tag:blogger.com,1999:blog-16401453269427078552024-03-05T00:04:02.177-08:00Throckmorton's other signsAmoung Throckmorton's many accomplishments in medicine, the sign that bears his name carries the greatest legacy. Just as his radiographic sign has helped many a trauma surgeon and ER physician rapidly identify a serious medical problem, it is hoped that his other signs will alert the voting public of other things that are seriously wrong with our medical and legal systems.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.comBlogger433125tag:blogger.com,1999:blog-1640145326942707855.post-41093545586748568912014-06-06T18:32:00.002-07:002014-06-06T18:32:29.723-07:00Anti-EvolutionI was going to jump in to the conversation in the locker room today but couldn't. One of the other docs was on a rant. He had just removed the second infected valve of the heart of a young IV drug abuser. It went something like this. "Evolution is BS! You don't see animals evolving into species that grow some plant only to grind it up, mix it with water, boil it and inject it into themselves. Then in a stupor fall out of a tree only to have other animals drop everything to save them, support them, rehab them, and then pay for them to go out and do it again!"Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com7tag:blogger.com,1999:blog-1640145326942707855.post-38276121736110484652014-06-06T18:15:00.001-07:002014-06-06T18:15:47.969-07:00STD'sI think I am just going to give in and file for Medicare Disability for writers cramp, trigger finger and depression. In addition to all the other forms, there is now a new plethora of other forms that must be filed out for Medicare compliance according to JACHO, CMS and WGF. (WGF is "who gives a +++!") I didn't even have clinic today and only had to round on a few patients but still I had to sign, time and date 87 separate forms! I daydreamed about a pen that after I scrawled an unitelligible swirl as a signature it would shoot a laser that burned the time and date into the paper as it set off smoke detectors in the administrators offices. To be even more passive/aggressive I wanted to date and time the orders in ancient Mayan but one of the other surgeons said their calender was over as the world ended! Some guy in a suit said it would all be better once all the records were paperless as the date and time would be automatic. Yeah, sure. We are "paperless"! Somehow, paperless means I have to sign more papers that the computer just spits out one after the other.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com3tag:blogger.com,1999:blog-1640145326942707855.post-40022760976754761582014-06-06T18:04:00.001-07:002014-06-06T18:04:27.361-07:00VA SpaLike many surgeons, part of my training was done at the VA Medical Center or the VA Spa as it was known. We called it the "SPA" because it was the place where you had to learn to relax. In our training at the University Hospital it was not uncommon to be working 17 hours a day. You get to the VA and they wouldn't even start any OR cases until 830 or 900. If you happened to be operating after 230 you could look out the window of the door of your operating room and see that all the other lights were off and they had closed shop. There was never a problem parking because even though the clinics were supposed to start at 8, most employees didn't show up to 830 or 900. Everyone got 1 1/2 hours off for lunch not to mention every holiday. <br />
<br />
I say it was the place you had to learn to relax because yelling at the staff for not doing their jobs accomplished nothing. In fact, they did even less. There were those who really cared and tried, but the whole system seemed to be set up to punish those who tried to correct the problems. I hope this recent publicity will finally bring attention to the whole problem. Then again, the VA is government single payer healthcare! Who knows the VA may be the model for the final Obamacare.<br />
<br />
Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com3tag:blogger.com,1999:blog-1640145326942707855.post-76164715534137400052014-04-13T17:57:00.000-07:002014-04-13T17:57:46.515-07:00Patient GradesWhen I strolled into the surgeons lounge I saw one of our best surgeons sitting there with her head in her hands. I sat down and asked if she needed to talk to someone. Usually when I see a surgeon like that she just had to give someone bad news or no matter what she did he could save the patient and they were going to die. Its a lonely place and sometimes it helps to be able to talk to a colleague to get it all out.<br />
<br />
