The crap we have to deal with…

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thegenius

thegenius

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I mean c’mon….what are we doing here?????
69B420D5-67F4-434C-9D9C-F853FF1DD739.jpeg
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You win!

You are always reliable for this kind of shiiiiit.

I mean...I can't stop laughing......

I'm laughing so hard........

What is Rusted Fox going to say to this patient? I want to be a fly on the wall!
 
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I'm serious are you making this shiiiiit up
And why is this an ESI 4?

LMAO



oh my god I cant' stop laughing.
 
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thegenius said:
The question is....will he discharge without either 1) giving a pill, AND 2) giving an Rx?
Click to expand...

That picture is so old. Pretty sure it was... 2013....
My first attending year was 2012, and this was before I worked with dchristismi in 2014, so had to be about then.

I had the DC papers in my hand and walked in the room, said - "I simply can't refill these; and there's not an ER doc anywhere that will. Refills for medications like these need to come from your pain management physician."

I remember the room the guy was in (room 8), In the old ER (before it was renovated). I remember his black T-shirt and beard.
 
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Best triage note, ever (and I didn't get a picture of it) was:

"I just got mad and punched the muthafcuking door. I just had pins up in this muthafcuker."
 
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thegenius said:
I'm serious are you making this shiiiiit up
And why is this an ESI 4?

LMAO



oh my god I cant' stop laughing.
Click to expand...

I'm not making this up.
I don't know what I did to deserve it; but I live some kind of bizarre life. Swear I'm cursed or something.
I keep it tame on here because I've been warned by mods for far, far less.
You guys have a very, very limited idea of just how strange my life often is.
 
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I think you are cursed. Honestly people seek out RustedFox for asinine complaints when you are on.

Its utterly ridiculous.

We really need to change EMTALA. We need to have our hospitals support us when we say "discharge" after patients utter "swollen elbows" or "food stuck in my teeth"
 
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thegenius said:
I think you are cursed. Honestly people seek out RustedFox for asinine complaints when you are on.

Its utterly ridiculous.

We really need to change EMTALA. We need to have our hospitals support us when we say "discharge" after patients utter "swollen elbows" or "food stuck in my teeth"
Click to expand...
What about "I keep getting pain in my lower abdomen" How often? ""About a month apart".

Legit pt I saw in SC. Menstrual cramps. Mother said nada to her.
 
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During intern year I made the mistake of picking up the phone and the young guy on the other end says, “Hey do you guys have Wi-Fi?” I was pretty stupid and said yes.

He came not twenty minutes later. Chief complaint: “not feeling well. Too hot”. It was summertime.
 
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I was listening to a mid pandemic EM:RAP short about EM being a dying specialty, and the guest was arguing that the way to save EM was to pivot to fulfilling these unmet "needs" in an evidence based manner, which is cool. I'm sure there's no reason to consider replacing a board certified EM doc with a cheaper alternative once you've inflated EM visits with things that aren't just not emergencies but aren't actually "medical" problems.
 
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Arcan57 said:
I was listening to a mid pandemic EM:RAP short about EM being a dying specialty, and the guest was arguing that the way to save EM was to pivot to fulfilling these unmet "needs" in an evidence based manner, which is cool. I'm sure there's no reason to consider replacing a board certified EM doc with a cheaper alternative once you've inflated EM visits with things that aren't just not emergencies but aren't actually "medical" problems.
Click to expand...

The sad reality is that most of us would be out of a job without these "non emergent" visits. I had such a horrible attitude about ridiculous chief complaints until the pandemic hit and our volume plummeted. People stopped checking in, doc and mlp hours were slashed and it quickly became apparent to me that if the pattern persisted....many of us were out of work or working for half the salary. When volume picked up, I slapped a silly grin on my face and adopted the most obsequious waiter/customer service rep mentality and have lots of interactions with patients that go something like this:

"No, don't feel bad about coming in for THAT! We're open 24/7 and THAT'S WHAT WE'RE HERE FOR!"

or

"What?! You feel silly for checking in for THAT? Listen, sometimes when dealing with your health...it's better to be SAFE THAN SORRY, AM I RIGHT OR AM I RIGHT?!"

or

"M'aam, this age on here can't be right....There's NO WAY you're 65/75/85. YOU LOOK 20/30 YEARS YOUNGER! What's your secret?! What kind of vitamins are you taking?! You must have some great genes...your husband over here won THE JACKPOT when he took you to the altar!" (The women eat that one up. Maximum Press Ganey on those.)

Maybe I'm not quite as over the top as all that...

Masks help me hide my stifled yawn midway through sentences, so I actually don't mind wearing them...

I think what helps is that I'm really good at camouflaging my sarcasm and it's kind of fun pushing it to the limit and making people wonder..."Is this guy for REAL?"
 
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RustedFox said:
I'm not making this up.
I don't know what I did to deserve it; but I live some kind of bizarre life. Swear I'm cursed or something.
I keep it tame on here because I've been warned by mods for far, far less.
You guys have a very, very limited idea of just how strange my life often is.
Click to expand...

