Saturday, September 25, 2010

Puttin it Bluntly

It was the usual type of case in the OR. As I went to sew up the fascia, the needle wouldnt go through the tissue, in fact it broke right in half. We then spend the next five minutes trying to free the piece of the needle that was stuck in the tissue. When I looked at the package, it was the usual 3-0 vicryl SH but then it said "blunt"!

It turns out that a while back there was a study that showed there may be a decrease in accidental needle sticks in OR personnel if blunt needles were used because they were less likely to penetrate a surgical glove. At one point it was even recommended that they be used in some closures. On more careful examination, it turns out that the real reason there were less needle sticks was that the blunt needles were useless and pushed to the side.

So, some government suit decided to mandate blunt needles (OSHA and JACHO), so all the needles were replaced without letting the surgeon know! I had to to fill out 3 forms for each needle that I use now that I want sharp to satisfy these new mandates!

I wonder what will happen next, will they take away scalpels and make us use plastic sporks?

Thursday, September 23, 2010

Yellow Omega Sign

(on the inside bottom corner of the patient chart) One of our internist was really upset today. He is one of the most caring physicians I have met. He was beside himself. It turns out that a patient had demanded narcotics and he said no. As a result the patient went onto a physician rating site at slammed him so that if you Google his name, that rating turns up. That made me wonder. If patients can anonomously rate docs, why cant docs do the same for patients?

When I was a resident, we would put a yellow Omega sign on the inside bottom corner of patients charts who were crazy or obnoxious. That way the poor sod who had to take care of them next would be prepared. I wonder how we can do that now in the digital age? Think of it, we could identify those that are faking disability, those who are hypochondriacs, those who are noncompliant, drug seekers, the whole bit.

Wednesday, September 22, 2010

Saturday, September 11, 2010

Redirect ala-Michelle O

It is bad enough to have hospitals dump patients on you but now with all the healthcare changes, they are following Michelle Obama's plan as well as her husbands. Becuase everyone's health care costs are going up and this Medicaid expansion means no one can afford to take care of those with it, hospitals are following Michelle Obama's South Side (of Chicago) Healthcare Care Initiative. Before the patient even has a chance to enter the hospital, they are met by a person who encourages them that it would be better for them to go somewhere else and they will even pay for the cab or bus ride to get there. This is exactly what she devisedd when she was a VP of U of C in Chicago and even had David Axelrod promote it.

So, we are now having patients arrive not by ambulance but by cab and airport limo!

Candyman, Candyman,Candyman

I had a patient say to me " wow, your the Chief of Surgery, you must be good". I wanted to puff up and say "of course", but told the truth. I explained that I missed too many meetings so the ones who were actually at the meetings mad that they were there voted me in when they went down the list to see who hadn't already done it.

Anyway, part of my duties as "Chief" is to be the physician who oversees the risk management committee. It is amazing at what it tracked, everything from patient complaints, to infections, to food quality. On my desk last week was a thumb drive full of data from the ED. Outcomes and encounters are all tracked. They are broken down by diagnosis, provider, and shift. In all these data streams, we look for trends.

One of the things that jumped out was that there was a big difference in the number of patients seen by different physicians, this was independent of shifts. It also showed that the physicians were seeing the same number of true emergencies but that the difference was in patients there for back pain or "acute fibro". To find out what was going on, I called over to our head patient registar for the EDs. As a side note she is amazing. When people ask her how long she has been there she tells them that she was always there, they just built the ED around here). Anyway, she explained it all. She went down the list of docs and said, Candyman, Candyman, Candyman, HardA***, HardA***, B*****, Candyman and so one.

Sure enough, she matched the list. The word gets out quickly which docs are in the ED. In fact, people call the EDs to see which doc is where. The Candyman docs will write for a little pain meds to get you through until you can follow up with your own doctor for your long standing pain. After all, your "pain is a vital sign". When there is a Candyman, everybody runs to the ED to claim that their pain is "horrible" to get their fix. When there is a HardA***, the ED is quiet. She even explained to me that they alter their staffing depending on which providers are where.

As I was leaving she took a piece of paper off the stack of Memos next to here. It was from the med center administration. It was about a decrease in the Press Gainey scores for the ED during certain shifts. It recommended that they try to find the problem and then report back. I looked at the memo and then went to the office. There on the flash drive was the Press Gainey data. You guessed it, the scores were higher for the Candymen!

Wednesday, September 8, 2010

Chicken Little Syndrome

One of the problems we have in the ED is people lying about their symptoms to be seen sooner, or to be seen by a MD instead of a ARNP or PA. With the ED filled with people who really dont need to be there, some people who also dont need to be there think that they can lie about their symptoms and get in faster. Mind you our triage nurses are pretty adept at determining who is and is not reatl. This weekend though one got through the cracks. He was in the ED trying to get an excuse for missing a meeting with his parole officer. He thought he would tell the nurse that he had chest pain, then when he got back explain that it was his ulcer that was bothering him and get a script and go home. Anyway, before he could say anything they hooked him up to an ekg and he got his wish, he was right back. In fact he was right back through the ED and straight to the CCU and then to cardiac cath. He kept trying to explain that it was his ulcer and all he needed was an excuse. The third degree block on the EKG said different. Turns out he never really had an ulcer, he has a new bypass though and by the way he got an excuse for missing his next parole officer meeting.

Tuesday, September 7, 2010

Acute ORS

I was the "man in the barrell" over the Labor Day Weekend. It was like being the only duck in the shooting gallery. Patients were being dumped from four states as fast as the ambulances could carry them. The outlying hospitals were doing all they could to get rid of the nonpay medical liabilities. Six were children who had health insurance but the parents had got rid of it "cause they were getting it free from Obama". I guess nobody told them that SCHIP was broke in their state. One was a former Teamsters local president who had worked for a trucking company that went bankrupt. He was a local guy who even appeared in an Obama commercial. Several were elderly patients who couldnt get in to see a doctor and had let their problems get so out of hand that they were immediately turfed.

It seems that acute ORS (Obama Regret Syndrome) is spreading like an epidemic. Unfortunately, it has already destroyed the medical system that could have treated it.