Thursday, December 09, 2010

There's No Blood in the Urine

So I don't work in the ER much anymore and you have heard that many of my compatriots, board certified in ER medicine too, do not work there either. So who does? Well, lots of PAs, and I like PAs, and lots of doctors who trained in 'something else'. Usually 'something else' is family medicine, sometimes internal medicine, hell, I even know an anesthesiologist who prefers to work in the ER.

So at my super duper government clinic job we get all ER follow ups. And our ER sucks the big one. I mean SUCKS it. If you are sick where I work do not go to the ER, they will not do a spinal tap on you if you have fever and a headache and vomiting, they will punt any sick person immediately to civilian land, and they will send you home with a kidney stone calling is 'muscle spasm'.

See, having blood in the urine is cool and all, but it only happens in 85% of those with a kidney stone. Add to that a history of kidney stones and if you come in and see me with a bloodless urine, but excruciating back pain, I am going to assume you have a stone (or something worse) and I am at least going to take a plain film KUB to help the urologist out in following the stone, and in satisfying myself that you have renal colic.

To have this poor sap show up in my clinic which ALSO punts sick people immediately, and have me, with an old Xray machine, make the diagnosis is, I think, where ER medicine is headed. They need me in Alaska, they need me in Missouri, Montana, Virginia.... 'critical shortages', but I'm not going. And I know my friends who have kicked the habit ain't goin' either... Shame. Real shame that. 


  1. The sucky docs in your ER can't be any worse than the yahoos working in the VA ER

  2. 911doc,

    What would it take to bring you back to the ER? You can't be happy in that dull, bureaucratic job.


  3. StorytellER Doc and ERP (er stories blog) seem to be going strong. I think Panda was dead on arrival

  4. 911doc,

    I'm a medical student intent on Emergency Medicine. I look forward to your posts everyday (you've been leaving me hanging...) but I worry that I might encounter a lot of the bureaucratic crap that you so frequently rail against, especially as I'm doomed to fifteen years of Navy medicine after graduation.

    I know there's not much I can do to avoid the common pitfalls and annoyances of EM, but I was hoping you might be able to lend some advice as to how I can best prepare for an EM Residency/anything I can do as an MS-1 to better experience EM.

    I'm one enzyme away from tossing my biochemistry books out the window, and I can't wait to be active in the ED. Your posts provide a welcome insight into clinical emergency medicine and a brief respite from the TCA cycle.


  5. Greg,
    All that needs to happen is EMTALA getting repealed, Obamacare getting repealed, JCHAO getting disbanded, Press-Gainey getting sent to clear minefields in Afghanistan, me getting six-hour day shifts only, and me getting back the ability to tell patients, when appropriate, "no".

    Dear MS1... More when I can get to a computer.

  6. Hey 9-11,
    and whats the deal with Mark Richt?? I don't care how Good of a Christian he his, how does he NOT throw to AJ Green every 1st Down??
    Oh excuse me, EVERY FIRST DOWN!!!!!!!!!!!!
    OK it's cool, you beat GEORGIA TECH!!!!!!!!!!!
    Yey UGA,
    and I'm not bein sarcastic, my daughter goes to Georgia Tech, and I'm getting used to 20-Something Korean-Vietnamese-Korean Bio-Mechanical-Engineering dudes trying to cozy up to me......
    Seriousy, Mark Richt
    MARK RICHT..................
    let it vent


  7. mark richt is a nice man and a good football coach... sometimes nice guys win... probably not in the sec though.

  8. Urban so tired of you Bore Eagles and Bullfrogs that he quit. Twice!

    My Fightin' Caymans are comin' after you, led by a 4-A high school coach, next fall.