Is it a curse....or superpower?
 
Groove said:
The sad reality is that most of us would be out of a job without these "non emergent" visits. I had such a horrible attitude about ridiculous chief complaints until the pandemic hit and our volume plummeted. People stopped checking in, doc and mlp hours were slashed and it quickly became apparent to me that if the pattern persisted....many of us were out of work or working for half the salary. When volume picked up, I slapped a silly grin on my face and adopted the most obsequious waiter/customer service rep mentality and have lots of interactions with patients that go something like this:

"No, don't feel bad about coming in for THAT! We're open 24/7 and THAT'S WHAT WE'RE HERE FOR!"

or

"What?! You feel silly for checking in for THAT? Listen, sometimes when dealing with your health...it's better to be SAFE THAN SORRY, AM I RIGHT OR AM I RIGHT?!"

or

"M'aam, this age on here can't be right....There's NO WAY you're 65/75/85. YOU LOOK 20/30 YEARS YOUNGER! What's your secret?! What kind of vitamins are you taking?! You must have some great genes...your husband over here won THE JACKPOT when he took you to the altar!" (The women eat that one up. Maximum Press Ganey on those.)

Maybe I'm not quite as over the top as all that...

Masks help me hide my stifled yawn midway through sentences, so I actually don't mind wearing them...

I think what helps is that I'm really good at camouflaging my sarcasm and it's kind of fun pushing it to the limit and making people wonder..."Is this guy for REAL?"
Click to expand...
I've definitely known docs that could bag on the patient the entire H&P and walk away with the patient asking them to be a godparent. I can pretend the idiocy doesn't exist but I can't engage with it without my entire body screaming "this is BS" at the patient.

I agree that the non-urgent stuff pays the bills, the problem is that the non-urgent stuff is also what created this cycle of boom and bust. Imagine a world in which "sore throat/itchy eyes/R hip pain/constipation/STI check/tadalafil refill" never started making their biweekly pilgrimage to the ED.

There'd be fewer EM docs, but most of that change would come from people never applying to EM. I think my med school class had 4 people go into EM in '04, now it's 2-3x that many for the last 8 years. Without double digit year over year increases in patient volume, we'd have significantly more mid size private groups (MSPGs). The profit incentive for CMGs to blow huge chunks of money to buy the MSPGs would be reduced and the competitive disadvantage in MSPGs ability to recruit would matter less due to more stable staffing. Private equity money would make a later and more limited appearance as the growth/profit potential PE demands takes far longer to appear.

Wandering even further into this fantasy, fewer NP/PAs would be needed due to a dearth of fast track patients. Additionally, since patient volumes are more stable, the trend of creating an APP shift due to rising volumes not sufficient to justify another physician shift and then adding another APP shift when volumes rise again rather than firing the APP and hiring a new doc wouldn't become common. Finally, I think the quality of our nursing colleagues would have improved since you'd still have the turnover to less chaotic work environments and advanced degrees but stable volumes would allow more thoughtful hiring and on-boarding. We have generations of ED nursing now that don't see enough acuity during the training/on-boarding to be comfortable recognizing sick patients.

But all of this is a world that never was and never will be.
 
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wook said:
Is it a curse....or superpower?
Click to expand...

Thanks for trying to put a good spin on it.

I have deleted so many of my posts en bloc and never hit the "Post" button because I knew I would be slapped for "language" or because I took a swipe at whatever the "current thing" is.

Maybe I'll write a book.
 
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Chief complaint: cough

Hey doc I had a cough last week and it went away. I want to know why I was coughing last week.

No joke.
 
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EMhawkeye said:
Chief complaint: cough

Hey doc I had a cough last week and it went away. I want to know why I was coughing last week.

No joke.
Click to expand...
My personal favorite in line with that one was (granted, at an urgent care so the guy is... slightly less dumb?):

Pt: I feel like I'm going to get sick.
Me: What kind of symptoms do you have?
Pt: I feel fine. I just haven't been sick in a long time and I feel like I'm due, you know?
Me: So you feel completely fine, were worried that you were going to get sick, so you came to a building that is definitionally full of sick people in order to prevent this from happening?
Pt: *eyes widen slightly*
Me: Yeah, let's get you out of here. I recommend that you hold your breath on the way to the elevator.

Probably one of the more ironic ways I've seen someone likely contract a URI.
 
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Saw 25 last night in 8hrs. Only 2 admits, one of which was social, and one long dead CPR.

Emergency medicine in America in 2022.
 
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I remember my friend sending me another shot of their board...it was something like "Walked through puddle without shoes, now feels cold".

I think people just: "I'm bored. I know! I think I'll go to the ED for something".
 
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Single coverage overnight at a level 2 trauma center (WTF).
My F's to give definitely hit zero at 0400 with two hours left.
Definitely had 8 or 10 folks check in between 4-6AM (our relief comes at 0600, typically don't start notes/primary any new patients in the last 60-90 minutes depending on how busy we are).

Of course had a laceration repair to do on a demented, deaf, 900 year old patient. On top of dispo'ing four middle-aged women with abdominal pain that checked in at 0100.

