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HighPriest said:
Got a call from a lady via our answering service. She said her daughter had had her tonsils out 4 days ago by my partner. She’s 13 and bigger, so we had given her some narcotics for her pain. But she was having itching and nausea and couldn’t sleep. So the caller had given her some of her grandmother’s leftover tramadol. That worked great and it’s “not a narcotic,” so she was hoping she could get a refill. I told her I would look in to it and give her a call back when I filled the Rx. She said she was in a hurry, they were out of town because of a funeral, and she really needed it as soon as possible.

You can see where this is going.

Shockingly, her daughter hadn’t ever been in to see us. The lady came up on our narcotics monitoring system. Or, at least, her children did. She’d been calling all over the region and having painkillers filled for her kids for procedures they either had or hadn’t had. She had filled at least 60 tabs of tramadol in the last two weeks. Or her kids had. You know. Whatever.

Apparently she works at a family medical practice (not a provider).
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Did you report her to anyone? I wouldn't really know who but maybe the cops or children's services since there are kids involved that are being used for fraud at the very least.
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dpmd said:
Did you report her to anyone? I wouldn't really know who but maybe the cops or children's services since there are kids involved that are being used for fraud at the very least.
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No idea where I would report her. She’s on the state list for potential abusers. I’ve never actually met her, nor had she ever been to my practice. She was just a voice on the phone.

And, as much as I’d like to say otherwise, the city she lives in won’t even arrest someone with less than 3 grams of heroin on them. So I imagine they wouldn’t send out the wagon for her.

I’d be interested to know if anyone else has reported someone to some agency for this kind of thing.
 
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3am “patient would like regular diet for breakfast”....which doesn’t take orders till 7
 
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swoopyswoop said:
Wait, I'm sorry- are we the same person? I did an ex lap on someone today who came from the med/surg floor and I said he needed step down unit post op and had this EXACT conversation.

RN: "are you sure? there are no beds."
Me: OK, then I'll put him in the ICU.
RN: "well there are no ICU beds either."
Me: well I guess he's staying here until space is available!
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I loathed that as a fellow when I was in charge of all icu bed flow. The pacu nurses and various higher ups in the hospital would want me to give up my last couple icu beds for step down or floor patients so they could close the pacu. Uhhh....no, I’m not giving up my trauma or code bed so you don’t have to pay shift diff.

Now, since I attend in the MICU I’ll occasionally get it. No, I’m not taking a post-op crani so you can close the pacu into a unit where my nurses don’t know what crani stands for.
 
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sb247 said:
3am “patient would like regular diet for breakfast”....which doesn’t take orders till 7
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It’s not about the time. It’s about teaching you a lesson, Mr. Dr. You don’t know everything! You see?!? You forgot this order!! You don’t even care about your patient! You and your fancy degree!
 
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HighPriest said:
No idea where I would report her. She’s on the state list for potential abusers. I’ve never actually met her, nor had she ever been to my practice. She was just a voice on the phone.

And, as much as I’d like to say otherwise, the city she lives in won’t even arrest someone with less than 3 grams of heroin on them. So I imagine they wouldn’t send out the wagon for her.

I’d be interested to know if anyone else has reported someone to some agency for this kind of thing.
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I was more thinking about potential for child endangerment or something. Like if she decides to cause injuries to them in order to score. But that is a stretch so doing nothing besides not calling in the med is probably enough.
 
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HighPriest said:
It’s not about the time. It’s about teaching you a lesson, Mr. Dr. You don’t know everything! You see?!? You forgot this order!! You don’t even care about your patient! You and your fancy degree!
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Intractable vomiting and prior shift nurse wasn’t happy that patient kept trying to force food and was vomiting all over the room so we went npo until n/v calmed down

But yeah, fun times
 
dpmd said:
I was more thinking about potential for child endangerment or something. Like if she decides to cause injuries to them in order to score. But that is a stretch so doing nothing besides not calling in the med is probably enough.
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I did think about that. Except that her daughter never actually had any kind of surgery. At least, not with us. That was a complete fabrication. So it’s not like she had her tonsils out so she could score.
 
HighPriest said:
Got a call from a lady via our answering service. She said her daughter had had her tonsils out 4 days ago by my partner. She’s 13 and bigger, so we had given her some narcotics for her pain. But she was having itching and nausea and couldn’t sleep. So the caller had given her some of her grandmother’s leftover tramadol. That worked great and it’s “not a narcotic,” so she was hoping she could get a refill. I told her I would look in to it and give her a call back when I filled the Rx. She said she was in a hurry, they were out of town because of a funeral, and she really needed it as soon as possible.

You can see where this is going.

