What a way to start the day x 2

[JustPlainBill]

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Yesterday ---

53 y/o nonadherent diabetic, somnolent, weak, dizzy, CBGs 392, urinary glucose 500, trace ketones with acetone breath --- EMS to ER;

Today ---

48 y/o male with crushing substernal chest pain, left arm paresthesias, in moderate distress with elevations in II, III --- EMS to ER

first patient of the day both days --- this has got to stop....

 

[primadonna22274]

Gotta love the people who suffer all night to wait for the doctor's office to open....

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[FrustratedFamDoc]

Usually I can get a good feel on how the day is going to go with the first few patients. If the first few patients start breaking out their written down lists, I know it's just going to be one of those days...

Been trying to get one of my patients off of Alprazolam and wrote an SSRI. He stopped taking it after a week because he was "afraid of the side effects." I asked him if he was ever afraid of the potential side effects of the Alprazolam and we all know what that answer was. Had one of my chain smokers say the same thing about Topamax.

 

[Doctor4Life1769]

Yesterday ---

53 y/o nonadherent diabetic, somnolent, weak, dizzy, CBGs 392, urinary glucose 500, trace ketones with acetone breath --- EMS to ER;

Today ---

48 y/o male with crushing substernal chest pain, left arm paresthesias, in moderate distress with elevations in II, III --- EMS to ER

first patient of the day both days --- this has got to stop....

Do y'all have triage nurses?
Those should have been addressed before they saw you. They ask me and I refer to ED across the street.

 

[deleted87716]

Do y'all have triage nurses?
Those should have been addressed before they saw you. They ask me and I refer to ED across the street.

That only works if they call first. Once they're in your office, you need to see them and evaluate them. If they have to go to the hospital, they need to go via EMS. If you just turn them away and tell them to go to the ER, you're setting yourself up to lose a malpractice case.

 

[Doctor4Life1769]

That only works if they call first. Once they're in your office, you need to see them and evaluate them. If they have to go to the hospital, they need to go via EMS. If you just turn them away and tell them to go to the ER, you're setting yourself up to lose a malpractice case.

Fair point.
Now that I think back, they did call.

 

[FrustratedFamDoc]

Guess today was my day.

first pt of the morning. Nephrology took him off his lasix and he's in heart failure. Got labs and refilled his lasix, will see him back next week. Lab just called about a crit potassium 2.4. Awesome.

First pt of the afternoon. Diabetic, CHF, COPD with a known kidney mass that he has rejected any sort of further investigation. Hasn't seen me since October. He had called me last week and said he was coughing and having SOB. I told him that I really needed to see him int he office. He came in today and triaged with CC of sob, coughing and knots on belly. He's too heavy to stand and weigh. first saw him in 2014 and he was 224 lbs. Today, he's easily 350 by my estimate. I asked about the knots on his belly and he pulled up his shirt to reveal the tightest belly of ascities and the biggest varices I've ever seen. Sat is 88% and lungs sound awful. He's in the ER now. Hope it's not what I think it is.

Saw my next 2 patients without issue. Came out and one of my front office girls brings me a note on a critical mammo on one of my patients.

Edit: about to see a very nice schizophrenic patient of mine. Was a lifer at the local hospital until it closed down. His sister has taken him in after the whole family has washed their hands of him. I'm the only doc he trusts so it's either me managing his schizophrenia or nobody.