Showing posts with label Humor. Show all posts
Showing posts with label Humor. Show all posts
Tuesday, January 24, 2012
Pre-op
Damn I'm hungry! ENT doc just came in an said, "You are goin to hate me." getting tons of mileage over the "allergic to succinylcholine" gag as they have sent in about thirty different representatives from anesthesia... So much fun. Well, Simone focus that heat ray to the back of my throat for the next ten days. Zowee.
Friday, January 20, 2012
Anesthesia Evaluation (blogging my surgery part 2)
Hoping they send in a medical student or intern to pre-op me for my surgery. Going to tell them I'm allergic to something called Succinylcholine. They will ask me what my allergy is and I'll tell them that it paralyzes me. They will tell me that it's supposed to do that. I will tell them that I have been seeing an allergist for two years and getting immunotherapy to make me immune to this drug because I do not want to be paralyzed again. Also allergic to Halothane, Isoflourane, Diprivan, Fentanyl, Sufentanyl, milk, eggs, and peanuts. Can't wait.
Thursday, December 15, 2011
Advice to ER Drug Seekers (shameless rip off reprint from Craig's List)
So I really wish I had written this, but I didn't. Enjoy.
"OK, I am not going to lecture you about the dangers of narcotic pain medicines. We both know how addictive they are: you because you know how it feels when you don't have your vicodin, me because I've seen many many many people just like you. However, there are a few things I can tell you that would make us both much happier. By following a few simple rules our little clinical transaction can go more smoothly and we'll both be happier because you get out of the ER quicker.
The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like shit because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.
The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn't require me to do a four thousand dollar work-up in order to get you out of the ER. If you tell me that you headache started suddenly and is the 'worst headache of your life' you will either end up with a spinal tap or signing out against medical advice without an rx for pain medicine. The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm. And while I am 99% sure its not, I'm not willing to lay my license and my families future on the line for your ass. I also don't want to miss the poor bastard who really has a bleed, so everyone with that history gets a needle in the back. Just stick to a history of your 'typical pain that is totally the same as I usually get' and we will both be much happier.
The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I've seen people in a 10/10 pain and you sitting there playing tetris on your cell phone are not in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8. That means to me you are hurting by you might not be lying. (See below.)
The fourth rule is never ever ever lie to me about who you are or your history. If you come to the ER and give us a fake name so we can't get your old records I will assume you are a worse douchetard than you really are. More importantly though it will really really piss me the fuck off. Pissing off the guy who writes the rx you want does not work to your advantage.
The fifth rule is don't assume I am an idiot. I went to medical school. That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.) However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy. So if I read your triage note and 1) you list allergies to every non-narcotic pain medicine ever made, 2) you have a history of migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart enough to read that as: you are scamming for some vicodin. That in and of itself won't necessarily mean you don't get any pain medicine. Hell, the fucktards who list and allergy to tylenol but who can take vicodin (which contains tylenol) are at least good for a few laughs at the nurses station. However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying douchetard who is scamming for vicodin. (See rule # 4 about lying.)
The sixth and final rule is wait your fucking turn. If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are. You getting a fix of vicodin is not more important than the 6 year old with a severe asthma attack. Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you. Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances. And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen, I should be able to piss in a glass and make you drink it before you leave the ER.
So if you keep these few simple rules in mind, our interaction will go much more smoothly. I don't really give a shit if I give 20 vicodins to a drug-seeker. Before I was burnt out in the ER I was a hippy and I would honestly rather give that to ten of you guys than make one person in real pain (unrelated to withdrawal) suffer. However, if you insist on waving a flourescent orange flag that says 'I am a drug seeker' and pissing me and the nurses off with your behavior, I am less likely to give you that rx. You don't want that. I don't want that. So lets keep this simple, easy, and we'll all be much happier.
Sincerely,
Your Friendly Neighborhood ER Doc"
"OK, I am not going to lecture you about the dangers of narcotic pain medicines. We both know how addictive they are: you because you know how it feels when you don't have your vicodin, me because I've seen many many many people just like you. However, there are a few things I can tell you that would make us both much happier. By following a few simple rules our little clinical transaction can go more smoothly and we'll both be happier because you get out of the ER quicker.
The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like shit because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.
The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn't require me to do a four thousand dollar work-up in order to get you out of the ER. If you tell me that you headache started suddenly and is the 'worst headache of your life' you will either end up with a spinal tap or signing out against medical advice without an rx for pain medicine. The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm. And while I am 99% sure its not, I'm not willing to lay my license and my families future on the line for your ass. I also don't want to miss the poor bastard who really has a bleed, so everyone with that history gets a needle in the back. Just stick to a history of your 'typical pain that is totally the same as I usually get' and we will both be much happier.