I wasn't prepared for what she had to say. A few months before she had saved a patient from certain death, a bad mesenteric ischemia with perforated bowel. The patient had a rough course but pulled through. The patient was an IV drug abuser and the bowel infarction was a septic emboli. Because the surgeon would not give the patient all the narcotics he wanted and instead set him up in a treatment program, the patient went on HealthGrades and slandered the surgeon up and down. This is now the first thing you see when you google her name. I did my best to console her but all I could think of is "We need a PatientGrades where we can list all the drug seekers, psychopaths and Munchhausen's patients!"<br />
<br />
Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com4tag:blogger.com,1999:blog-1640145326942707855.post-68279699585010198492014-04-06T06:03:00.000-07:002014-04-06T06:03:17.760-07:00Lordy Lordy, we just hit 40!Just finished a week on call where I cover several emergency departments. On average there will be about 60 consults for "emergencies". In the past one third would be uninsured. This week it was 2/3rds. Worse 7 had insurance but had to drop it because it became too expensive. <br />
<br />
I guess I'm confused, I thought Obamacare was going to cover the uninsured and make it affordable.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com2tag:blogger.com,1999:blog-1640145326942707855.post-37502258868337692562014-03-17T17:28:00.002-07:002014-03-17T17:28:40.119-07:00McCarthy OrchitisAs of this morning there were 23 cases of mumps at Ohio State University with the epidemic expected to increase as the result of so many students that have not been vaccinated. I wonder how many of them are also following Jenny McCarthy's other areas of advise and smoking E cigs? Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-21672699425008562402014-03-17T17:17:00.001-07:002014-03-17T17:17:26.287-07:00Going PostalI had to renew my passport and went to the Post Office where I thought I could get the picture and mail it right away as that is where I got the last one. When I got there a sign was posted that said they had met their passport quota for the day and were now closed. I went to a nearby shop that took the photo and I attached it to my application and went back to the post office to mail it. When I got there, the passport window was now open! I asked the person, "I thought that you had met your quota for the day?". He said, "Oh, we put that up when we go to lunch". I was about to ask "why don't you put a sign that says gone to lunch" but then the answer hit me. People would line up and wait for them to come back. By saying "quota met", people would just leave. Gotta to love the Federal work ethic!Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com3tag:blogger.com,1999:blog-1640145326942707855.post-9475300590549299712014-03-14T06:16:00.000-07:002014-03-14T06:16:03.596-07:00The Sound of SilenceI was called to a code last night, luckily everything turned out ok but it was one of those things that make me just wonder about the people. A patient with bad lungs secondary to COPD was in the hospital secondary to an exacerbation. He was on oxygen and a pulse oximiter. The patient had a family member who decided to stay with him that night but they couldn't sleep because the oximeter alarm would go off if the patients sats dropped below 89%. So they could sleep better, they silenced the alarm on the pulse ox. Luckily for the patient, the nurse saw the sats go to 70 and she was able to get him on 100% O2 about the time he went brady.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com3tag:blogger.com,1999:blog-1640145326942707855.post-44086387725677841842014-03-14T06:08:00.000-07:002014-03-14T06:08:00.911-07:00Obama MathIn our area we had a huge increase in the cost of health insurance and big changes in health care plans as the insurance companies prepare for the costs of Obamacare. As a result, we are seeing patients come to the office where their office copay is more than the cost of the visit! Talk about a disincentive to seek medical care! Some insurances allow us to then refund the difference to the patient but if the insurance is one of the "Obama Compliant" plans we have to send the difference to the insurance company!<br />
<br />
As near as I can figure it the math works this way "The Affordable Care Act saves you money by costing you more!"Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com2tag:blogger.com,1999:blog-1640145326942707855.post-86186104531483477372014-03-08T14:20:00.000-08:002014-03-08T14:20:01.976-08:00F20.1I saw Harry Reid's take on Obamacare and I was relieved. Did you ever notice that his affect is getting more and more flat with fleeting of ideas? Anyway, It let me tell the patient who cant have his surgery because his insurance premiums, deductible and out of pocket costs have tripled that its "all a lie". I was able to tell the uninsured patient that he really has insurance, that its "all a lie". I was able to tell the patient who had their policy cancelled and now they can no longer afford insurance, its "all a lie". I was able to tell the college student that he is covered by his parents insurance but their costs have went up so much that none of them have insurance, that these problems are "all a lie". I was able to tell the medical oncology nurses, physical therapists that they are not being fired because of the medicare cuts, that its "all a lie". I'm glad all these Obamacare horror stories are lies. Oh, wait a minute, it may just be Harry Reid's schizo/delusional disorder.