Things I Learn From My Patients

Started by docB
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I should also say that some of these things I've read are kinda hilarious and sad at the same time. I actually understand a lot of these issues, as I have a lot of friends who are med or what have you. and I also watched a lot of House, Scrubs and other medical shows and understand better thanks to those shows and friends when someone says they have this and that.
 
Birdstrike said:
Right. They think you're a total heathen of you say no, or blow off the bacitracin goodie bag. Give free useless bacitracin, unnecessary antibiotics that breed multi-drug resistant GC, DNA-scrambling radiation or indiscriminate opiates and your patient satisfaction goes through the roof.

The government needs to get this, that patient satisfaction fuels bad medicine. It just does. We all know it, yet these toxic healthcare-system ruiners just refuse to believe it. That's why so many doctors just don't care anymore.
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I totally agree. They will never admit it though. Just like no one will admit that our current "prescription pain medicine addiction crisis" was the utterly foreseeable and frequently warned about result of the "pain is under treated, oligoanalgesia, pain is the 5th vital sign and pain is what the patient perceives it as" movement of the late 90s.
 
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Birdstrike said:
Have you seen this?

http://drwhitecoat.com/wp-content/uploads/Grassley-Feinstein-Letter-to-CMS-2014.pdf
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Yes. And I agree with it wholeheartedly (yes, that's now on the record, docB agrees with Sen. Feinstein about something). However the mess we are in now started before the advent of the patient satisfaction movement. It started with the JCAHO led movement to increase narcotic use in the 90s. There were even lots of studies finding that minorities got less narcotics than whites which implied "if you're not writing for narcs you're a racist." Patient satisfaction is gas on that fire to be sure but it started before this lunacy.
 
docB said:
Yes. And I agree with it wholeheartedly (yes, that's now on the record, docB agrees with Sen. Feinstein about something). However the mess we are in now started before the advent of the patient satisfaction movement. It started with the JCAHO led movement to increase narcotic use in the 90s. There were even lots of studies finding that minorities got less narcotics than whites which implied "if you're not writing for narcs you're a racist." Patient satisfaction is gas on that fire to be sure but it started before this lunacy.
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It's started before that. It started right here:


Chronic use of opioid analgesics in non-malignant pain: report of 38 cases.

Pain. 1986 May;25(2):171-86.

"No toxicity was reported ...We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain ..."

http://www.ncbi.nlm.nih.gov/m/pubmed/2873550/
 
Birdstrike said:
It's started before that. It started right here:


Chronic use of opioid analgesics in non-malignant pain: report of 38 cases.

Pain. 1986 May;25(2):171-86.

"No toxicity was reported ...We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain ..."

http://www.ncbi.nlm.nih.gov/m/pubmed/2873550/
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On the lead author, for us young ones that don't know the details:

http://hcrenewal.blogspot.com/2012/12/the-king-of-pain-recants-pharmaceutical.html?m=1
 
One from a while ago...

If you have enough lung capacity to give a running commentary, that is loud enough for the entire department to hear you, on how you're having trouble breathing then you're not actually having trouble breathing (that and the fact that your pulse ox hasn't dropped below 95% in the four hours plus you've been here). As for why that other person (ie me) is getting 'special treatment' (extra pillows, warm blankets, magazines to read, cups of tea), it's called having manners, you should try it some time.
 
docB said:
If my patient education must begin with "Don't take random pills you find in the street." you may be beyond my ability to help you.
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That's where you're like..."You know what? Just forget it. Thanks for coming in, Sir. Pleased have a blessed day. And please don't forget to remember 'DocB' was the one who hooked you up with the free turkey-sando and blanket that you pulled over your head for 6 hours. Good bye."

🙂
 
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Birdstrike said:
That's where you're like..."You know what? Just forget it. Thanks for coming in, Sir. Please have a blessed day. And please don't forget to remember 'DocB' was the one who hooked you up with the free turkey-sando and blanket that you pulled over your head for 6 hours. Good bye."

🙂
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I like it but it's missing something. Oh yeah. Here we go:

That's where you're like..."You know what? Just forget it. Thanks for coming in, Sir. Please have a blessed day. And please don't forget to remember 'DocB' was the one who hooked you up with the free turkey-sando and blanket that you pulled over your head for 6 hours. So please rate me highly at the survey kiosk on your way out the door and if you ever get an HCAHPS form remember that the correct answer is "Always." Good bye."

I knew all that scripting would come in handy.