The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I've seen people in a 10/10 pain and you sitting there playing tetris on your cell phone are not in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8. That means to me you are hurting by you might not be lying. (See below.)
The fourth rule is never ever ever lie to me about who you are or your history. If you come to the ER and give us a fake name so we can't get your old records I will assume you are a worse douchetard than you really are. More importantly though it will really really piss me the fuck off. Pissing off the guy who writes the rx you want does not work to your advantage.
The fifth rule is don't assume I am an idiot. I went to medical school. That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.) However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy. So if I read your triage note and 1) you list allergies to every non-narcotic pain medicine ever made, 2) you have a history of migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart enough to read that as: you are scamming for some vicodin. That in and of itself won't necessarily mean you don't get any pain medicine. Hell, the fucktards who list and allergy to tylenol but who can take vicodin (which contains tylenol) are at least good for a few laughs at the nurses station. However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying douchetard who is scamming for vicodin. (See rule # 4 about lying.)
The sixth and final rule is wait your fucking turn. If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are. You getting a fix of vicodin is not more important than the 6 year old with a severe asthma attack. Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you. Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances. And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen, I should be able to piss in a glass and make you drink it before you leave the ER.
So if you keep these few simple rules in mind, our interaction will go much more smoothly. I don't really give a shit if I give 20 vicodins to a drug-seeker. Before I was burnt out in the ER I was a hippy and I would honestly rather give that to ten of you guys than make one person in real pain (unrelated to withdrawal) suffer. However, if you insist on waving a flourescent orange flag that says 'I am a drug seeker' and pissing me and the nurses off with your behavior, I am less likely to give you that rx. You don't want that. I don't want that. So lets keep this simple, easy, and we'll all be much happier.
Sincerely,
Your Friendly Neighborhood ER Doc"
Wednesday, April 06, 2011
ACEP* Consensus Statement on Non-Academic Emergency Medicine as a Career
*Atomic College of Emergency Physicians
Tuesday, March 22, 2011
Here's the Bullseye... It's on My Back... Fire Away
Kevin MD has turned the internet medblog into a business (and damn him for being better at it than we are... uh, I mean, congratulations, doctor). He is kind of the Drudge of Medical News. Recently he posted this, from a Child Psychiatrist, and it kinda struck a sour note on my first read, and on my second and third the sour note turned sour-er.... I'm going to stay out of the gutter on this one, but I do want to take issue with this physician's viewpoint.
Here's the statement that got me, and one that, no doubt, in today's post-modern society, didn't raise an eyebrow with many who, thirty years ago would have said, 'hmmm.'.
We should be the most supportive profession when it comes to our colleagues becoming parents? Why. I'll stop there for a minute because I really want an answer to that. Why should we be? So as to model good parenting for our patients? Really, that's the reason?
Shouldn't have to pick one or the other??? Why? Because you want it all? Really, why?
Since when has becoming a physician been anything less than a dog-eat-dog marathon of sleep deprivation and ladder climbing, and patient care above all else? I'm not saying it should be that or that it has to be that, but what, doc, exactly, did you think you were signing up for when you walked into first year med? I mean, did you not know about the demands of the most demanding profession? Did you expect them to be lessened for you specifically?
And Dr. Baker, it's America and you can find your bliss however you want. And I'm glad you are putting your kids first... honestly I am. But you signed on to put your patient's first. Who is taking care of them now? Your partners? Is that a good thing for your patients? For your partners? Honestly? Is it?
And what of you female residents who get pregnant in residency. Is it fair to make your colleagues, male and female, make up for your three month absence with every other night call and missed vacations? Really? And did you have to make up that lost time or did the program simply graduate you 'as is'?
Let me take you back twenty years, before the walls of medicine began to crumble, back when the shortage of physicians was beginning to have an impact.
How much sense did it make back then, when planning for twenty years down the road, to offer not just equal opportunity to female applicants to medical school, but preferential admission to medical school? And how many of those female docs twenty years ago are practicing full time?
So what, you say? So why is no one talking about this as a cause of our current physician shortage? In the name of PC feel-goodism we essentially dropped the number of full time physicians by 33% by mandating a 50/50 male-female ratio. Hell, in many med schools women outnumber the men. It doesn't last...
In my class alone four of the female graduates got pregnant and didn't even go to internship. Fair? Maybe. Smart? No, not unless the women who desire to be doctors are made to understand, up front, that full time medicine/surgery and being a mom is not realistic in many of the medical subspecialties. It should be HARDER for women to get into medical school... not grade wise, but interview wise.... Women should be put on the spot in the interview process about their desire for a medical career and not just a medical degree.
So how about it Dr. Barker. How are your partners taking your two year absence? Your patients? I can see from what you write that their reactions have surprised you. But why are you surprised? There's a question.