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-67716835452997164082014-02-22T11:10:00.002-08:002014-02-22T11:10:13.734-08:00Molly, molly, molly get your adverbs here!Looks like we have another of Darwin's herd culling drugs. Sooner or later the IV drug shooters die of ODs and endocarditis, the crack addicts die of MIs and stokes and the meth heads fry their brains. All of which serve to self limit the epidemic. Molly seems to be doing the same thing. These users show up hypermetabolic in renal failure and seizing, permanent brain damage occurs and they end up in a SNF where they slowly die of aspiration and bedsores.<br />
<br /><br />
Here are molly's adverbs : stupidly, hastily, fatally, painfully, hopelessly, violently and permanentlyThrockmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-71324386927196759942014-02-22T10:57:00.002-08:002014-02-22T10:57:57.169-08:00Unsolicited Medical AdviceI cant imagine being a pharmacist! It must be horribly boring and tedious and I am so grateful when they catch a stupid mistake I made regarding a dose, allergy or interaction. They drive me nuts though when they starting suggesting other medical treatments. One of my patients recently had a script filled for flagyl. The pharmacist asked her what it was for, and the patient replied that it was for some problems she had "down below". The pharmacist then suggested several vaginal douches and also recommended that the patient be tested for other STDS. The patient was horrified that she might have something else and called the office upset. We had to explain that the flagyl indeed for her antibiotic induced diarrhea and not for the vaginal issue the pharmacist was discussing!Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-89173867207853122142014-02-22T09:01:00.001-08:002014-02-22T09:01:20.830-08:00Code Brown Boomerang!All to often a patient from the ICU will have to go to the OR for a procedure. These patients are usually on vents with lines everywhere. A code brown will happen, usually right before they have to go to the OR. Our basic rule is if it happens on your watch, you take care of it. So if it happens in the ICU, the ICU team cleans it up. If it happens in the OR, the OR team takes care of it. There are some who try to hide it in the ICU because it is hard to move the patient and they think "well the OR team will have to move them to the OR table, so it will be easier for them to clean it!" but this doesn't happen to much. The real problem, is what happens during transport. One patient had a bad blow out in the ICU and they cleaned it, in the OR they were clean and they were clean when they went back on the ICU bed. When they got back to the ICU, there it was again. the blow out happened right between the OR and the ICU. The ICU nurse got all mad and demanded the OR team come back and clean it up. There was a huge discussion on the rules of code browns and "he who smelt it must deal with it", but when it was all over both teams took care of the patient, who had another code brown a few minutes later.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-66758372584888926032014-01-17T08:44:00.001-08:002014-01-17T08:44:39.309-08:00Clinical SummaryIf having to use the EMR is not bad enough, we now have to provide each patient a printed out summary of the visit before we leave. Given we are a tertiary referral center and each patient comes with multiple records, films and studies there is no way that we can go through everything and as soon as they leave the exam room hand them a summary without it being totally useless. Too make matter worse, patients now come to their consults with their clinical summaries from other doctors thinking these things actually help. Yesterday a patient come in with a handful of these, one of them simply said "in order to comply with Federal Regulation, this is a clinical summary of your visit. We saw you as a patient on this date. These tentative diagnosis were discussed but they were not confirmed."<br />
<br /><br />