PS - For all the students and residents who read that and are thinking "Survey kiosk? Scripting? What is he talking about?" just don't worry about it. Ignorance is bliss and you will miss it soon enough.
 
docB said:
I like it but it's missing something. Oh yeah. Here we go:

That's where you're like..."You know what? Just forget it. Thanks for coming in, Sir. Please have a blessed day. And please don't forget to remember 'DocB' was the one who hooked you up with the free turkey-sando and blanket that you pulled over your head for 6 hours. So please rate me highly at the survey kiosk on your way out the door and if you ever get an HCAHPS form remember that the correct answer is "Always." Good bye."

I knew all that scripting would come in handy.

PS - For all the students and residents who read that and are thinking "Survey kiosk? Scripting? What is he talking about?" just don't worry about it. Ignorance is bliss and you will miss it soon enough.
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No benzo/narco discharge goodie bag? Are you even trying to keep your PG competitive?
 
Please note: If you are an 80yo lady with advanced osteoporosis and a couple rods in your back DON'T fall off your deck.

The result might be the obliteration of one of the bones those rods was attached to (T1?), and a bunch of screws and bone chips occupying the region of your body that used to be your back. Also, you will have a titanium rod sticking out the back of your shoulder.

Somehow, your spinal cord will remain patent and you will be writhing in pain and begging for pain meds (which you will receive in abundance) while the ED docs call every orthopod and neurologist in the state to figure out what to do with you.

Lastly, your Xrays will make it into the "holy crap did that really happen?" files of a dozen physicians. Immortality: achieved.
 
scummie said:
If you are in the ED already and don't feel like waiting, feel free to call 911 while in the waiting room so you can be transported to another hospital.
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Yes! This is the classic, Holy Grail of passive aggressive behavior. And we've all seen it. I love it! And that person, never, never, is actually sick, right? Ah...and God just looks down, smiles and shakes his head.
 
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Spinach Dip said:
Please note: If you are an 80yo lady with advanced osteoporosis and a couple rods in your back DON'T fall off your deck.

The result might be the obliteration of one of the bones those rods was attached to (T1?), and a bunch of screws and bone chips occupying the region of your body that used to be your back. Also, you will have a titanium rod sticking out the back of your shoulder.

Somehow, your spinal cord will remain patent and you will be writhing in pain and begging for pain meds (which you will receive in abundance) while the ED docs call every orthopod and neurologist in the state to figure out what to do with you.

Lastly, your Xrays will make it into the "holy crap did that really happen?" files of a dozen physicians. Immortality: achieved.
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I've gotta know what the first guy you got a hold of said about it when you tried to explain it on the phone.
 
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PS - For all the students and residents who read that and are thinking "Survey kiosk? Scripting? What is he talking about?" just don't worry about it. Ignorance is bliss and you will miss it soon enough.[/QUOTE said:
I have been reading all the posts on this forum for quite some time now. At first I felt shock and disbelief at what practicing EM these days seems to entail. I appreciate all the view points; at least I could say I knew what I was getting myself into; and in spite of knowing all this if I still felt like this was what I wanted I would just have to find a way to deal with it.
I am constantly looking for something positive and posts from attendings who have found a way to make it work for them. Like Birdstrike.
I want to take heed. When I do find something positive I hold on to it, and allow myself to feel more optimistic about my choice of going into EM. But it doesn't last long. Either a post here or looking at some of the EM attendings on my rotation; and I am questioning my choice again.
I am sure there is much I don't know (and most of my attendings are not eager to share the reality of their practice experience either) but from what little I do know I can tell you already the 'bliss' and joy that I guess I should feel as a med student is over shadowed by a feeling of doom and the impending struggle in the years to come.
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mohi said:
I have been reading all the posts on this forum for quite some time now. At first I felt shock and disbelief at what practicing EM these days seems to entail. I appreciate all the view points; at least I could say I knew what I was getting myself into; and in spite of knowing all this if I still felt like this was what I wanted I would just have to find a way to deal with it.
I am constantly looking for something positive and posts from attendings who have found a way to make it work for them. Like Birdstrike.
I want to take heed. When I do find something positive I hold on to it, and allow myself to feel more optimistic about my choice of going into EM. But it doesn't last long. Either a post here or looking at some of the EM attendings on my rotation; and I am questioning my choice again.
I am sure there is much I don't know (and most of my attendings are not eager to share the reality of their practice experience either) but from what little I do know I can tell you already the 'bliss' and joy that I guess I should feel as a med student is over shadowed by a feeling of doom and the impending struggle in the years to come.
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It doesn't all have to be "overshadowed by doom." You will have lots of good times along the way. Remember, people are much more likely to post about a bad day or frustrating patient encounter, than a good one. They come here to dump the bad, so that they can discard it, walk away, and leave it here. But that doesn't mean the positives aren't happening. They are, but you have to open your eyes to them. Most people don't make a conscious effort to deposit them here. They keep the good ones for themselves. Although, I identify with nearly all of the dark humor on this thread, I've made the point to write about a few of the good encounters, and about a few of the positive things patients have taught me. I'm grateful, for what my patients have taught me. If you haven't read them, here's just a few:


Humility, from "Tony the Doorman."