The emergencies at 0400?
-URI for a week, negative COVID test already.
-Small abrasions to the toes from scraping them on a rock two weeks ago. Concerned that it's infected at 0300 and dragged her 50-60 y.o. mother to the ED with her. Looks fine.
-Bicep swollen for 3 days after working out in a 20-something. Probably a tendon rupture but seriously, 4 AM?
-Chronic abdominal pain for 1 month, promptly texting and asking for pain meds as soon as they are roomed.
-COVID exposure with mild COVID symptoms.
-I think my baby has something in her ear. They LWBS after being grumpy about waiting for 2 hours (mainly in the waiting room), figured out they weren't going to get seen any faster with a tantrum, then immediately signed back in with 40 minutes prior to shift change. Left that for the morning doc.
 
This doesn’t belong on this thread… but I’m too lazy to find an appropriate one. this is a record low bicarb for me:

8E344943-63F5-4CE3-A726-F5EEF38B58B8.jpeg
 
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thegenius said:
This doesn’t belong on this thread… but I’m too lazy to find an appropriate one. this is a record low bicarb for me:

View attachment 356115
Click to expand...
Makes dispo easy (assuming not in FSED).

Or depending on the ICU fellow on, give 10 unit of insulin, a liter or 10 of LR and recheck those numbers will be stable for floor
 
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Also off-topic, but this is also a piss-poor way to display lab values.
Seriously, all EMRs; there's a far better way to visually represent lab results.
 
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turkeyjerky said:
How so?
Click to expand...

My ideal visual representation of lab data on a computer screen?
Use those "stick diagrams", each with small labels.
Break down other values into relevant groups.
Make the text a lot fugging bigger.

Right now; its just a spreadsheet of numbers, in an order that makes limited sense (why start with glucose, then, BUN/CR and then go in a weird-ass order from there?), and its easy to overlook things.

"Ergonomics for the eyes and brain", so to speak.

And don't anyone go acting like what I'm saying is out of line or difficult for software to accomplish. The year is 2022, in three taps of an app, I can order tacos to anywhere I choose. I don't want to hear anyone say "bUt ImPLeMeNtAtIoN WiLl bE sO hArD". No. Fugg you. If CERNER and EPIC want to charge zillions for their software, they need to justify the cost by making it not a visual abortion and handing us some half-assed grey spreadsheet to look at CRITICAL PATIENT DATA.
 
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RustedFox said:
Also off-topic, but this is also a piss-poor way to display lab values.
Seriously, all EMRs; there's a far better way to visually represent lab results.
Click to expand...

it's got colors! vibrant colors. It also has asterisks.
How would you display lab values

139
6.9
110
12
42
1.72
175
8.8
 
thegenius said:
it's got colors! vibrant colors. It also has asterisks.
How would you display lab values

139
6.9
110
12
42
1.72
175
8.8
Click to expand...

I promise you all that I will show you what "a good idea" looks like even if I have to draw it with paper and pen.
 
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RustedFox said:
I promise you all that I will show you what "a good idea" looks like even if I have to draw it with paper and pen.
Click to expand...
Duuude, develop it yourself & sell it to Epic!
 
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WilcoWorld said:
Duuude, develop it yourself & sell it to Epic!
Click to expand...

If I were only so talented.
I don't speak code of any sort.

I'm just saying: the Chipotle app is easier to use, looks better, and is more functional than our BEST EMRs out there.
That's not okay.
 
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RustedFox said:
If I were only so talented.
I don't speak code of any sort.

I'm just saying: the Chipotle app is easier to use, looks better, and is more functional than our BEST EMRs out there.
That's not okay.
Click to expand...
Chipotle doesn't have to delivery data on demand to CMS
 
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Groove said:
The sad reality is that most of us would be out of a job without these "non emergent" visits. I had such a horrible attitude about ridiculous chief complaints until the pandemic hit and our volume plummeted. People stopped checking in, doc and mlp hours were slashed and it quickly became apparent to me that if the pattern persisted....many of us were out of work or working for half the salary. When volume picked up, I slapped a silly grin on my face and adopted the most obsequious waiter/customer service rep mentality and have lots of interactions with patients that go something like this:
Click to expand...

Spot on...and at some point insurances and public assistance will stop paying for these people to go to the ER. Then we are really screwed.

I very rarely tell people that they inappropriately use the ER.

However, this week I did tell a dad that he should not have come to the ER for his 9 yo son who was basically clearing his throat every 15 minutes. Literally that's why he came in. Dad's like "How do I know what's going on?" And I said..."I'm here if your son is unconscious. Or is in a terrible car accident. Everything else needs to go to his pediatrician!"

(Fact is...I spent another 3 minutes getting a history and the kid probably has PND.)
 
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RustedFox said:
I promise you all that I will show you what "a good idea" looks like even if I have to draw it with paper and pen.
Click to expand...
I'm so outta the loop on how to use the stick figures that I'm basically accustomed to excel spreadsheet numbers now.
Sad

I can't even remember how to do stick figure LFTs
 
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