Shockingly, her daughter hadn’t ever been in to see us. The lady came up on our narcotics monitoring system. Or, at least, her children did. She’d been calling all over the region and having painkillers filled for her kids for procedures they either had or hadn’t had. She had filled at least 60 tabs of tramadol in the last two weeks. Or her kids had. You know. Whatever.

Apparently she works at a family medical practice (not a provider).
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Do you work at my training program? I had a woman call around for various relatives to get a tramadol script. This went on for all 7 years I was there.
 
ThoracicGuy said:
Do you work at my training program? I had a woman call around for various relatives to get a tramadol script. This went on for all 7 years I was there.
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Trust me - they’re everywhere. Same as the fact that every major metro area has at least one spoon swallower.
 
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TimesNewRoman said:
Trust me - they’re everywhere. Same as the fact that every major metro area has at least one spoon swallower.
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At my place it was the same woman the whole time. I would get a page on the plastics rotation, then the next week on a county gen surg rotation, followed by another page a few weeks later at the university rotation. I still don't know what they want tramadol for. Do they cut it with other drugs?
 
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ThoracicGuy said:
At my place it was the same woman the whole time. I would get a page on the plastics rotation, then the next week on a county gen surg rotation, followed by another page a few weeks later at the university rotation. I still don't know what they want tramadol for. Do they cut it with other drugs?
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Some people just like it. People can get euphoric.
 
TimesNewRoman said:
Some people just like it. People can get euphoric.
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A few times I'd play along, ask all the details, then I'd ask who their surgeon was. They'd give some name or just a letter. Then I'd get to tell them that no one exists with that name. I also enjoyed getting to tell her that she had talked to me the day before when I was on another service to try and get the meds. By the time I was finishing up the hospital operators were on to her and would warn any residents she called.

Kinda sad really...
 
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ThoracicGuy said:
A few times I'd play along, ask all the details, then I'd ask who their surgeon was. They'd give some name or just a letter. Then I'd get to tell them that no one exists with that name. I also enjoyed getting to tell her that she had talked to me the day before when I was on another service to try and get the meds. By the time I was finishing up the hospital operators were on to her and would warn any residents she called.

Kinda sad really...
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You would think at some point the operators would be allowed to just not put her through to anyone.
 
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ThoracicGuy said:
A few times I'd play along, ask all the details, then I'd ask who their surgeon was. They'd give some name or just a letter. Then I'd get to tell them that no one exists with that name. I also enjoyed getting to tell her that she had talked to me the day before when I was on another service to try and get the meds. By the time I was finishing up the hospital operators were on to her and would warn any residents she called.

Kinda sad really...
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Haha. I had a patient a couple years ago in the ER get me confused with the nurse (I’m a male, but so was the nurse). I told her she wasn’t getting opiates and she screamed at me “but the doctor told me I could have dilaudid!!!!” - lady, that’s me, I’m the doctor. I said no such thing. I’m sending the nurse in with your discharge paperwork. No you can’t get a script, a cab voucher or a turkey sandwich. Don’t ever put words in my mouth again.
 
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"Dr, can I put a condom cath on her?"
 
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LucidSplash said:
Yeah that’s crazy. The Pure Wick just kinda sits there. Good for my demented old ladies that we did splice vein bypass on (don't get me started).
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I did an aortobifem on a lady who already had a BKA. They put the primafit on her and it did not prevent her sheets from being soiled constantly. It just encourages the nurses to never check on the patient, help them get to a commode or promote hygiene.
 
I had a lady with aka for nec fasc who also had some ICU myopathy and they had her using one of those things for a little bit. But she had enough strength to position it when she had to pee and then move it and wipe. It just made it a little less messy than a plain bedpan would have been.
 
Jolie South said:
I did an aortobifem on a lady who already had a BKA. They put the primafit on her and it did not prevent her sheets from being soiled constantly. It just encourages the nurses to never check on the patient, help them get to a commode or promote hygiene.
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Agree... the demented, incontinent patients this device could potentially help are the ones I find with the suction disconnected and the entire pad soiled. Then there’s the younger patients who just need a hand getting out of bed to the bathroom but now will sit around for days because the one thing motivating them to ambulate is gone. I have to complain to charge every time I find one of these things on an overweight but otherwise functional post op patient.

It’s worth noting I almost never see a Purewick at our site with a proper surgical floor and nurses.
 
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HighPriest said:
I did think about that. Except that her daughter never actually had any kind of surgery. At least, not with us. That was a complete fabrication. So it’s not like she had her tonsils out so she could score.
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Department of Family/Children's Services. I had a cranial surgery patient whose dad was taking him around to different ERs saying that he was having headaches so they'd give him pain meds that dad would then use. At his next follow-up with me he was already in grandparents' care with no headaches.
 
