Black Friday, Oh, my God Saturday and What the Hell Sunday

(Besides it's association with shopping, the day after Thanksgiving is associated with the most horrendoma's that present to the ER.) I have been trying to figure out if Prozac will fit in the battery compartment of my beeper because I think that my beeper may be suicidal. It went off 34 times on Black Friday, 31 times on Oh, my God! Saturday, and so far on "What the Heck, Sunday 21 times. These have not been the routine, hey "I am going to lie to you in the hopes that you will call me in narcotics over the holiday calls" but the urgent consults that are urgent because people waited to come in. People are driving home after being "pissed" with their family and taking it out on the packed roadways. Sic kids are visiting their grandparents who have COPD who then catch the cold and end up intubated. People are falling off roofs trying to put up their Christmas lights. That pesky indigestion that feels like an elephant on your chest radiating to the arm is getting worse and worse. Its the same thing every year.

The hospital seems more quiet but that is because there is not the elective surgeries or the outpatient diagnositic stuff going on. Instead it is filled with the hustle of the techs moving patients in and out of CT, OR and the cardiology labs. We have most of the senior nurses and techs working because they are the most efficient and we need them in a time like this. A tear was brought to my eye when in a code the charge nurse yelled to another nurse who grabbed a computer terminal to document what was going on, "F***the computer, take care of the GD patient!"

Triage Trolls

I love to hear the latest on how long people have had to wait to be seen in the ER. Most of the time it is because they misunderstood that it is the "Emergency Room" and not the "I have a back ache and cant sleep room" or the "I blew off work and need and excuse room". I had to follow up on a complaint by a local attorney who threatened to sue the hospital and the ER doctor because he had to wait 3 hours to be seen for a 1 cm laceration of his finger that did not require sutures. ( I have no clue what he thought his damages were.) This is what I found out. He had signed in and was seen by the triage nurse. They checked his vitals signs and saw that he was not bleeding and he was then triaged to the list of those who would be seen in order for the "minor" complaints. "Minor complaints" are those that mean you are not at risk of dropping dead that instant from your problems. These are who were seen ahead of him. Two people involved in an auto accident who were intubated in the field, one of which went immediately to surgery. A ruptured AAA. Three possible MI's (2 were positive) a copd patient who needed intubated. A pregnant woman with ecclampsia and seizures. A kid with a ruptured globe. 4 acute fractures. 2 pneumonia patients requiring oxygen, a brain bleed, 2 strokes and a slew of others.

I guess that he felt that people should be seen in the order in which they hit the doors and not by how sick they actually are. It doesn't really matter though. People will only look and say that the average wait was 2 hours, it doesn't matter that they didn't have an "Emergency".

404 Error

(Rounding in the world of electronic medical records). I know that the politicians and all those from the adminostratosphere think that electronic medical records are the best thing in the world but man they are a pain in the neck. It used to be that when I went to round on a patient, I had the chart and in it were the vitals, the drain outputs, pathology reports and lab values. I would talk with the patient, examine them and then go over all the values and answer their questions. Now, you first have to sit down and log in to the computer (If there is one open). Scan all the data, if necessary print out all the information you can and then go see the patient. Of course, a lot of the data is not in the chart because the nurse has not had time to enter it into the computer. You can try to track the nurse down but they are locked away at some other computer trying to catch up on all the other paperwork. So, you go see the patient and they ask you a question that would normally be in the chart. You then try to find an open computer and relog in (you get HIPPA'ed out if the computer is inactive while you examine and talk to the patient) and try to find out the answer to the question.

The tech guys then decided to help with the problem by having these little computer carts that the nurses can push from room to room. Of course when you pull up the patients chart after re-logging in for the 10th time you get 404 Error. You then have to push the cart around the room trying to find the sweet spot that will let it connect only to remember that this is a telemetry floor and the computer is probably setting off the guy in the next rooms AID. (Automatic defibrillator). After considerable wasted time, you find the nurse and ask her for the information you need and the answer is that it is in the EMR!

