Groove Member
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    Or a vets only ED a.k.a. VA. Man, I love taking care of vets when they grace my ED. Such nice people for the most part. Patient, respectful, grateful for their care, etc.. I'd totally work at the VA if it paid more.
     
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  20. GeneralVeers

    GeneralVeers Globus Hystericus
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    I like demented nursing home patients with NO family around. I essentially don't have to talk to them, and can make whatever disposition I want without interference.
     
  21. Apollyon

    Apollyon Screw the GST
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    I couldn't work at a VA, because I wouldn't do any medicine. I would just talk/bull****/shoot the breeze all day.
     
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  22. Groove

    Groove Member
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    It's a lot more attractive on the days where I feel like this during a shift...

    [​IMG]
     
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  23. filhodeinferno

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    Amen. But on the flip side, worst patients are the demented 90 year olds WITH family around that were too stupid to put them in a nursing home and are now there at 2 AM on a Saturday morning asking you to solve their problem on how they are going to take care of their old granny who had a negative workup. Especially bothers me when the family aren't poor and should otherwise completely be able to take care of something like that on their own. Not what I envisioned when I signed up for EM residency.....
     
  24. BoardingDoc

    BoardingDoc Don't worry. I've got my towel.
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    Meh, those don't bug me too much. Just admit them to obs. Physical therapy and case management consults. Sign chart. Next patient. Unless they code, I don't have to see them again.
     
  25. GeneralVeers

    GeneralVeers Globus Hystericus
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    Exactly. You want Grandma admitted? Sure thing. I explain to the hospitalist how family is REFUSING to take them home. Very rarely do I get pushback. These are super easy patients for them as it's all sorted by case management and PT with minimal work other than a D/C summary.
     
  26. Tipsy McStagger

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    Our hospitalists say “bad families are not a reason to admit” and they turn down almost all of these admissions. These patients can be very difficult for me. I wish I was in a place where admitting to medicine was that easy :(
     
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  27. DrMcCoyDO

    Physician Bronze Donor Verified Account 2+ Year Member

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    This is why I’m glad I’m at a hospital where medicine can’t refuse an admit. If the ED says they’re admitted, they’re admitted.
     
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  28. thegenius

    thegenius Senior Wharf Rat
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    Can't do that at my hospital, the hospitalists' will not admit them.

    Oh man if that were the case I would actually like EM.
     
  29. thegenius

    thegenius Senior Wharf Rat
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    Where I work the hospitalists don't give a s**t whether they refuse to take them back or not. If there is not an admitting diagnosis (and "weakness" is not one of them), they won't admit. Sucks...
     
  30. GonnaBeADoc2222

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    Mine take them pretty easily, and it makes my life easier. However, to be honest, why should these people be admitted? The hospital is not a hotel, and the tax payer (medicare) should not bear this burden. People need to plan for the future and not just dump their family in the ED.

    Sent from my SM-G928V using SDN mobile
     
  31. OP
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    RustedFox

    RustedFox We're all stars now. In the GOAT RODEO.
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    I agree, although my hospitalists generally admit these without a problem here in the United States Capital of Old People.
    Its a safety issue. If Grandma can't walk and lives alone, we'd rather admit them then say "GLMF"
     
  32. bravotwozero

    bravotwozero Chronically ambitious
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    Are your Hospitalists part of sound physicians? If they are, either find a way to get rid of them or run.


    Sent from my iPhone using Tapatalk
     
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  33. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Or have a calm, rational explanation with the C-Suite that a) the hospitalist are reducing the hospital's income by refusing admissions, and b) by not consulting on the patient they are violating EMTALA. Now, it may result in you no longer working there, but I still consider that a win.
     
  34. Dr Mantis Toboggan

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    Yup. Ability to admit without being questioned is one of my top 3 requirements for a job. Mandatory in my opinion.


     
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  35. GeneralVeers

    GeneralVeers Globus Hystericus
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    How is this a thing? If I want to admit a patient, I tell the hospitalist they are free to come examine the patient and discharge them if they want to. Most hospitals require consultants (including hospitalists) to come evaluate a patient on our request. Why not let the hospitalist spend his/her time arguing with unreasonable family over discharge? That leaves me free to do other things. This is why most hospitalists will just admit, as they know I've already had that argument, and don't want to waste their time as well.

