You are in the minority and not only that but literature doesn't support several of these points. PICCs and central lines both have their draw backs and their intended uses, if you want to know about them send me a PM and I'll give you the article which discusses the indications, pros/cons, and the financials behind the uses.
LPs are easy, besides the fat asses, I'm not sure why people would dish them off. I can nail most any back damn near blindfolded anymore.
First of all, I understand that there is literature about risks/benefits of procedures. There is no need to be pedantic. I agree that LPs are easy and that risks are negligible. Other procedures confer different risks. Perhaps when I get frustrated about having to do LPs, I think more about the octogenarians that come in with "altered mental status" who have had laminectomies, spinal fusions, and nasty scoliosis and need spinal fluid to "rule out encephalitis"--I don't like putting the elderly through torture trying to get an LP and instead doing a bone biopsy. Or maybe I just don't have the hands for procedures, but I guess that's why I went into medicine over surgery.
Para/thoras are easy as well, they can be both therapeutic and diagnostic. and you can make your pt feel much better.
Do you have any data to back up this claim? LPs really don't have a whole host of side effects to them as a blind procedure. And you're exposing your patient to radiation if you have IR do it. Radiation is not benign. There are those who claim that you will cause 1 cancer for every 6000 CTs you perform, so if the data is true, then add on one more 0 for fluero and 2 0s for xrays to that and think about that for a moment.
LPs are done by fluoro, which I suppose does carry with it the risk of getting cancer from radiation, yes. But paras and thoras as well as CVCs/PICCs can be done with ultrasound, which exposes patients to a negligible dose of radiation.
Pneumo has at most a 1.4% rate of pneumo with the majority of those being far less than the 10% size which would require a Chest tube. I'll stick to the CVCs.
And I'll stick to the argument that if we even think about the risk of having to put in a chest tube, that we should be able to put in the chest tube ourselves. That's one procedure I'm definitely going to leave to someone else better qualified.
It takes at most 30 minutes to do a line and it pays about what, half of what an appy pays? I think I've got an article around here which says Central lines pay just under $350 to the doc for doing one.
Sure, but I don't see $350 for doing a central line going into my paycheck. What I said was that as residents we are not reimbursed for the procedures that we will supposedly have to do in the real world. If we were, then I might be more eager to do them.
Uhm, I don't think that I will. I plan to do outpatient medicine. The closest things I plan to perform in the office are skin biopsies, pap smears, and if I'm feeling crazy, joint injections. And what I said applies to hospital medicine as well. At least in my experience, most of the attendings and private hospitalists I come into contact with rely on us to do their procedures because they have let their certifications lapse (or they just don't have the time). Patients are in fact admitted to the teaching services so they can get procedures done, and that's at a teaching hospital. Find me a hospitalist at a private community hospital that is going to gown up and do a bedside paracentesis. Am I the only one with this experience? I imagine not.
Here's my opinion. I hate being dependent on other people to do my job. Especially for things which can be done at bed side and with proper knowledge and technique can easily be beneficial to the patient. I will learn and become proficient at everything from bone marrows and up which can be done with a little local and a needle. As long as you know the indications, complications, and what the hell you're doing, you shouldn't have too many issues.
That's fine. As I stated before, I am not in any way dogging people that like to do procedures. You on the other hand seem to be satisfied with the status quo and are out to prove something. I am neither satisfied nor have anything to prove. Yes, procedures can be safe. Yes, I have done them at the bedside. Yes, they can be beneficial to patients. But you may have the best hands on the block and the latest literature on complication rates of bedside procedures and I'm still going to want my mother sent down to have an interventionalist do her thoracentesis. It's the nature of our service-based industry--we should be thinking about ways to make things more comfortable and safe for our patients. And I'll bet that if you ask any patient in your hospital or mine, they would want the same.
DS
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