And at the end of the day, I do honestly wish you all the success and happiness in the world for you and your kids and in your career. I just want to point out that in order for you to have things the way you want them, you have made others pay the price for a decision you made to become a doctor, perhaps without being honest about your desire to have a family or your ability to be both a great mom and a great doctor.
Here's the statement that got me, and one that, no doubt, in today's post-modern society, didn't raise an eyebrow with many who, thirty years ago would have said, 'hmmm.'.
Doctors should be the most supportive of professions when it comes to our colleagues becoming parents. We work every day with patients in difficulty and know the importance of a strong family, and yet our profession is one that makes it very difficult to balance both a working and parental role. Part time work is difficult to manage, clinical meetings and ward rounds are often held very early or after hours, and the on call work can be brutal. But we are more than doctors; we are mums and dads and wives and husbands, and we shouldn’t have to pick one or the other. We can’t do it all, and maybe we should stop trying to.
We should be the most supportive profession when it comes to our colleagues becoming parents? Why. I'll stop there for a minute because I really want an answer to that. Why should we be? So as to model good parenting for our patients? Really, that's the reason?
Shouldn't have to pick one or the other??? Why? Because you want it all? Really, why?
Since when has becoming a physician been anything less than a dog-eat-dog marathon of sleep deprivation and ladder climbing, and patient care above all else? I'm not saying it should be that or that it has to be that, but what, doc, exactly, did you think you were signing up for when you walked into first year med? I mean, did you not know about the demands of the most demanding profession? Did you expect them to be lessened for you specifically?
And Dr. Baker, it's America and you can find your bliss however you want. And I'm glad you are putting your kids first... honestly I am. But you signed on to put your patient's first. Who is taking care of them now? Your partners? Is that a good thing for your patients? For your partners? Honestly? Is it?
And what of you female residents who get pregnant in residency. Is it fair to make your colleagues, male and female, make up for your three month absence with every other night call and missed vacations? Really? And did you have to make up that lost time or did the program simply graduate you 'as is'?
Let me take you back twenty years, before the walls of medicine began to crumble, back when the shortage of physicians was beginning to have an impact.
How much sense did it make back then, when planning for twenty years down the road, to offer not just equal opportunity to female applicants to medical school, but preferential admission to medical school? And how many of those female docs twenty years ago are practicing full time?
So what, you say? So why is no one talking about this as a cause of our current physician shortage? In the name of PC feel-goodism we essentially dropped the number of full time physicians by 33% by mandating a 50/50 male-female ratio. Hell, in many med schools women outnumber the men. It doesn't last...
In my class alone four of the female graduates got pregnant and didn't even go to internship. Fair? Maybe. Smart? No, not unless the women who desire to be doctors are made to understand, up front, that full time medicine/surgery and being a mom is not realistic in many of the medical subspecialties. It should be HARDER for women to get into medical school... not grade wise, but interview wise.... Women should be put on the spot in the interview process about their desire for a medical career and not just a medical degree.
So how about it Dr. Barker. How are your partners taking your two year absence? Your patients? I can see from what you write that their reactions have surprised you. But why are you surprised? There's a question.
And at the end of the day, I do honestly wish you all the success and happiness in the world for you and your kids and in your career. I just want to point out that in order for you to have things the way you want them, you have made others pay the price for a decision you made to become a doctor, perhaps without being honest about your desire to have a family or your ability to be both a great mom and a great doctor.
Friday, February 25, 2011
MDOD Douchebags of the Month
Hands down, douchebags of the month, and, as a kind reader points out, whilst 'practicing' medicine in the streets of Madison, these doctors are in violation of the following...
1. HIPAA.
Clearly no one is concerned about patient privacy here. And if I'm not mistaken, I can read a whole lot of identifying information on these 'notes'... Doctor's name, patient's name... And an ersatz mini-me castrati Michael Moore (but I repeat myself)... Really, did you go to med school dude? Because I see you much more as a bear-cub... if you know what I'm saying.... Not judging you, just pointing out the obvious... Don't shave your chest. And get used to being on your knees. Federal law violations here. I'm sure the Obama administration is all over it (no need for action on our parts).
2. TOFKAJCHAO Guidelines.
I mean, you could poop a sterling-silver turd that smelled like roses and cured HIV and you would still run afoul of these.Clearly there is food (and or herbal supplements) in the patient care areas here, and even though lots of marijuana is being smoked (which is completely cool and all)... somewhere here, tobacco is being smoked, and that's a clear whatchamacallit violation.
3. The smell test. Smells like 8th grade, passive aggressive bullshit. Michael Moore look-alike in video, ergo, is, in fact, 8th grade, passive-aggressive bullshit. Besides, if any of these 'patients' had been truly ill, you would have done what you always do.... you would have sent them to the ER.
