JP2740

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"Any patient who has >= 5 drug allergies warrants a psych consult"

Thoughts?
 

SouthernSurgeon

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"Any patient who has >= 5 drug allergies warrants a psych consult"

Thoughts?
We use a crazy probability scale. Weighted items include:

> 5 allergies
> 3 phone notes
> 3 surnames/hyphenated name

Also points for presence of any of the following diagnoses:
-Fibromyalgia
-Chronic fatigue syndrome
-Restless legs syndrome
-Gluten intolerance
-CRPS
 
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What thoughts are you looking for?

Obviously getting a psych consult is an exaggeration but obviously you also have to think about what the patient considers as an allergy.
 

DrEnderW

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Too dependent on medical history.

For an atopic individual, it wouldn't be unreasonable to have 5 allergies such as pen, milk, eggs, latex, pollen. This would be especially true in pediatric populations and is increasing in prevalence.

New onset gluten allergy in a white female, middle class pt with history of yoga and pumpkin spice latte consumption --> immediate psych consult and likely admit.
 

username456789

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True, it's a tad antiquated. But I still like it.
I've never really been a fan of what seems like "forced" slang in medicine. Other examples are "shop" instead of "hospital/emergency department" (used solely by emergency medicine physicians) and "med stud" (used by residents everywhere).

Guess I'm weird like that.
 
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SouthernSurgeon

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I've never really been a fan of what seems like "forced" slang in medicine. Other examples are "shop" instead of "hospital/emergency department" (used solely by emergency medicine physicians) and "med stud" (used by residents everywhere).

Guess I'm weird like that.
I tend to agree with you. There is natural medical slang, and forced medical slang. Fleas falls into the latter.
 
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Guillemot

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As a medical student you will be amused by the novelty of having detailed information about how many people are stupid and neurotic.
 

KinasePro

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I've never really been a fan of what seems like "forced" slang in medicine. Other examples are "shop" instead of "hospital/emergency department" (used solely by emergency medicine physicians) and "med stud" (used by residents everywhere).

Guess I'm weird like that.
I tend to agree with you. There is natural medical slang, and forced medical slang. Fleas falls into the latter.
Meh, I don't think it qualifies as slang bc it's not commonly used. It's really just an old derogatory term for IM, used jokingly most of the time. I've never heard a crusty old surgeon use flea outside the context of a complaining or critiquing an IM resident/attending.
 

touchpause13

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That seems a bit ridiculous. Plus are you only counting legit allergies or "I had a flu shot and it made my arm hurt" ?
 

SouthernSurgeon

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You'll find that ~90% of "allergies" listed in patient charts are either expected side effects, or completely unrelated and coincidental symptoms.
And yet we live in such fear of litigation that we go to extreme lengths to deal with these faux "allergies", up to and including using expensive alternate medications and placing patients in intensive care for desensitization protocols.
 

username456789

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And yet we live in such fear of litigation that we go to extreme lengths to deal with these faux "allergies", up to and including using expensive alternate medications and placing patients in intensive care for desensitization protocols.
I have seen plenty of patients (as an intern and in Derm) Who have "allergies "to Benadryl.

"Nah doc, I'm allergic to that."

"Oh? What happens when you take Benadryl?"

"That **** makes me sleepy."

"Good, take two of them."
 

DermViser

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That seems a bit ridiculous. Plus are you only counting legit allergies or "I had a flu shot and it made my arm hurt" ?
Only the narcotic allergies that knock out every possibility except dilaudid (IM of course)
 

Promethean

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Have seen allergies to benadryl and epinephrine.

My personal rule is 10 allergies or more is suggestive of psych etiology, if at least half of them are not real allergies.

Unless red dye is in the list. Red food dye in a list of a child's allergies is 100% sensitive and specific for guanopsychotic parents. Child is also likely to be unvaccinated and diagnosed as ADHD, autism spectrum, ODD, PDD and sensory processing disorder. Parents will demonstrate a total lack of parenting skills and child will demonstrate precocious manipulation skills, but little actual pathology.
 

DermViser

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inb4 some IM flea lectures us on multiple drug allergic patients
Now, now. Someone has to take care of the patient's heart and circulation to get Ancef to the bone. That's the purpose of the heart and blood vessels right?
 

Winged Scapula

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I've never really been a fan of what seems like "forced" slang in medicine. Other examples are "shop" instead of "hospital/emergency department" (used solely by emergency medicine physicians) and "med stud" (used by residents everywhere).

Guess I'm weird like that.
The term shop has always annoyed me for some unknown reason.
 

DermViser

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The term shop has always annoyed me for some unknown reason.
I get annoyed when attendings use the expression, " 'Oh, nothing, just talking shop' with the residents/med student" to the patient. It's like a bad Dad joke.
 