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I can always try. It'd be more or less an anonymous call-in, as I've never actually met the patient or her mother. Just spoke on the phone once. I don't even have an address for the patient.
 
kitsunepixie said:
Department of Family/Children's Services. I had a cranial surgery patient whose dad was taking him around to different ERs saying that he was having headaches so they'd give him pain meds that dad would then use. At his next follow-up with me he was already in grandparents' care with no headaches.
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I want to know where there are multiple EDs where the docs will write for opiates to go for headaches, ESPECIALLY in a kid. That is a wreck on a wreck.
 
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Apollyon said:
I want to know where there are multiple EDs where the docs will write for opiates to go for headaches, ESPECIALLY in a kid. That is a wreck on a wreck.
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The only thing that works is that one that starts with a "d." I can't remember the name.....
 
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Apollyon said:
I want to know where there are multiple EDs where the docs will write for opiates to go for headaches, ESPECIALLY in a kid. That is a wreck on a wreck.
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Several states. As you are well aware, opiates are terrible for headaches. This regularly makes me want to scream.
 
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Apollyon said:
As I tell patients, the only time I'll give them opiates for headache is for a brain tumor, or a skull fracture.
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Apollyon: Stop your belly aching, that’s not even the worst subarachnoid hemorrhage I’ve seen this week!!
 
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Page: the patient has a bruise on their hip. Please come evaluate.

Patient: honestly, I don't know why she paged you about this. It's a bruise.
 
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Every single after hours page for an order that has already been placed.

0200: "There is fluid draining AROUND the JP. Please come evaluate." For the 300th time, that is expected.

0100 on a Saturday from a patient who will be undergoing a prostatectomy in a week: "Doc, is ok for me to have sex tonight? I think I'm about to get lucky." Enjoy that boner while you can, buddy.
 
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Thought this belongs here...

Page comes through service at 4:59pm. Reason for consult: Patient has a femoral TLC and is "high risk for bleeding," vascular consult to pull line.
 
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TraumaLlamaMD said:
Agree... the demented, incontinent patients this device could potentially help are the ones I find with the suction disconnected and the entire pad soiled. Then there’s the younger patients who just need a hand getting out of bed to the bathroom but now will sit around for days because the one thing motivating them to ambulate is gone. I have to complain to charge every time I find one of these things on an overweight but otherwise functional post op patient.

It’s worth noting I almost never see a Purewick at our site with a proper surgical floor and nurses.
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These Purewick's just showed up at our county hospital and they are getting promoted like crazy because UTI's don't count as a CAUTI if the Purewick was used since the urethra was never officially catheterized. The hospitals are getting dinged financially for CAUTI's so guess who doesn't get foleys anymore? (hint it's the patients that need them.)

We hate them on the ortho service since every time we check on the patient they are sitting on soiled bedsheets with urine sitting right next to the surgical wound on their leg...
 
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A couple of the most recent ones I’ve had to deal with...

EM resident calling from ED at 3am: “Hey so, I’m discharging this patient, when is ENT clinic so I can tell them when to show up?” We do not cover ENT clinic, I have no idea when it is.

Senior Medicine resident calling from telemetry 2am: “sorry to bother you, but where are the OR’s?” I guess some visiting procurement team member got lost and ended up wandering around the ICU, but still bro, you’ve been working this hospital for at least 2 years how do you not know where the OR is? There are literal signs all over the place.
 
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Nurse: "Hello, I just wanted to let you know your [16 yo, >80kg pt] had a blood pressure of 130/70. He had surgery today and had some pain. I gave him some pain meds, and now his blood pressure is 110/60."

Me: "Ok....is he doing ok? What are his other vitals?"

Nurse: "Yes, he is doing ok. Vitals are [stone cold normal]. I just wanted to let you know."

Me: "Ok. Thanks. Anything else?"

Nurse: "No, that's it."
 
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WinslowPringle said:
Nurse: "Hello, I just wanted to let you know your [16 yo, >80kg pt] had a blood pressure of 130/70. He had surgery today and had some pain. I gave him some pain meds, and now his blood pressure is 110/60."

Me: "Ok....is he doing ok? What are his other vitals?"

Nurse: "Yes, he is doing ok. Vitals are [stone cold normal]. I just wanted to let you know."

Me: "Ok. Thanks. Anything else?"

Nurse: "No, that's it."
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For that nurse:

giphy.gif
 
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Bring patient to PACU after AV fistula revision on patient on plavix.
Me: this dude will have some oozing bc he is on plavix. If the dressing saturates, just replace it.
Nurse: ok

1 hour later, nurse pages.
Nurse: the dressing is saturated. I know you said that would happen, but is that ok?
Me: *stifling f bombs* yes, just replace it. I don’t care.
 
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Synchronous said:
A couple of the most recent ones I’ve had to deal with...

EM resident calling from ED at 3am: “Hey so, I’m discharging this patient, when is ENT clinic so I can tell them when to show up?” We do not cover ENT clinic, I have no idea when it is.