4.The "Out and Proud" sensibilities of the United States of College Campuses of the Western World. Clearly the two chick doctors are lovers. Clearly the female teachers, every single one of them, are rug-munchers. The problem is that we don't even get to see them kiss, and their unshaven axillae are not flaunted, nor are they carrying a 'we hate penises' sign. I have no doubt they are in the Family Practice residency, which, to be fair, is quite demanding compared to becoming a teacher (though both eventually pay about the same), and they are going the extra mile to be trained in the fine art of dilation and curettage so as to limit the impact of overpopulation on mother-Gaia.
5. American sensibilities. Contrary to what Al Gore and Nancy Pelosi say, these exist, and are definable. Challenge... Go show this video in your local pub/ pool hall... see what reaction you get. You can ignore it or criticize it, but it's there. What you get there is what you would get everywhere except Portland, Seattle, San Francisco, NYC, Boston, and certain very special sections of Atlanta.
America! Support your teachers! Say, how are those kid's test scores doing? How is that public education these days? And hey, Dr. Shropshire and colleagues... you guys are a really bad joke. You are lying for the mob bosses and you didn't even get paid. Snoop Dog is frowning. Straight up.
Saturday, August 21, 2010
The ER Ruins a Great Movie for Me
Watched this with the kids the other day. This song stuck in my head because darling Veruca reminded me so much of so many of my ER patients. Here Mr. Salt stands in for ACEP, Obama, or your personal bete noir. Mr. Wonka has one up on us ER docs however, as he is allowed to say 'no'. Updated lyrics follow the song.
Veruca: IM! IVs! I want my IV to be a Demerol PCA!
ER Doc: It will, sweetheart.
Veruca: At least a hundred an hour!
ER Doc: Anything you say.
Veruca: And by the wayyyyyy...
ER Doc: What?
Veruca: I want a feast.
ER Doc: Oh, I’m sorry, you’re NPO.
Veruca: I want a starbucks!
ER Doc: Oh, one of those, there’s one in the lobby.
Veruca: Cream buns and doughnuts and fruitcake with no nuts so good you could go nuts!
ER Doc: But Ma’am you said you had abdominal pain and vomiting, I think you should wait for that.
Veruca: No, now!!
I want lipo!
I want a boob-job!
I want teeth-whitenting and laser hair litening and vaginal tightening…
Give it to me! Rrhh rhhh! Now!
I want a rating (disability)!
I want free parking!
I want a handicapped placard forever
For inclement weather...
Give it to me!
I want today, I want tomorrow...
Obama is paying so here I am staying you know what I'm saying!
Don’t care how, I want it now!
Give me the call button!
The freaking nurse call button!
This IV is faulty the food is too salty
The ativan too halty….
Someone will pay!
(Bridge)
I want a private room on the corner
With a view of the sunset and ‘rise...
And if I don't get the things I am after…
I'm going to ‘seize'!
I want the works!
I want the whole works!
Presents and prizes and sweets and surprises
Of all shapes and sizes
And now...
Don't care how
I want it now!
Don't care how I want it nowwwwwwwwwwwwwwwwwwww…………..
(death panel drone enters quietly, administers succinycholine)- FINIS
Veruca: IM! IVs! I want my IV to be a Demerol PCA!
ER Doc: It will, sweetheart.
Veruca: At least a hundred an hour!
ER Doc: Anything you say.
Veruca: And by the wayyyyyy...
ER Doc: What?
Veruca: I want a feast.
ER Doc: Oh, I’m sorry, you’re NPO.
Veruca: I want a starbucks!
ER Doc: Oh, one of those, there’s one in the lobby.
Veruca: Cream buns and doughnuts and fruitcake with no nuts so good you could go nuts!
ER Doc: But Ma’am you said you had abdominal pain and vomiting, I think you should wait for that.
Veruca: No, now!!
I want lipo!
I want a boob-job!
I want teeth-whitenting and laser hair litening and vaginal tightening…
Give it to me! Rrhh rhhh! Now!
I want a rating (disability)!
I want free parking!
I want a handicapped placard forever
For inclement weather...
Give it to me!
I want today, I want tomorrow...
Obama is paying so here I am staying you know what I'm saying!
Don’t care how, I want it now!
Give me the call button!
The freaking nurse call button!
This IV is faulty the food is too salty
The ativan too halty….
Someone will pay!
(Bridge)
I want a private room on the corner
With a view of the sunset and ‘rise...
And if I don't get the things I am after…
I'm going to ‘seize'!
I want the works!
I want the whole works!
Presents and prizes and sweets and surprises
Of all shapes and sizes
And now...