Laughter, from "Lighterman."

Surprise, from the lady with "Some Serious Constipation."

Resilience, from "An Amazing Little Girl."

Gratitude, when "Blown Away."


It's there, you just have to choose to see it.
 
Birdstrike said:
It doesn't all have to be "overshadowed by doom." You will have lots of good times along the way. Remember, people are much more likely to post about a bad day or frustrating patient encounter, than a good one. They come here to dump the bad, so that they can discard it, walk away, and leave it here. But that doesn't mean the positives aren't happening. They are, but you have to open your eyes to them. Most people don't make a conscious effort to deposit them here. They keep the good ones for themselves. Although, I identify with nearly all of the dark humor on this thread, I've made the point to write about a few of the good encounters, and about a few of the positive things patients have taught me. I'm grateful, for what my patients have taught me. If you haven't read them, here's just a few:


Humility, from "Tony the Doorman."

Laughter, from "Lighterman."

Surprise, from the lady with "Some Serious Constipation."

Resilience, from "An Amazing Little Girl."

Gratitude, when "Blown Away."


It's there, you just have to choose to see it.
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I love it! I've been prowling this thread for a while and somehow I've never seen your blog. Thanks so much for sharing. Lighterman cracks me up!
 
dudeliness said:
I love it! I've been prowling this thread for a while and somehow I've never seen your blog. Thanks so much for sharing. Lighterman cracks me up!
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Thank you. It's not my blog, though. I just guest post on it sometimes. It's owned by a guy that goes by "White Coat" (different than White Coat Investor on the SDN EM forum). The posts that have "By Birdstrike MD" are mine, and all of mine are SDN EM Forum posts first, before going on the blog. A few have been reposted by Kevin Pho, also, FWIW. All the others (90%) are by White Coat. Thanks again
 
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TimesNewRoman said:
Nor is your vagina
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Not true. Vaginas tend to be a hair better form that purpose, truth be told, since they're not a never ending tube (in theory, anyway). That still doesn't stop a HUGE amount of people from coming into the ER to have random and inexplicably lost inanimate objects fished out of their vaginas in no more than 3 seconds by a hurried doctor, necessarily between the hours of 12:00 midnight and 7 am, generating a $1000 ER bill in the process (of which approximately only $50 goes to the ER doctor) for the assembly of the required team of medical providers, registration staff, scribes and triage staff.

"Here you go, nurse," eye glasses tip down over the nose. "Send to pathology please. Though my clinical instinct tells me it's likely the third French Tickler we've removed on this shift alone. Is somebody running a sale on these things? Hmm. How many heart attacks are waiting Betty Sue?"
 
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Birdstrike said:
Not true. Vaginas tend to be a hair better form that purpose, truth be told, since they're not a never ending tube (in theory, anyway). That still doesn't stop a HUGE amount of people from coming into the ER to have random and inexplicably lost inanimate objects fished out of their vaginas in no more than 3 seconds by a hurried doctor, necessarily between the hours of 12:00 midnight and 7 am, generating a $1000 ER bill in the process (of which approximately only $50 goes to the ER doctor) for the assembly of the required team of medical providers, registration staff, scribes and triage staff.

"Here you go, nurse," eye glasses tip down over the nose. "Send to pathology please. Though my clinical instinct tells me it's likely the third French Tickler we've removed on this shift alone. Is somebody running a sale on these things? Hmm. How many heart attacks are waiting Betty Sue?"
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Seriously. That thing is like having a safety deposit box and a key to the city all at the same time.
 
While a good mnemonic device for Step 1, do not equate medicine names ending with the same letters as doing the same thing

No matter how much augmen-TIN you give to your husband it will not make up for you running out of dilan-TIN & he will end up in the ER @ 3 am
 
EmpericalNinja said:
have them stitch you up, and then offer you Vicodin. Refuse and explain you're immune and it has no effect on you. Doctor and nurse look at you, like you're from another planet.
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Valium has no effect on me whatsoever. When I tell doctors this, they are very skeptical. So I feel your pain (metaphorically speaking, of course! 😉)
 
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