Note to self

[deleted65604]

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We found a memo under a patient's bed after they were discharged from the ER. It read: "use a kane when I go and see doc on Monday. Be in a lot of pain and cry... raise pain meds and xanax." We all know this kind of behavior goes on, but to see it in written form brings an extra level of frustration and irritation.

 

[e30ftw]

..sometimes it's nice to have a written reminder when your gorked out of your head from taking the rest of your roxi's and xani bars because you knew you'd get a refill that day..

how many times have you seen someone basically making the Q sign, borderline apneic, w/ a RR < 10 asking for IV meds "caaaaause daahc ahh huuourt wallll overh"

zombies

 

[Birdstrike]

We found this under a patient's bed after they were discharged from the ER. We all know this kind of behavior goes on, but to see it in written form brings an extra level of frustration and irritation.

You might be able to help this person by making sure their prescribing doctor knows about this.

 

[Spinach Dip]

Oh no!

That poor person! How are they going to trick their doctor without their note?

Now they may have to live without an increase in their Xanax. How sad.

 

[Birdstrike]

We found this under a patient's bed after they were discharged from the ER. We all know this kind of behavior goes on, but to see it in written form brings an extra level of frustration and irritation.

Just realized...your first post in 8 months. Where've you been?

 

[Groove]

Hahaha, oh man... Please tell me you scanned that into their chart...

 

[EM Junkie]

Awesome.

 

[nlax30]

Did he really come in with a Kane? 😉

http://en.m.wikipedia.org/wiki/Kane_(wrestler)

'cause that'd be pretty cool.

 

[Cinclus]

That this person found the need to write this out as a note-to-self is amazing/disturbing.

 

[wholeheartedly]

curious what was on the other half of the sheet, looks like there's more?

 

[e30ftw]

had a pt this evening prick his finger then stir the blood in his urine.

cc: hematuria.

luckily registration saw him do it.

discharge, f/u w/ police.

 

[NdNThunder]

👍

 

[GreenEydGem]

👍

Totally amazes me at what lengths people go to for pain meds. I used to manage a Vascular Surgery Fellowship and talk about far fetched stories. I've also seen patients become violent when they are told they are being referred to the pain clinic.

 

[Apollyon]

Hahaha, oh man... Please tell me you scanned that into their chart...

Just to be a killjoy, but, if the note was under the bed, you couldn't be sure that it was from that patient. Circumstantially, yes, but not sure. Then, bring in a scumbag POS lawyer, and there's trouble.

 

[WilcoWorld]

Just to be a killjoy, but, if the note was under the bed, you couldn't be sure that it was from that patient. Circumstantially, yes, but not sure. Then, bring in a scumbag POS lawyer, and there's trouble.

Reasonable point, but what if you explicitly state your doubt in the chart too?

Such as "The attached note was found in this patient's room immediately after he was discharged. While he presented with a kane [sic] and requested Xanax, it remains uncertain whether Todd O. Body-Dolor actually authored this note, so future providers should interpret this information with caution."

 

[Birdstrike]

Reasonable point, but what if you explicitly state your doubt in the chart too?

Such as "The attached note was found in this patient's room immediately after he was discharged. While he presented with a kane [sic] and requested Xanax, it remains uncertain whether Todd O. Body-Dolor actually authored this note, so future providers should interpret this information with caution."

I hate to be Mr. Cold Shower, but...

It could also be a HIPAA violation by posting the note online (if it's real). It would be easily identifiable by the person who wrote it, anyone who was there when he wrote it, or anyone who recognizes the handwriting. Personally, I wouldn't have posted an actual pic of the note online, but typed a version altered in content and wording to make it unidentifiable and therefore HIPAA compliant, and fictionalized. You can do this without losing the spirit of what's there. I would take the pic down, personally.

 

[Apollyon]

Reasonable point, but what if you explicitly state your doubt in the chart too?

Such as "The attached note was found in this patient's room immediately after he was discharged. While he presented with a kane [sic] and requested Xanax, it remains uncertain whether Todd O. Body-Dolor actually authored this note, so future providers should interpret this information with caution."

That I would do (and have done) - there is no speculation in the affirmative; it is simply stating and restating what I know. I would not say "this "patient"/"customer" is a crock of ****", but "patient is well-known to me from multiple prior visits and professional conversations with colleagues, and was noted to ambulate without difficulty and symmetrically through the emergency department. While interviewing pt, he tried negotiating with me, and threatened me with "reporting you to the state", and "I'm gonna (sic) call my lawyer!". When I enquired as to the name of his lawyer, pt was unable or unwilling to answer with a name. As I was discussing options with the patient, he interrupted me, stating "go **** yourself", and walked out, without difficulty, while I was talking. The registration staff member reported to me that the pt. said "you can all go F yourselves" while he was leaving. When I asked the staff member to elaborate, she was not willing to state the word which began with "F", as she said that it was "obscene". Pt did not sign AMA paperwork. I did speak with his primary physician, to apprise him of the patient's presence and requests. The PMD stated that he was unaware that this pt was seeking care and medications in the ED."