Don't care how
I want it now!
Don't care how I want it nowwwwwwwwwwwwwwwwwwww…………..
(death panel drone enters quietly, administers succinycholine)- FINIS
Saturday, June 12, 2010
Etiology of Fibromyalgia, Chronic Fatigue Syndrome, and Terminal Ennui Discovered
During the course of the nil-nil Uruguay v France tie in World Cup soccer yesterday I contracted end-stage fibromyalgia and fulminant ennui. Arising this morning to the Nigeria v Argentina match I was seized with an irresistible desire to go back to bed. I quickly changed the channel to reruns of curling from the Vancouver games and have recovered fully. I believe have solved a great medical mystery here and await the Nobel Prize committee's phone call.
Saturday, May 08, 2010
Pop! Ouch! Get the Translator (the word is 'lengüeta')
This patient was very nice and quite easy to work with. He was thankful and did well, but it was all in Spanish. I do medical Spanish, but how do you ask if there is a barb in the nail that is buried to the hub in your lower leg?
Now notice the nail on the X Ray above... nail-gun injuries used to be so ho-hum, but the folks who make the nails figured out that if you put barbs in them that they will not back out of the wood over time. Problem is, they don't back out of bone too well either. No matter! A little propofol and a mighty pull with some vice-grips and we were done, but, this muchacho will always have a small piece of barb in his tibia. A reminder of the day he said whatever 'oops' is in Spanish.
Tuesday, February 23, 2010
What Can I Add? Nothing! I See Nothing! (updated 2/24)
The Canuck's know the deal. Obama is increasingly becoming a person who would be better pictured with a riding crop and a monocle.
Happy Happy Joy Joy!
(Colonel Klink played by Werner Klemperer, and the series produced by... drum roll please... Bing Crosby)
Monday, February 15, 2010
Sports Medicine and the Winter Games
I'm always so proud when the Olympics roll around. Love to see the US represented well, win or lose, it's super.
The field of sports medicine has evolved at a blistering pace over the past thirty years. It used to be that all you had on the sideline or on the bench was a trainer, essentially a medical technician who learned a lot about treating sports injuries both in school and on the job, or, in the pros, you had an orthopedic surgeon at every game praying no one got hit in the throat or got their noggin' cracked open.
Witnessing the terrible, fatal luge crash the other day reminded me that the days of the Orthopedic surgeon as the sole 'team doc' are gone. To be sure, most sports injuries and syndromes still fall within the penumbra of orthopedics (in fact, orthopedic surgeons can do a one year fellowship to specialize in sports orthopedics), but more and more, primary care and ER docs are being called upon because so many problems with athletes ARE NOT of the orthopedic variety.
A primary care or ER doc can also do a sports medicine fellowship (also one year of extra training) to prepare to specialize in treating athletes. It might be hard to imagine, but many athletes DO have issues outside the bones and joints that can impact performance.
Saturday, January 23, 2010
"Science" to the Rescue (Healing Touchers and "Doctor" Asa Andrew)
There's hard money to be earned in the traditional allopathic or osteopathic route, but there's some damned easy money to be made by the disciples of 'scientology' and 'lifestyle medicine'.
Now I will be the first to admit that the scientology creeps are actually in Haiti and I am not. Ten points for their side, but here's what they are doing. I imagine that these skilled practitioners of jack-shit will be able to open clinics and start seeing patients when they return from healing the nervous systems of the Haitian earthquake victims.
And I just can't let it go... I'm starting to hear on some syndicated AM radio show a guy who calls himself "Dr. Asa Andrew" and he is very interested in helping me "lifestyle my way" back to good health. He fields calls and gives answers which usually go something like this... "Your migraine, if on the left side is caused by an arginine deficiency, and if on the right, is caused by an iron deficiency." He recommends taking 'probiotics' with meals and is very against sugar and even soy. Now the soy thing, that caught me off guard! He will also glowingly make an ass of himself when he tries to talk traditional medicine by stating that an h. pylori test is done on the stool (normally not), and that the bacteria h. pylori can be wiped out by bismuth salts 'like pepto bismol', but the 'organic ones' are better, no doubt the very ones he has, conveniently for sale, at his very upscale and feng shui clinic.
Just for the record, bismuth salts can be part of the treatment for h. pylori ulcer disease, but many current regimens simply use a proton pump inhibitor and some antibiotics. Oh how much money I would pay to see him on rounds in the SICU being peppered with questions by a disbelieving CT Surgeon who, at the end of my fantasy, stabs him in the heart with a trochar which he never thought he would have to use in that fashion.
