Administrivia stat pages

It was a new record at our hospital this week. Within 30 minutes of admission of a patient to the hospital I got three seperate pages including one from a RN and another from the nurse manager that I did not fill out their newest JACHO form. 2 hours later when I finished surgery, I went to check the patient that I had admitted and found out that no nurse had yet been in to see them. Out of spite I filled out the form and gave it to the patient as well as a copy of the incident report that I filled out. I then recalled the nurse manager who paged me and told her that the form was in the patients room.

I cant fault the nurses on the floor. They were creamed. They are understaffed because so many of them that should be taking care of patients are now walking around with clipboards making sure that the paperwork is done, regardless of the actual patient care. We now have nurses that take care of patients and nurses that take care of paperwork and manage the administrivia. The more admistrivia they manage, the more they create. The more paperwork nurses we need. Since the hospital is going broke, they cant afford to hire more nurses. The result, less patient care and more administrivia.

So I get three pages regarding a nonessential paperwork form within 30 minutes and the patient with a severe infection was not seen for 2 and a half hourse and did not get his first dose of antibiotics until 4 hours after he was admitted.

Homeopathic Waterboarding

In the service I was never waterboarded but it was demonstrated to us during survival school. It is basically forcing someone to lay back while you pour water over their nose and mouth to simulate the effect of suffocating. This causing an intense feeling of distress and panic. Much like using a Nettie pot, I found out. With one of these as much hyped my Oprah, you twist your head back and pour water into your nose while it spouts out the other side and down your throat and out your nose. Causing first much dread and panic with a little bit of suffocation. When I first did this to treat my sinus infection, I would have given up my social security number and ATM pin number to anyone that asked to not have to do it again. But, do you know what? It worked! My head was as clear as could be. In fact, I did it again, this time I held my breath and it was much more tolerable. Now I pretty much waterboard myself whenever I have sinus problems.

I am now working on other homeopathic medical treatments we can use on Enemy Combatants. Maybee we can put lit candles in their ears! Force them to drink urine? Or, the worst, herbal colonics! Tell us what we want to know or you will have lilac flatus!

Lateral Boomerangs

The perfect administrative federal healthcare medicolegal storm seemed to hit this weekend. Medicare has a whole bunch of diagnosis that it will not pay for if a patient is discharged and then is readmitted within a certain peroid of time. Because of lawsuits and threats of lawsuits our nursing homes and extended care facilities are decreasing in number and want nothing to do with complicated patients. This leaves as the only option home care and home health for those patients that do no meet Medicare admission criteria anymore but cant get into an extended care faclility. So many go home and then need to be re-admitted. So what do you do. The answer that comes rapidly is to re-admit them but at another hospital. A so called lateral. A lot of folks went away for the holiday weekend, so what do you do with grandma? Just take her to the hospital! She was just there 2 weeks ago for her COPD exacerbation, they will admit her for a few days while we go to the beach!" Since she was just there and was dumped at the ER you have no choice to admit her, but then the shell game starts. Doesn't her internist also have privaledges at the other hospital? And so goes the lateral.

The long and short of it. Medicare wont let you keep them in the hospital. The nursing homes and ECFS wont take them because of liability and lack of pay, so you discharge them and readmit them to another hospital. Welcome to the world of federally managed healthcare.

"That Others May Live"

"That Others May Live" is on the emblem of the finest men and women to wear the uniform of our armed forces and in no way to I equate the events of today to their mission and sacrifice. I am very proud though that there are other Americans who who jump in on the civilain side to help others.

As we drove back from visiting a relative in poor health, we saw a tragic site. Some motorcyclist were riding side by side behind several cars. As the cars slowed down to take the exit the motorcyclist found themselves too close and one of the bikes went down on the interstate and flipped. We immediatly pulled to the side and ran to help. Car after car stopped and people jumped out to render assistance. One man ran into the interstate and directed cars away from us as we held pressure and held the motorcyles passengers neck in line. Another man ran into the road to save the motorcycle's driver who in his post concussion was walking right into the traffic. All told we had at least 10 people there is less than a minute. There were 4 nurses including one from our trauma center, 2 physicians, an off duty EMT and three others who risked the high speed traffic to help. EMS was there in a few minutes, the same gentleman who ran into the interstate to save the driver directed the traffic to clear a lane for the ambulance. The rider and his passenger will be OK, rain will wash the blood off the road and others will go home after putting their life on the line to save anothers.

Not the Disability I wanted!

How come if you are "legally completely disabled" you still get to drive? Today I had yet another disablity form cross my desk. We tell patients ahead of time that we do not fill these out as we are not qualified to determine disability. When the patients ask me why I am not qualified I answer that "I dont know why if you can drive why you cant get a job as a driver."

Oops, I did it again!

I think that if you are suing the trauma center and the docs that saved your life, you should probably move to another city before you get shot in another drug deal. One of our local unregulated pharmaceutical distributors managed to get shot 7 times. The trauma team pulled him through but of course he has filed several lawsuits against the medical center claiming everything from chronic disabling pain to loss of consortium due to "negligence" of the doctors and not his GSWs. He has even managed to get full Social Security Disability. The suits are bogus but of course they are a slap in the face to the docs and still represent a huge pain in the neck. The guy is just trying to see if he can be a big enough pain to get some settlement.

Well, as luck would have it, he managed to get shot again in another drug deal and was brought right back to the trauma center where the group of docs that he is suing had to save his life again. Traditionally, trauma patients are entered into the system for their labs and xrays by a code name until their real name is known. He was recognized immediately by the ER staff. Rather than using the standard trauma name from the list, they entered him as Plaintiff Plaintiff into the computer. The doctors and nurses of the trauma center now refer to themselves as co-defendants.

I would hate to be in the intensive care unit with the docs and nurses who I am frivoulously suing in charge of my sedation and pain medication.

Pretend Doctors

This has been a long call week so I am pretty fried. Several of the emergencies that I was called to see where the result of pretend doctors for which it seems we are seeing more and more. The first was a patient with mylodysplastic syndrome that makes what little platelets he has not work well. When he went to get his pain medication filled he was told by the pharmacist that he could also take aspirin or ibuprofen to help with the pain. Of course, this made the few platelets he had not work and came in bleeding. When I asked the patient why he took the aspirin, even though he had been told not to, he said "the pharmacist was a doctor! "

The very next patient came into the ER with severe back and shoulder pain. He had been seeing his independent nurse practicioner for a large swelling on his shoulder that did not get better with the multiple courses of antibiotics. The back pain had been getting worse for months. Our xrays showed that shoulder mass was a metastatic tumor as was the tumor that had eroded the body of his T6 vertebrea causing his severe back pain. Turns out he had been having hemoptysis a few months ago and the same NP treated it with antibiotics for his cough. His lung cancer is unresectable. We tried to get medical records from the NPs clinic. They do not answer the phone on the weekends or have an answering service.

The last case was the one that really broke me. A really nice gentleman who came in to the ER with generalized weakness and headaches. He was really proud that he had never had any medical problems and he attributed it all to his holistic lifestyle. In fact he goes and sees his holistic physician once a month. They had been trying all different types of therapy but he was getting weaker and weaker and ended up in the ER when he fell. His EKG showed AFIB, his ejection fraction on echo was about 20% and his lungs were full of emboli from atrial clots. His histrory was a bit hard to get as he had to breathe with the rebreather.

I know that there are good nurse practicioners, good pharmacists and good holistic practicioners out there. I also know that there are bad doctors out there. What I think makes the ones that are good, good is that they know that something is out of their league and they get help. Hopefully, they get help for their patients before its too late.