Senior Medicine resident calling from telemetry 2am: “sorry to bother you, but where are the OR’s?” I guess some visiting procurement team member got lost and ended up wandering around the ICU, but still bro, you’ve been working this hospital for at least 2 years how do you not know where the OR is? There are literal signs all over the place.
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Eh. I have no idea where the ORs are, but my hospital takes up a couple city blocks.
 
Early enough in the morning I'm still at home, asleep...
Me: "Hello, WinslowPringle with Surgery, returning a page."
Nurse: "Hello, are you taking care of Patient X in room Y?"
Me: "Not any more, we were consulted but signed off a few days ago."
Nurse: "Oh. Well, I saw your name in his chart."
Me: "Yes, I saw him a few days ago, but not today. We were consulted for [elective surgical procedure P], but didn't due to [host of risks and contraindications]."
Nurse: "I was looking for who to call, and I saw your name in his chart."
Me: "I'm not taking care of this patient."
Nurse: "Oh. Well. But you had seen him."
Me (internal sigh): "What are your concerns?"
Nurse: "He just flipped into a fib with RVR. Would you like me to start an amio drip?"
Me: "You'll need to call his admitting team - he's admitted to Internal Medicine. I'm a general surgery resident and I haven't seen him recently and we aren't going to operate on him, and haven't recently operated on him."
Nurse: "Do you know who the Internal Medicine attending on him is?"
Me: "No. You'll have to look in his chart. I'm not at a computer right now."
Nurse: "Oh. Ok."


(There is an Internal Medicine HP, daily Internal Medicine progress notes, all the orders are from Internal Medicine, the Internal Medicine attending is listed under 'calls to' order as well as the 'admit' order, and in the right upper screen of the patient's EMR...My name was on two progress notes and zero orders....)
 
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WinslowPringle said:
Early enough in the morning I'm still at home, asleep...
Me: "Hello, WinslowPringle with Surgery, returning a page."
Nurse: "Hello, are you taking care of Patient X in room Y?"
Me: "Not any more, we were consulted but signed off a few days ago."
Nurse: "Oh. Well, I saw your name in his chart."
Me: "Yes, I saw him a few days ago, but not today. We were consulted for [elective surgical procedure P], but didn't due to [host of risks and contraindications]."
Nurse: "I was looking for who to call, and I saw your name in his chart."
Me: "I'm not taking care of this patient."
Nurse: "Oh. Well. But you had seen him."
Me (internal sigh): "What are your concerns?"
Nurse: "He just flipped into a fib with RVR. Would you like me to start an amio drip?"
Me: "You'll need to call his admitting team - he's admitted to Internal Medicine. I'm a general surgery resident and I haven't seen him recently and we aren't going to operate on him, and haven't recently operated on him."
Nurse: "Do you know who the Internal Medicine attending on him is?"
Me: "No. You'll have to look in his chart. I'm not at a computer right now."
Nurse: "Oh. Ok."


(There is an Internal Medicine HP, daily Internal Medicine progress notes, all the orders are from Internal Medicine, the Internal Medicine attending is listed under 'calls to' order as well as the 'admit' order, and in the right upper screen of the patient's EMR...My name was on two progress notes and zero orders....)
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I can’t believe you made her job harder. What a jerk. Your NAME is on the CHART. you just don’t care about patients.

She already tried for 10 minutes to get this Dr. Epic on the phone, but he hasn’t given his number to anyone...
 
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Finished ex-lapping the Pt around 7pm. Order PCA then. Big incision, big surgery. Pt does fine in PACU, gets to floor. Keeping him NPO for the night, will need to reassess in the AM.

1am, nurse. "Hello, I was calling to see if we could DC the PCA on Pt Xlap."
Me (super bleary, must have been deep in REM...):"Whaaaa...?"
Nurse: "His pain is well controlled. Could we switch to oral meds?"
Me: "Whaaattt? I don't understand. I ordered a PCA. Why do you want it canceled?"
Nurse:"He hasn't used much. (Snippy, defensive tone). I just thought we should save the PCA pumps for appropriate pain control for someone else who might need it."
Me:"He had a big surgery. It's a PCA. I'm just not understanding....why do you want to cancel it?"
Nurse Snippy: "Well, if you want to keep it, I guess we can, I just want to make sure we have PCA pumps for appropriate pain control for patients who might need it."
Me: "Ok, we'll keep it for now. Thank you."


I still don't know, man. Never had a call like that before. Sometimes people complain that it beeps, but that wasn't the case here. Seems like nurse thought there was going to be a 1AM mad rush for the PCA pumps. I checked my pager in the later AM, and it wasn't just a bad dream...

Oh, and following morning, Pt said his pain was well controlled and the PCA was working great for him...
 
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