    If they refused to see them, I would just bump it up to charge nurse/house supervisor, and have them go up the chain from there while I see other patients. Seriously, regardless of your hospitalist, this shouldn't take any energy to get a dispo.
     
  36. scummie

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    Yes, this makes it a lot easier. Every so often I get some push back and then it’s some phone tag with utilization management that goes my way. A lot of what I do every day has nothing to actually do with medicine or antibiotics or how to reduce a fracture—it’s about the social stuff.
     
  37. scummie

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    Wait, the ER is not a hotel? No one mentioned this on the yelp review.
     
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  38. WilcoWorld

    WilcoWorld Senior Member
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    Yep, the medicine is the easiest part of working in the ED!
     
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  39. southerndoc

    southerndoc life is good
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    Our hospitalists will admit these types of patients, but usually I can get the family to take them home by simply staying "I'm sure the hospital can put you in observation status. Just be advised that you will have to pay a higher copay, pay for your medications, etc." Then I tell them the hospitalist can be fined if he/she inappropriately certifies them as an admission.

    That usually makes them want to go home. If not, I then add the spill that they won't be getting "respite" in the hospital because of frequent vital signs checks, lab draws, etc.

    If they continue to want to be admitted, then the hospitalist will admit them. A good portion will want to go home.
     
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  40. thegenius

    thegenius Senior Wharf Rat
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    They argue that it's not their job to discharge patients from the ED, just like it's not my job to discharge admitted patients. Their approach is every admission is a "consult" and they agree to admit them, or not. They just say "they do not meet criteria for admission."

    So if a family dumps their old grandma because they can't take care of them anymore, they stay in the ED for a few days while our social workers try to place them somewhere.
     
  41. thegenius

    thegenius Senior Wharf Rat
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    yes they are!!!!!! LMAO
     
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  42. thegenius

    thegenius Senior Wharf Rat
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    I agree, in general. Hospital should be for acute care medicine. I think sitting in a hospital getting an IV antibiotic q24hr for an infection with stable vital signs is also a misuse of resources, in general.
     
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  43. thegenius

    thegenius Senior Wharf Rat
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    They will consult, they understand that part. They put up a fight, complain, or say things like "get an ABG, another troponin in 3 hours, and if OK you can discharge." So the patient stays in the ER for at least 3-4 more hours.

    Plus you end up not having a good relationship with them, and that's no fun. Patients are hard enough to deal with, none of us want to have a bad relationship with consult services too.
     
  44. thegenius

    thegenius Senior Wharf Rat
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    Is there something that clearly delineates what observation status means? I've heard it reimburses less...but didn't know about these copays, paying for medicines, etc.

    Problem where I work is nobody has money, they are all under CA medicaid, so none of this stuff matters because it doesn't really affect the patient's bottom line.
     
  45. OP
    OP
    RustedFox

    RustedFox We're all stars now. In the GOAT RODEO.
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    Anyone else getting this?

    Me: "I have your results. Your influenza, or flu swab is positive. You have the flu."
    Pt: "Whazzat mean, then?"

    Come on, r/tard - you freaking know what "having the flu" is.

    This is generally followed by another stupid question, most commonly:

    "Well howscome I feel so baaad, then?"
     
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  46. thegenius

    thegenius Senior Wharf Rat
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    Every shift
    astounding that humanity can advance when the IQ of tens of millions of people is that of a soap dish.
     
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  47. OP
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    RustedFox

    RustedFox We're all stars now. In the GOAT RODEO.
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    Yep.
    EM is so frustrating for me because I really have a hard time tolerating "stupid".
    Its encounters like these which make me say stupid things like: "I wish I had done surgery."
     
  48. WilcoWorld

    WilcoWorld Senior Member
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    it's probably bad for the patient too
     
  49. WilcoWorld

    WilcoWorld Senior Member
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    first shift back after a nice winter break and it was a goddamn dumpster fire
     
    #49 WilcoWorld, Jan 4, 2019
    Last edited: Jan 5, 2019
  50. Perfect Hair Day

    Perfect Hair Day Grapes of Wrath, Chocolate Ice Cream, Johnny Cash.
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    [​IMG]
     
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