Or something like that - many times.

 

[Groove]

That I would do (and have done) - there is no speculation in the affirmative; it is simply stating and restating what I know. I would not say "this "patient"/"customer" is a crock of ****", but "patient is well-known to me from multiple prior visits and professional conversations with colleagues, and was noted to ambulate without difficulty and symmetrically through the emergency department. While interviewing pt, he tried negotiating with me, and threatened me with "reporting you to the state", and "I'm gonna (sic) call my lawyer!". When I enquired as to the name of his lawyer, pt was unable or unwilling to answer with a name. As I was discussing options with the patient, he interrupted me, stating "go **** yourself", and walked out, without difficulty, while I was talking. The registration staff member reported to me that the pt. said "you can all go F yourselves" while he was leaving. When I asked the staff member to elaborate, she was not willing to state the word which began with "F", as she said that it was "obscene". Pt did not sign AMA paperwork. I did speak with his primary physician, to apprise him of the patient's presence and requests. The PMD stated that he was unaware that this pt was seeking care and medications in the ED."

Or something like that - many times.

I would have typed "Pt eloped." and seen 2 more pt's in the time it took you to write that.

I might have been tempted to dictate that paragraph but my Dragon Dictate at work would have mutilated it.

😀

 

[Groove]

Plus, you guys are incredibly distrusting. The least we can do is scan it and have someone try to contact the poor guy to facilitate return of his potential note. Whoever wrote it obviously has some serious concerns about medication refills and needs a pain intensity scale so that they can remind their physician of their discomfort...next Monday...from the Monday that they were seen.

We've only got a week to return the note, people.

 

[WilcoWorld]

That I would do (and have done) - there is no speculation in the affirmative; it is simply stating and restating what I know. I would not say "this "patient"/"customer" is a crock of ****", but "patient is well-known to me from multiple prior visits and professional conversations with colleagues, and was noted to ambulate without difficulty and symmetrically through the emergency department. While interviewing pt, he tried negotiating with me, and threatened me with "reporting you to the state", and "I'm gonna (sic) call my lawyer!". When I enquired as to the name of his lawyer, pt was unable or unwilling to answer with a name. As I was discussing options with the patient, he interrupted me, stating "go **** yourself", and walked out, without difficulty, while I was talking. The registration staff member reported to me that the pt. said "you can all go F yourselves" while he was leaving. When I asked the staff member to elaborate, she was not willing to state the word which began with "F", as she said that it was "obscene". Pt did not sign AMA paperwork. I did speak with his primary physician, to apprise him of the patient's presence and requests. The PMD stated that he was unaware that this pt was seeking care and medications in the ED."

Or something like that - many times.

I used to get job satisfaction from good saves. While I still get joy from making tough diagnoses, my favorite part of the job has become quoting patients (as above) in their charts. Folks can say some pretty hilarious stuff.

 

[Birdstrike]

I used to get job satisfaction from good saves. While I still get joy from making tough diagnoses, my favorite part of the job has become quoting patients (as above) in their charts. Folks can say some pretty hilarious stuff.

+1

Also, these are the most likely patients to sue and file complaints to medical boards, so it's best if every f-bomb and threatening statement is objectively quoted. Have nurses and all other members of the team document this stuff word for word. This way, 2 years later, when they have hired a lawyer and rebranded themselves as cruelly mistreated saint, their true colors can be exposed.

 

[Apollyon]

For Groove, I type about 50 words a minute, so that doesn't take me long.

And, just for information, I did not censor - that was vBulletin/SDN. I put all of the actual words in, cussin' and all.

 

[la gringa]

I used to get job satisfaction from good saves. While I still get joy from making tough diagnoses, my favorite part of the job has become quoting patients (as above) in their charts. Folks can say some pretty hilarious stuff.

mine too... takes a bit of time b/c Dragon doesn't recognize the usual manner of speech and it is clearly different than mine, but the quotes most clearly depict the manner of the interaction.

given that i have VERY few of these, it's quite telling if one of my charts is worded like this!!!

 

[Groove]

Heh, reminds me of that excerpt from "Rape of EM"

"A well-known, unshaven, unkempt, foul-smelling, slightly-cyanotic, sixty-two-year-old alcoholic genleman was carried into our emergency room by three million lice, all screaming, 'Please save our host.'""

excerpt from the doctor's written note shown to the jury in a medical malpractice suit, circa 1977

lol...

You know, maybe I should document those encounters more, but I pretty much just say... "Pt became very aggressive, threatening, demanding narcotics, shouted obscenities, refused all medical care and eloped. Pt was educated on risks of leaving without further treatment including death and disability. Pt refused to sign AMA. "

I feel that the more details I give, the more difficult it is for me to hide my general "pissed off'edness" about the encounter. I feel that a lawyer would try to pick apart everything I wrote and try to paint me as having an agenda, discriminating or worse. I try to have the chart sound as objective as possible. Some of you seem to be better at doing that, and there's no telling what Dragon would have put in there with my southern accent. I cringe when I look at some of my charts that proofreading before signing at the end of a shift, lol.