  9. 9-11,
    its not "Hatin", lets see, how can I explain it to someone who didn't go to a Real Football School???...
    Its like in 3rd grade when you dunked Mary Jane Crotchrot's Pigtails in the Inkwells to let her know you liked her...
    Some people look at the glass and say it's "Half Full" some people say it's "Half Empty", I pour 1/2 of it out, piss in it, and wait for some sap to take a sip...
    And when you finally make it to the top of the Mountain, you can't take time to enjoy the view, its much funner to piss on those below you..
    Some men dream of things that never were and ask "Why Not", I see things as they are, and say "WTF"
    And I know Mark Richt has a hot wife and doesn't diddle little boys, but if he'd coached the Bad Guys at Gettysburg I wouldn't have to pick my own Cotton...
    But hey, y'all have another year to waste AJ Green blocking on end-arounds....

    Frank, proud Alumnus of the 2010 BCS Champions, who's contributed absolutely nothing to Society, and even less to the University..

  10. frank,
    do you know something i don't? AJ for another year? no way, but PLEASE let it be true... Richt needs to channel his inner dark side, which is probably a lot like George Will when he's angry... looks just the same as when he's not. Best thing Richt ever did was get the team on the field the last time we stomped Florida, which was, hell, four years ago now? but he repented from that, which is also a real shame that.

    you are so over the top with the War Damn Eagle thing i actually hope you guys thump Oregon, and i'm just the kinda guy that if they lose, i don't thing i will be giving you too hard a time...

    and glad to know who it actually is who is pissing in the glass of water... shoulda known it was you all along...

  11. dear MS1,
    you are set... the military might be the best place to practice real emergency medicine in the forseeable future because everyone has a primary care 'doctor' and you get to punt the not sick immediately. of course, if this thing in afghanistan keeps doing what it's doing you may get to practice it in a CASH or support hospital in the land of the poppy.

    but seriously, screw the first year, it's all more hoop jumping. and the clinical years is where you make your mark. you want to do something simple to get way ahead on ER med and lots of other things? buy 'emergency medicine secrets'... markovchik and pons. read it once every two months. it will make you look like a genius.

    other than that jump in and don't worry about the freaking amino acid cycles... the evidence on the worthlessness of that is well demonstrated by PAs who do their school in a couple of years and learn on the job. work with many, and many don't swim very long in the ER, who, after a few years, are right up to speed with advanced ER residents or docs...

    get the best grades you can but enjoy it. you will do fine. thanks for reading.

  12. 9-11,
    I guess it's true Asians can't recognize sarcasm...
    AJ Green has about as much chance playing for the Bulldogs in 2011 as I do, or Cam Newton Do, I mean Does. Or Elizabeth Edwards...Was that tasteless enough??
    And y'all had your chance to win the SEC East this year, Seriously, SOUTH CAROLINA?? Who would be lucky to finish 4th in the SEC West BTW, and I know they beat Alabama.
    Of course, you'd just have gotten a Second Beatdown in the Dome, and your pasty White QB might have gotten his hair mussed, so it was probably a master Strategic move by Coach Markie Mark.
    But I'm afraid the Gators will be back with a Vengeance next year, Muschamps Certifiable, and has more testosterone in his little finger than Mark Richt has in his entire too-tanned-for-a-Coach-with-a-Losing-Conference-Record body.
    You know where Nick Saban is Sunday Mornings??
    NOT at Church, he's watching game film, checking out highlight clips from junior high schools in parts of Alabama even those hillbillies in "Deliverance" wouldn't go to, and game-planning for the Auburn game...
    The 2017 Auburn Game!, he looks at the long view, just like the Russkies and Chinks..
    and Markie Mark Richt? he's probably teachin Sunday School, and praying for Nick Fairley's Soul...
    And You wanta know how good Auburn is, the Football Team scores more points than the Basketball Team!!!
    Which shows how much Auburn B-ball Sucks, not that any True Southern Male Heterosexual gives a flip about Basketball, heck, I didn't even go to games when Barkley played there and I could get in for free...

  13. so frank,

    your daughter is dating a techie named long duk dong? now it all makes sense.

    very clever dinner. Appetizing food fit neatly into interesting round pie. donga need food!