Thursday, July 21, 2011

Amazing Discovery

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.

12 comments:

  1. 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.

    Where I'm at now...wow. People pretty much fuck everything up.

    Ms1

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  2. OK 9-11, I'll see your missed meningitis and raise you a missed Glioma...
    and 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

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  3. 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.

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  4. I 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!
    Dr. J

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  5. "working on the periphery of a military hospital"???
    I thought DA/DT was over...
    So are you like Carl Spackler, walking the grounds, dispensing a little Manganese along with the finger wave...
    cute female surgeon general???
    you mean the spic, I mean hispanic lesbian???
    she WAS sorta hot...

    Frank

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  6. 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.

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  7. Cholera Joe...
    "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

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  8. 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.

    One 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...

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  9. @ Minimedic..
    Only Homos go to the ER with another Dude/Poison Oak.
    OK, if the "Other Dude" is 5 MP's cause that what it took to subdue you at the O-Club with your .87 BAC,raging erection, and subdural hematoma, thats different.
    And I don't even wanta ask what "BOLC" is.
    "Balls On Lover's Chin"?
    "Bend Over Lieuteniant's Coc*"
    Its like the first patient I ever saw in the ER with a Wasp Stang.
    No anaphylaxis, ChestPain, Airway Obstruction, just an Owie where the Wasp stung
    the Pussy. "People go to the ER for Wasp Stings?" I asked one of the other Mid-Level-Health-Care-Providers.
    I've been to the ER once in my near 50 years, and that was only cause I was unconsious with a broken leg.
    Got a rectal exam(from an XX) and had to pay my deductible till the collection agency gave up and settled for ruining my ruinous credit rating.
    Seriously, the only one who would loan me money was Uncle Sam.
    Sucker.
    Haven't been back yet, which made that ER rotation tough...

    Frank

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  10. Nice article, thanks for the information.

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  12. Awww, military docs...... good times from 29 palms.

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