Working on the periphery of a military hospital has been wonderful. I have been able to hide very well, and, at the same time, have been able to do some good medicine (a lot of ortho stuff, derm, and some infectious disease) pretty much on my own. Folks tell me I'm doing a good job so I'll believe them. But it has been nothing short of revelatory to have to deal with the docs they have staffing their "ER". Most are civilian contractors and most of them either don't care, or are incompetent, or both.
Example: patient with chest pain, abnomal EKG, and blood pressure of 190/110. Discharged home after initial set of markers negative.
Example: patient with high fever, headache, neck stiffness. Discharged to follow up in clinic after shot of toradol and CBC.
Example: patient with shoulder pain, pulsatile in nature (absent injury) and pain radiating to hand. Discharged to follow up after shot of toradol.
Patient one ended up getting stented three days later, luckily, without infarcting. Patient two had, drum-roll, meningitits. It was viral. He lived.
Patient three has a tumor in his axilla. He will probably live for a while. It took us a month to get the MRI that diagnosed him.
Lovin' me some government health care. Hopefully I'm one of the good guys in a very crappy system. So here's the amazing discovery... in a system which is highly regulated and top heavy with administrative lackeys the care delivered tends to be, well, a piece of shit. This came as a great shock to me as it will to you I'm sure.
Thursday, July 21, 2011
Subscribe to:
Post Comments (Atom)
When I was at school the Navy docs missed a cancer diagnosis on a guy. He was allowed to stay on and take extra time to graduate as a sort of consolation prize for metastasis. I think he did end up graduating a few weeks before he died.
ReplyDeleteWhere I'm at now...wow. People pretty much fuck everything up.
Ms1
OK 9-11, I'll see your missed meningitis and raise you a missed Glioma...
ReplyDeleteand ohyeah, MS1, Navy Docs fucking something up? its expected, like Air Force Docs sucking Coc*
December 1992, Marine Staff Sergeant who never came to sickcall showed up at my Sickcall.
Dude wasn't even in my unit, but his (Minority)Batallion (Minority)Surgeon (Minority) had called (Minority)in "Sick" which really meant he was tired after moonlighting all weekend, so I had to see all his patients that day.
Long story Longer, even Trig Palin could have figured out this guy was sick, but as a measely GMO I couldn't order a scan, only the appropriate specialist could, so after half an hour with a Neurologist, who's flaming homo-ness apparently got by the vaunted MEPS physical exam, said I'd have to treat with NSAIDs, biofeedback etc etc, until he could see the patient in 3 months.
So I did like Spike Lee, and told the guy to go to his hometown ER, since he was leaving that day for what would be his last X-mas..
And of course when the Congressional Investigation happened a few months later they tried to make me the Bad-Guy, which was tough, cause I like bein the Bad-Guy.
Good thing I taped all my calls to specialists back then, which is perfectly legal on federal property...
and I walked into the "Quality ASS-urance" conference room, did my best Jack Nicholson, and slammed the cassette on the table...
and the Neurologist, he's still mal-practicing, he was one of those USUHUSU guys, owes the Navy like 50 years...
Frank
Only the female Air Force physicians did as you insinuate, Frank. We male physicians were on the receiving end. I'll never forget that cute little female general surgeon.
ReplyDeleteI am sensing a little dissatisfaction with the govt job 911. Want to cover my Saturday night shift?? It's the annual drunken drag race festival at the town one mile over from my place so it should be fun.....come on, jump back in the pool!
ReplyDeleteDr. J
Frank, as you may recall, the beauty of aviation medicine is that you work for the folks who visit swift and vient death on our enemies. They don't give a rats-ass about " patient cate initiatives" and the like. They just want you to take care of their peeps. This is why, in most places, including mine, the aviation clinic is as far from the " hospital" as possible. Literally and figuratively. Chinch bugs... Manganese... 'Lot of people don't even know what that is.
ReplyDeleteCholera Joe...
ReplyDelete"cute little female surgeon general"????
Hmm somehow I took you for a C. Emerson Koop fan..
I thank your thankin of Angie Novello, hot little hispanic dish, appointed by President GHW Bush in 1990..
bought her a drank at the Camp Lejeune Officer's Club, but she was more of a Bush fan if you "Nome Sane"
that was back in my Mrs Robinson days when I thought a hot older woman was my ticket to total consciousness..
seriously, with that Navy Uniform the Surgeon Generals wear I thought she was just another horny O-5 Nurse Corpse Officer..
Frank
My husband and another officer went to a base hospital during BOLC with rather fercious cases of poison oak. (We know it was poison oak because they were practically living in it at one point.) Benadryl wasn't TOUCHING it, so he was forced to go the ED route.
ReplyDeleteOne provider examines my husband, gets the history, and promptly perscribes a tube of coriscosteriods. The other guy's provider INSISTED that he had an infection...
Nice article, thanks for the information.
ReplyDeleteDear 911Doc,
ReplyDeleteIt’s a great pleasure to read your blog. I find your post very informative. Thank you for sharing.
As a reader, I consider your writing to be a great example of a quality and globally competitive output.
As a moderator for Physician Nexus (a community for physicians) I would like to share your genuine ideas and knowledge. With this you can gain 1000 physician readers on Nexus.
We would love for you to visit our community. It's free, takes seconds, and is designed for physicians only - completely free of industry bias and commercial interests.
Best,
Janmar Delicana
On behalf of the Physician Nexus Team
www.PhysicianNexus.com
Awww, military docs...... good times from 29 palms.
ReplyDelete