We have now told patients that they are more than welcome to wait for their clinical summaries, it may be until very late at night until we can personally talk to their referring doctors and review all of their studies. Invariably, they leave before then.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-45870161530589877852013-11-09T16:48:00.001-08:002013-11-09T16:48:41.633-08:00Doppler Effect Turn Around TimesIt seems that the closer you get to the setting sun, specifically closer to about 3 o'clock, the OR turn around times get longer. The exact opposite happens once the sun sets as the times get shorter. Looking into this phenomenon I found that it had nothing to do with space time but rather laziness. The morning OR shift knows that if the case starts before two, they will have to do it and get the room set up. If they drag their heels, there wont be time to set it up and then they can leave it for the second shift. Since the second shift comes in at 3 the morning shift will push all the work on to the them. They then have to set up everything and now you have a 2 hour delay. The second shift then wants to get everything done and will hustle to get any follow on cases done so they can have the rest of the night to chill. Rule to the wise, if you are NPO and have surgery scheduled for 2 or 230, remember the doppler effect and be ready to be hungry for at least 2 additional hours.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-82326191185718676722013-11-08T07:23:00.000-08:002013-11-09T16:39:49.579-08:00Code Green!Every now and then I would hear a code green called overhead and really didn't pay much attention to it. I know what a code brown(pooped in bed) and a code yellow ( peed in the bed) are, but a code green was one those that I just didn't know. Was it bile? Tube feeds? Now it seems that a code green is being called every few minutes. Finally, I had to ask one of the unit clerks what a code green was. She looked at me and said it was a press ganey! I asked her what she meant. She explained that if a patient was belligerent or if their family members were belligerent or stealing or drug seeking they could call a code green which is security. Once security is called, the patient never will receive a press ganey survey!Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com2tag:blogger.com,1999:blog-1640145326942707855.post-32773645450964651802013-10-14T17:22:00.000-07:002013-10-14T17:22:12.991-07:00No Care DispairIt is always hard when a patient cries. You want to comfort them and do all you can to ease their suffering. Today was one of those days but their was no comforting. Three separate patients broke down in tears today. Each has a chronic medical condition and just found out that their employer can not afford to pay the increased cost of their health condition and as a result, they have to go out on their own and purchase Obamacare only to find out that they cant afford it. I did my best to try to help them and assured them that I would take care of them no matter what. That didn't comfort them because they didn't know how they were going to pay for their meds and the hospital costs. So much for the affordable care act.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-45025358368617989902013-09-22T18:34:00.000-07:002013-09-22T18:34:56.298-07:00"It costs more to provide less"Just for grins I looked to see how much it would cost to get my family health insurance through one of the Obamacare exchanges. Turns out that for about 40 percent more cost, I can get a higher deductible plan that covers less. What a great deal! I hope the medical center doesn't decide to drop our coverage.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com2tag:blogger.com,1999:blog-1640145326942707855.post-17108709320904720062013-09-22T18:27:00.002-07:002013-09-22T18:27:57.469-07:00Dope Flu20 y/o male in the ED brought in by his parents because he was nauseated, vomiting, tachycardic, sweating and gnawing abdominal pain. Parents are convinced that he has appendicitis. They said that he got sick right after they pulled him out of college last week because of his bad grades. I asked Mom and Dad to step out while I examined him. Yep, its been a week since he had his last fix of Oxys. Good ole dope flu. We checked an US of the belly to be safe. Gave him the numbers of AA. HIPPA says we cant tell his folks.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-50592576021485203042013-09-16T14:37:00.003-07:002013-09-16T14:37:45.883-07:00Pop tops and blow holes for DummiesI think I am going to have to call the publishers of those "Dummies" books to see if they would consider a series on medical issues. There are already tons of books about caring for cancer, "what to expect when you are expecting", and dealing with grief but I think the post-trauma market is untapped. Especially for the "I took Vodka and Molly and then drove my car into the overpass" crowd. There could be Dummies books for "pop tops" (PEG tubes) which if you are going to shot gun beer into them let it go flat otherwise, the top pops and you spray all over. "Blow holes for Dummies" (what little cigars fit into the trache tube), "Keg taps for dummies" (suprapubic catheters), and last but not least "Bung holes for Dummies" for the colostomy bags. Hey, you know how they have those anti smoking commercials with the people who lost their voice box and legs and stuff on TV. Maybe they could have some that say "I'm cool, I joined a gang and now I have a pop top, blow hole, a keg tap and this great bung hole!Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-19851987317534864372013-09-16T14:20:00.000-07:002013-09-16T14:20:12.058-07:00Reconcile This!!As part of yet another JACHO mess, we are supposed to reconcile all the patients medications when they leave the hospital. This means that we are supposed to say what medicines they are to take and not take regardless of what we are threating them for. We are then responsible for those medications both medically and legally. This is hard enough because they might be in the hospital for a hernia but all the meds are cardiac or psyche meds. Now we have to reconcile all the herbals and all the other things that they take. "Lets see they take gin sing, oral silver, and a powder from the flea market". On the computer I cant find a way to check the button that says "call the person who told then to take this stuff", or the button that says "sue someone else" so I just click "do not continue". Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-15862701865471914732013-09-15T18:10:00.001-07:002013-09-15T18:10:19.935-07:00Action HeroI was driving home from a trip and traffic on the Interstate started to slow down. I saw the sign that said "right lane closed ahead, merge left". I moved to the left lane and joined the other cars that were already there slowed down. After several minutes of slowly moving ahead, car after car sped past on the right to see how far up they could get and then barge into the line. Of course they slowed the whole thing up and made everyone have to slam on the breaks. One almost caused and accident. Suddenly the pickup in front of me moved into the left lane. He didn't speedup, he just stayed even with me. I made sure I left his space in front of me open. Car after car flew up behind him, honking and honking. He just stayed even with me. The line moved steadily without incident. When the right lane closed he slipped back in front of me. I gave him the best thumbs up and salute I could! You sir are a true hero! By the way, his license plate was from Texas and had a combat wounded veteran symbol!Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com3tag:blogger.com,1999:blog-1640145326942707855.post-62623421865870235182013-09-06T08:54:00.000-07:002013-09-06T08:54:05.937-07:00AchromatopsiaIt was early morning rounds before surgery and one of the medical students was presenting a case that came in during the night. She explained that it was a 24 y/o male with severe abdominal pain that was out of proportion to exam. I stopped her right then and asked what his race was. She said that they were told not to mention race as that is "prejudicial and stereotyping". Before, I could saw anything else, one of the residents said, Asians don't get sicke cell crisis. I cant wait until we cant mention sex in the evaluation of pelvic pain.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1tag:blogger.com,1999:blog-1640145326942707855.post-57994403511512473942013-08-26T14:12:00.000-07:002013-08-26T14:12:13.311-07:00Bathroom OragamiI though I was imagining things. I double checked, yes the toilet paper in the hospital was getting narrower. I checked at home, it was narrower as well. I didn't measure but I had the distinct thought that my bottom was getting bigger. This is a problem! A Conspiracy! before I could dwell on the possible regulations and profit motivations of decreasing the toilet paper by a half inch I went into problem solving mode. How do you fold something to make it wider. It turns out that you can fold the paper on itself in kind of a star rosette pattern that makes it at least 6 inches wide but it takes alot more paper. I decided I have two choices, be in the lavatory longer and have people yell "what is taking you so long?" and yell back "origami!", or just go in with a roll of Brawny.Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com3tag:blogger.com,1999:blog-1640145326942707855.post-80841564147527136272013-08-26T14:02:00.000-07:002013-08-26T14:02:38.280-07:00Bumper Sticker LibI had an older patient who had afib and a stent and needed surgery for a malignancy. Anesthesia saw him and wanted the opinion of his cardiologist in regards to his cardiac status. The cardiologist then stated that they no longer accepted Medicare and that he would be happy to see him if he paid his usual and customary charge without any discount. Needless to say the patient could not afford it. I got on the phone and found another cardiologist who worked him up and we were able to do the surgery. Today I was walking though the parking lot and saw the cardiologist who no longer accepts Medicare. On his bumper were two stickers. "If you have Medicare, thank a Democrat" and "Change".Throckmortonhttp://www.blogger.com/profile/12362147065452723155noreply@blogger.com1