I think I figured out why people think EMRs will save money and prevent medical mistakes. They first make it hard to see patients, so you see less patients and therefore there will be less spent on medical care. Secondly, you cant make a medical mistake because you cant actually treat patients. (Oh, I am writing this now as they are trying to re-boot the servers that run the EMR system. Go figure!)

OB/GYN - GYN = 66%

Wow. I was talking with several of our OB/GYNs in the doctors lounge. One had just decided to stop delivering babies and found out that her medical malpractice premiums would drop by two thirds! She coldn't believe it, when she did all the numbers she would make more by doing less! In fact delivering babies was actually costing her.

I am sorry to see her stop her OB practice. She took care of those with no insurance, those who came in to the ER with no prenatal care, those on Medicaid. It all came down to simple economics, she could not afford to deliver babies and carry insurance.

Auto-transfusions

I am not the sharpest person in the world, but I know that if my patient is very anemic I can't get him better by taking blood from the right arm and transfusing it into the left. This is why I dont understand this new "job creation plan" that hit the news today. As near as I can figure out, money to the federal government comes from taxes. These are the various income taxes, corporate taxes and tarrifs. Taxes that come from the private sector are what fund the government because government jobs cant fund the government. This is because the government pays the federal employee with tax dollars that it then recollects a smaller portion in the form of income tax. This is like transfusing yourself but letting most of the blood fall on the floor. The more government jobs you create the more money you lose and the more money the government needs in the form of tax dollars from the private sector. This causes the private sector to sink and recess as it has to pay more and more to the Federal Government. The report today stated that the new administration is expecting to create 2.5 million jobs in developing new infrastructure, schools and other government funded areas. This isn't an auto-transfusion, its a hemorrhage.

Fecal Encephalopathy

(S****for brains) JACHO hit us again. I really wonder if they have any clue on what really goes on in a hospital. We used to be able to keep some medications in the OR because you never know when you will need them. These are things like lidocaine with epi, heparin, thrombin, surgicel, pitocin for the OBS, DDAVP to decrease bleeding, etc. Well JACHO has determined that these need to be kept in the pharmacy or at least somewhere other than where they will be needed. So, when the need arises which is usually out of the blue the circulating nurse has to run out of the room to find it or we have to call someone to go and try to find it instead of just having it. God forbid the nurse actually stays in the room to help care for the patient. This is especially a problem for trauma cases where we are going straight from the ER to the OR. Apparently we can't have a generic pharmaceutical bag or set for each case so at least all the meds could at least be put into the room either.

Why can't JACHO do something that will really improve patient care, like decrease the paperwork so nurses can actually care for patients and help them be more efficient. Oh, nevermind, I forgot, they are self supporting bureaucrats from the high admistratosphere.

INTJ in an ESFJ world

(Myers-Briggs Personality types) I know that many people disregard the Myers-Briggs test but I am amazed by how many others use it. It is used to help determine which jury can be most swayed by emotion rather than facts, who will buy what type of car based on how others will look at them, and how to sway the results of an election by avoiding facts. By researching which personalities tend to group together and act a certain way, the deck can be stacked. This is especially true when you see that of the 16 personality types, 4 make up over 50% of the population. I leaned all this from a friend who is a marketing professor with a Ph.D. is in psycology and has a side job as a consultant for picking jurors!


In medicine, it has been shown that physicians in the same field tend to have a high correlation with the same personality types on the Myers-Briggs test. I dont know if they are that way going into the field or if the field makes them that way. But I can assure you that surgeons have a very different personality compared to pediatricians. The other thing that has been seen is that physicians tend to be in the personality types that are least represented in the general population and in the types that are the least likely to get along. There is also good data that shows which personality types are most likely to sue.

I dont know about politicians. For the Myerss-Briggs to be accurate, it must be filled out by the individual and honestly. Somehow, I get the feeling that politicians would try to fill out the test based on what they want you to think they are rather than what they really are. I cant help but think that the personality type that goes into politics more often than not is not the same one that tends to make the best leaders. Unfortunately, the types that make the best leaders are not the ones that tend to be the most popular.