Then I do a little research and go look at this guy's site because I figure he's one of those MDs who is really into the metabolic treatment of disease by using le chatelier's principle and loading people with amino acids or depriving them of others in order to tilt particular biochemical equations the way they should go, but no.
This colossal ass is not a medical doctor, he's a chiropractor who does not advertise the fact, rather, everything this guy does is intended to make the casual listener think he's an MD. Look at the nice stethoscope he wears on his website! I am flummoxed and amazed that this guy has a radio and publishing empire because he has, no doubt played a big part in making people sick or hastening their deaths with his recommendation of goat's milk for brain cancer, and the like. Is he immune from malpractice because he doesn't create a doctor patient relationship on his show? Someone, please, tell me. He's giving people 'ionic foot bath detoxification treatments' in his office for the sake of all that is good and pure! There is less than zero science behind this, but why let that get in the way... the water changes color and everything... aren't those 'toxins' that are coming out through the bottom of your feet?
At the same time, I know there will always be people like "Dr. Asa" and the goofball "healing touch" scientologits. People want their snake oil. For whatever reason, they love their snake oil, hope and change, whatever the flavor of the day is. Dr. Asa, here's a 'lifestyle' question for you... How much malpractice insurance do you carry. I figure it's either a tremendously high amount, or zero. You probably have your callers agree on tape before talking to you that your advice is 'for entertainment purposes only'. You are the first douche of the month on MDOD for the new decade. Congratulations. Douche.
Now I will be the first to admit that the scientology creeps are actually in Haiti and I am not. Ten points for their side, but here's what they are doing. I imagine that these skilled practitioners of jack-shit will be able to open clinics and start seeing patients when they return from healing the nervous systems of the Haitian earthquake victims.
And I just can't let it go... I'm starting to hear on some syndicated AM radio show a guy who calls himself "Dr. Asa Andrew" and he is very interested in helping me "lifestyle my way" back to good health. He fields calls and gives answers which usually go something like this... "Your migraine, if on the left side is caused by an arginine deficiency, and if on the right, is caused by an iron deficiency." He recommends taking 'probiotics' with meals and is very against sugar and even soy. Now the soy thing, that caught me off guard! He will also glowingly make an ass of himself when he tries to talk traditional medicine by stating that an h. pylori test is done on the stool (normally not), and that the bacteria h. pylori can be wiped out by bismuth salts 'like pepto bismol', but the 'organic ones' are better, no doubt the very ones he has, conveniently for sale, at his very upscale and feng shui clinic.
Just for the record, bismuth salts can be part of the treatment for h. pylori ulcer disease, but many current regimens simply use a proton pump inhibitor and some antibiotics. Oh how much money I would pay to see him on rounds in the SICU being peppered with questions by a disbelieving CT Surgeon who, at the end of my fantasy, stabs him in the heart with a trochar which he never thought he would have to use in that fashion.
Then I do a little research and go look at this guy's site because I figure he's one of those MDs who is really into the metabolic treatment of disease by using le chatelier's principle and loading people with amino acids or depriving them of others in order to tilt particular biochemical equations the way they should go, but no.
This colossal ass is not a medical doctor, he's a chiropractor who does not advertise the fact, rather, everything this guy does is intended to make the casual listener think he's an MD. Look at the nice stethoscope he wears on his website! I am flummoxed and amazed that this guy has a radio and publishing empire because he has, no doubt played a big part in making people sick or hastening their deaths with his recommendation of goat's milk for brain cancer, and the like. Is he immune from malpractice because he doesn't create a doctor patient relationship on his show? Someone, please, tell me. He's giving people 'ionic foot bath detoxification treatments' in his office for the sake of all that is good and pure! There is less than zero science behind this, but why let that get in the way... the water changes color and everything... aren't those 'toxins' that are coming out through the bottom of your feet?
At the same time, I know there will always be people like "Dr. Asa" and the goofball "healing touch" scientologits. People want their snake oil. For whatever reason, they love their snake oil, hope and change, whatever the flavor of the day is. Dr. Asa, here's a 'lifestyle' question for you... How much malpractice insurance do you carry. I figure it's either a tremendously high amount, or zero. You probably have your callers agree on tape before talking to you that your advice is 'for entertainment purposes only'. You are the first douche of the month on MDOD for the new decade. Congratulations. Douche.
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And if Dr. Asa can make millions without having to do the usual science stuff like, uh... research and boring other things, then maybe you guys would enjoy sending a few shekels my way by visiting our sponsor, Scrubs Gallery, and using the following coupon for a nice discount...
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Wednesday, August 26, 2009
Saturday, September 06, 2008
My Medical Holiday
Having been on the giving side of the medical equation 18 months longer than was good for my sanity I have decided to take a little back.
