Was it Bucks fascia by any chance? Then she could still be correct.
Oh man. Thankfully no TIA for me but sure brought back flashbacks to the days I had to sign 30-50 midlevel charts at the end of my shifts often several hours after the midlevel left. Holy cow. That was 8x as stressful as running two codes simultaneously. (For the medical students - that’s not a joke - codes become relatively low stress events at a certain point in ones career, but bad supervision policies never do).
Just as long as you didn't sign it with a Sharpie, right? (If I recall correctly, some neurosurgeon did that. However, I am just way too busy (haha, lazy) to even look it up.)
Yeah there are a few nut jobs who have done that. Honestly, none of our patients are worthy of my sig.
I agree. One of our local urgent care chains got dinged on a hand case a few years back. Their response was to completely stop treating hand issues. Anyone who showed up was given first aid, like a bandage or a splint, sometimes an X-ray, and sent to the ED. They charged a full visit and co pay for this. They weren't bound by EMTALA so they could have told the patient "We don't do hand. Go to the ER." and charged them nothing. But that's not what they did. The worst was when I saw this poor guy who broke his 4th finger. Very clean fx mid shaft of the middle phlange angulated to about 45 degrees. They had X-rayed him, splinted him exactly as is in this weird, huge volar splint that went from about 6 cm above the wrist out past the fingertips, and sent him. The finger was just laying there on this big splint pointing off to the side. I took off the splint, looked at the film they sent (this was back in the days of film), straightened the finger and put on a proper splint. He was a regular guy so the traction and straightening was quick and less painful than a dig block. He was really nice to me but he kept asking why they hadn't done that it the urgent care. I couldn't give him a good answer. I just kept apologizing for their silliness.
If I were a mod here I would start a new sub-forum under MD/DO for Jenny McJennyson stories, please don't stop with these
There are physicians out there who don't like to start anticoagulants unless there's a proven problem. They are relatively risk meds so I get the concern, but a single dose of lovenox for next day U/S seems fairly low risk to me.
Yeah. I agree that it goes beyond the fear of last touch. There's a real issue with providers (docs, apps, nurses operating essentially on their own in SNFs and LTACs, etc.) who have a vague idea about what to order to "rule out" this or that. But they don't have enough knowledge or experience to know what to do with an abnormality. They can't discern what's an incidental finding or meaningless radiology blather.
I'll take this one:
Ah, my bad.
Yep. Had a patient get an outpatient CT scan recently which read epiploic appendagitis. Sent in at 10pm by the ordering NP for urgent surgery. One shot of toradol and a quick explanation about what that is and why they don't need surgery (and why their NP absolutely should know what this is if they're going to try to treat patients) and they were out the door.
I agree that financially this is good for us, to see primary care and urgent care stuff. But simply, I don't wanna. I don't want to be the clinic of convenience. I know it's good money, better RVUs/hr than Level 5s or critical care, but it's just not what I went into this for. The fact that it falls to us and that we are heavily incentivized for it makes me see how broken the system is. I point out to my students and residents how under the current system the ED is actually in competition with the PMD clinics in our own MOB. They get kind of dejected and angry once I explain it.
I recently got in a lot of trouble for telling a patient their PMD was lying to them. The PMD had led the patient to believe that they had ordered a diagnostic study for them when what they had actually done was just tell them to go to an ED and ask for it. I told the patient the PMD had lied to them because they were getting angry that the test wasn't started the instant they hit the door. And, when I walked in, they realized that there were going to be bills for the ED visit.
I disagree. I think the lawyers are fully to blame. Their profession has created this whole industry for the purpose of enriching lawyers. It does not do an adequate job of either of its purported goals, to compensate the aggrieved and punish the incompetent. It has been grown and crafted to maximize job security and income for lawyers. It is kept alive and protected by legislators who are lawyers. Our profession has a lot to answer for but the legal profession owns this. This could all be fixed with the stroke of a pen but they will fight it to the end.
I think you're right. I actually can't believe we haven't been squeezed on this already.
No, not racist - ageist!! He's mocking old cash registers, and the people that use or used them! They're old, and useless! (The cash registers, and, maybe, the people, too.)
The sound formally known as an onomatopoeia that was expressed when a cash register which was designed to use a mechanical bell was struck. This has been used lately as a pejorative to express exchange in monetary value, usually in an unscrupulous fashion. better?
Not even just lately. There was a Doonesbury strip back in the 80s that had a panel with a dermatologist cutting off a skin CA, and saying, "$500, cha-ching!"
