Clinical Summary

If 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."


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.

Doppler Effect Turn Around Times

It 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.

Code 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!

No Care Dispair

It 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.

"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.

Dope Flu

20 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.

Pop tops and blow holes for Dummies

I 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!