I just flew up to northern Montana where I went hiking and crossed into Canada. I then hired a 'coyote' to smuggle me back into the US. I dropped all my IDs and money in an envelope in Moose Jaw, Saskatchewan and mailed it back to my home address. I purchased a bottle of fine Canadian Mist whiskey and hit the road with my escort to Minot North Dakota. Wow, was I a drunk asshole.
As agreed upon when I hired my 'coyote' he dropped me just outside Minot and punched me in the face and called 911. In relatively short order the fine paramedics arrived and found me head- injured and slurring my speech. Without any ID and with me only being able to say, "It hurts, eh?" I was able to stay a few days in Minot General courtesy of the U.S. taxpayers.
Of course, since I kept having "seizures" and pain and remembered I was allergic to toradol, motrin, tylenol, phenergan, and reglan, they have been dosing me with dilaudid and valium and feeding me to my hearts content. They also went ahead and fixed my deviated septum which made me snore and has been bothering me for some time and which was made a bit worse by the well-delivered punch.
Since my case of amnesia is not resolving I'm working on getting the nice docs in Minot to airlift me to the Mayo for a thorough Neurology evaluation. I think I will be able to make my way back through the specialty hospitals (as I will continue to present protean manifestations of rare diseases requiring, again, lots of good drugs... Hell, maybe they will bring in 'House, MD'?) to near my hometown where I will leave AMA from the hospital around midnight, and walk home after two or three weeks of a fine holiday. Thank you all for paying for my vacation, and thanks, EMTALA.
Wednesday, August 27, 2008
Reasons I'm Leaving Emergency Medicine (number 2)
This is a turd.
In medicine today this is what's known as a beautiful turd, a really nice turd, or not a turd at all, but something that only resembles a turd to the untrained eye. What this really is, according to those in charge today, is an opportunity to partner.
See, while I see this as a turd, this observation is not welcome. In fact, it may impact our Press-Gainey scores or our core measures, and this is unhealthy for the group and for the contract. The cynical amongst you might say, at this point, that those seeing this as a golden poo are merely motivated by money but no! They are motivated by a collectivist wisdom which is but a foretaste of humanity's next step up the ladder of evolution.
I admit that my feeble brain is not able to see this, so I am going to go hang out with other non-Mensans and other non-leaders.
To me, medicine today is a turd because we call patients 'customers', try to do better 'customer service' with all comers, most of whom do not meet the traditional definition of 'customer' (ie someone who pays for their services), worship at the feet of a terrible unfunded mandate called EMTALA, and also worship at the feet of a bunch of worthless committee hacks called TOFKAJCAHO (the organization formerly known as JCAHO).
We also shuffle money from the folks who actually gave more than a second's thought to their health to those who have made, and continue to make, poor decisions. In other words, there are tons of doctors and hospital CEOs and legislators who fancy themselves as modern-day Robin Hoods. They are not, they are the Sheriffs of Nottingham, but then again who am I to say, I think the thing at the top of this post is a turd
EMTALA has killed the best medical system in the world, and why? Because some douchebag legislators thought that it would buy them votes (and they were right). I also know how to fix our mess, but, since I major in plain-talk, I will never be elected nor will anyone who says this and here it is.
Everyone in the country should pay for their own medical care even if only for a small portion of it. Buy insurance or not, your choice. Get catastrophic coverage only and establish an HSA. Finance your care. Can't get insurance? There's no one to blame but the authors of EMTALA.
If you walk out of the hospital or out of the ER two hours after calling an ambulance AND you really have no money, no problem, we can arrange for a few hours of community service at the local free clinic. If "the government" wants to mandate that no one be turned away from the ER then let them pay for the care we are legally obligated to give or at least let us deduct it from our gargantuan income taxes.
Emergently ill patients should get our best and that's exactly what they get. They should then pay for what they received in whatever way they can. Insurance rates? Down immediately. ER waits? Gone. Bullshit EMS calls? Gone. Doctor retention and satisfaction? Up (and quickly). My job? Immediately better because I am not constantly presenting the golden turd to my consultants. In other words I'm for the good old American notion of personal responsibility. Hard in the short run, the only sane way to do things in the long run.
Pictured above is a turd. It can not be polished and there's no way to pick it up by the clean end.
Thursday, May 01, 2008
The Bill of Rights
All this talk about a right to free health care got me kind of mad because I didn't believe it existed under our constitution. I also thought that patients should bear at least some of the burden for maintaining their own health and paying a reasonable fee either for insurance, or to physicians who treat them. Boy was I wrong! Witness the genius of America!
The Bill of Rights
Amendment I Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances. And all humans within the border of the United States have a right to free health care.
Amendment II A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed. Health care for free is a right for any organism with 23 chromosomes found within the borders of the United States.