Winged Scapula

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Can I have "shop" used in a sentence? Can't say I've ever heard that in a medical setting.
Quotes from the SDN EM forum:

http://forums.studentdoctor.net/threads/what-is-the-admission-rate-at-your-shop.895435/

http://forums.studentdoctor.net/threads/sexual-assault-exams.1068407/#post-15180957

http://forums.studentdoctor.net/threads/lets-talk-about-marijuana.1046897/#post-14732980

and so on. A search yielded 13 pages with threads that contained the word "shop". I've heard it rarely in other specialties; it seems to be an EM thing to refer to their "department/room/office" etc.
 

DermViser

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username456789

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I get annoyed when attendings use the expression, " 'Oh, nothing, just talking shop' with the residents/med student" to the patient. It's like a bad Dad joke.
I don't mind it so much. It's the very bizarre usage of the word almost solely the property of EM docs when referring to their ED that puzzles and annoys me.
 

colbgw02

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Quotes from the SDN EM forum:

http://forums.studentdoctor.net/threads/what-is-the-admission-rate-at-your-shop.895435/

http://forums.studentdoctor.net/threads/sexual-assault-exams.1068407/#post-15180957

http://forums.studentdoctor.net/threads/lets-talk-about-marijuana.1046897/#post-14732980

and so on. A search yielded 13 pages with threads that contained the word "shop". I've heard it rarely in other specialties; it seems to be an EM thing to refer to their "department/room/office" etc.
I started out "meh". Now I'm "ugh". Stupid ED.
 
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Winged Scapula

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I started out "meh". Now I'm "ugh". Stupid ED.
You see my pain. 14 years of reading those posts. I don't know why it annoys me.

I think its because it seems like the use of the word "shop" is akin to the attempt by many EM physicians to act like they're just "one of the guys"; "Hey just call me Dr. Joe, we're not formal around here. You can even call me Joe if you want. I've got tattoos, a trucker hat, I'm wearing jeans and a scrub top and you've just come into my shop for some service, I'm just like your mechanic. Ha ha…just one of the guys."
 

SouthernSurgeon

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Stop. Reading. Now.

First the NYT and now this. Its not safe to continue.
I did after I reached the post by an ED attending with a personal adult admission rate of greater than 40%. GAH.

I also resisted reading the comments section of the NYT article. I need to maintain what little sanity I have left.
 
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ACSurgeon

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I did after I reached the post by an ED attending with a personal adult admission rate of greater than 40%. GAH.

I also resisted reading the comments section of the NYT article. I need to maintain what little sanity I have left.
it's like they speak a totally different language. One ED attending stated "it must be heaven" to work somewhere that admits 30-40%…

The one resident talk about their admission rate being "horrible" at 15%. I think I'm done for today.
 

username456789

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it's like they speak a totally different language. One ED attending stated "it must be heaven" to work somewhere that admits 30-40%…

The one resident talk about their admission rate being "horrible" at 15%. I think I'm done for today.
Where I presume these ED docs work:

 

Rirruto

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  1. Is the patient wearing sunglasses indoors?
  2. Does the patient request that his/her entire posse be allowed into the ER room with them?
  3. Does the patient have >2 medical allergies?
  4. Does the patient have >2 piercings on non-auricular sites?
  5. Did the patient use the phrase “I KNOW my body!! (extra point if the patient snaps his/her fingers on the word “KNOW”)
  6. Could the patient’s first name make a halfway decent stripper name? (examples include Amber, Destinee, or Misty)
  7. Did the individual and a family member both check in as patients at the same time (extra point for each additional family member)
  8. Did the fully-grown adult patient bring blankets from home to the ER (extra point for a stuffed animal)
  9. Did you know the patient’s name before he/she showed you a form of identification?
  10. Is the patient crying loudly despite lack of kidney stone, gonad torsion, active labor, penetrating wound, severe blunt trauma, or dislocated joint?
  11. Did the patient try to convince you of his/her high pain tolerance?
    0Actual disease possible
    1-3Actual disease unlikley
    4-6No testing needed, offer them 20 percocets to leave
    6-8Page psych
    >9Pretend to not understand english until the patient gives up and goes to another ER. Consider
    having a pseudoseizure
    *from http://www.gomerblog.com/2014/07/triage/
 

Dral

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"I'm allergic to Benadryl pills, I can only have IV." said to me the pt who faked having sickle cell dz to also get pain meds.

One of my attendings Intern year told me that same thing about 5 or more allergies.
 

Psai

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it's like they speak a totally different language. One ED attending stated "it must be heaven" to work somewhere that admits 30-40%…

The one resident talk about their admission rate being "horrible" at 15%. I think I'm done for today.
Why is admission rate even a thing? Why not measure by how many people actually needed to be admitted if you had to measure something?
 
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JP2740

JP2740

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What thoughts are you looking for?

Obviously getting a psych consult is an exaggeration but obviously you also have to think about what the patient considers as an allergy.
Well, if I didn't make this thread, I wouldn't have been able to laugh my ass off at this:

I have seen plenty of patients (as an intern and in Derm) Who have "allergies "to Benadryl.

"Nah doc, I'm allergic to that."

"Oh? What happens when you take Benadryl?"

"That **** makes me sleepy."

"Good, take two of them."
 
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