Amendment III No soldier shall, in time of peace be quartered in any house, without the consent of the owner, nor in time of war, but in a manner to be prescribed by law. Doctors are required by federal law to see and treat all patients regardless of their citizenship, state of intoxication, assaultive behavior, or ability to pay for said care.
Amendment IV The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no warrants shall issue, but upon probable cause, supported by oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized. Doctors are to accept 30 cents on the dollar for their services. Dentists, Complimentary and Alternative Medicine practitioners, chiropractors, and life-coaches are to be reimbursed at 100 cents on the dollar.
Amendment V No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a grand jury, except in cases arising in the land or naval forces, or in the militia, when in actual service in time of war or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation. The right to free health care is universal while in any state, territory, or possession of the United States. The right to payment for goods or services delivered is universal except for physicians who are greedy, rich bastards and should be held in the lowest esteem especially by the uninsured, addicted, politicians, liberals, and attorneys.
Amendment VI In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the state and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the assistance of counsel for his defense. The right to sue physicians for negligence occurring in the delivery of free health care shall not be abridged unless the physician guilty of negligence is employed by the United States Government, in which case the plaintiff is shit outta luck dude!
Amendment VII In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any court of the United States, than according to the rules of the common law (except for physicians, who may be forced to settle lawsuits by their insurers or surrender their privileges, or insurance and therefore their ability to practice). Also, it is hereby mandated that physicians have no right to sleep, or to the pursuit of happiness.
Amendment VIII Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. An exception shall be made for physicians, especially physicians in training, who may be imprisoned by their hospitals and kept awake for up to 72 hours at a time while performing surgery or fetching stool samples.
Amendment IX The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people. Did we mention that primo allopathic health care for all is a right?
Amendment X The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people (physicians excepted, of course).
The Bill of Rights
Amendment I Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances. And all humans within the border of the United States have a right to free health care.
Amendment II A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed. Health care for free is a right for any organism with 23 chromosomes found within the borders of the United States.
Amendment III No soldier shall, in time of peace be quartered in any house, without the consent of the owner, nor in time of war, but in a manner to be prescribed by law. Doctors are required by federal law to see and treat all patients regardless of their citizenship, state of intoxication, assaultive behavior, or ability to pay for said care.
Amendment IV The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no warrants shall issue, but upon probable cause, supported by oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized. Doctors are to accept 30 cents on the dollar for their services. Dentists, Complimentary and Alternative Medicine practitioners, chiropractors, and life-coaches are to be reimbursed at 100 cents on the dollar.
Amendment V No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a grand jury, except in cases arising in the land or naval forces, or in the militia, when in actual service in time of war or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation. The right to free health care is universal while in any state, territory, or possession of the United States. The right to payment for goods or services delivered is universal except for physicians who are greedy, rich bastards and should be held in the lowest esteem especially by the uninsured, addicted, politicians, liberals, and attorneys.
Amendment VI In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the state and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the assistance of counsel for his defense. The right to sue physicians for negligence occurring in the delivery of free health care shall not be abridged unless the physician guilty of negligence is employed by the United States Government, in which case the plaintiff is shit outta luck dude!
Amendment VII In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any court of the United States, than according to the rules of the common law (except for physicians, who may be forced to settle lawsuits by their insurers or surrender their privileges, or insurance and therefore their ability to practice). Also, it is hereby mandated that physicians have no right to sleep, or to the pursuit of happiness.
Amendment VIII Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted. An exception shall be made for physicians, especially physicians in training, who may be imprisoned by their hospitals and kept awake for up to 72 hours at a time while performing surgery or fetching stool samples.
Amendment IX The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people. Did we mention that primo allopathic health care for all is a right?
Amendment X The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people (physicians excepted, of course).
Tuesday, April 29, 2008
Can I Get Prior-Authorization To Kick Your Ass?
Whoever decided to put high-school dropouts in front of a computer with headsets on to speak with physicians or medical providers to discuss and approve or deny drugs or other therapies for patients was a real fucking genius.
Let me tell you how it usually goes when I try to get a wonderful, newer drug approved for my patients. I love Byetta and prescribe a ton of it. It is the only commonly-used drug for type 2 diabetes that lowers glucose AND helps patients lose weight. Unfortunately, since Byetta is newer and more expensive than your typical, cheaper generic diabetes drugs that cause FURTHER weight gain in these already-obese patients, it often required pre-approval from insurance carriers. We'll start with how the prior-authorization call usually goes (in reality), then we'll slide into the 'Twilight Zone' where both me and the insurance company customer service rep say what we actually WANT to say to one another.
Dr. Lofty: Hi, I was asked to call to get prior approval for Byetta for my patient.
CSR: Yes?
Dr. Lofty: Yes?
CSR: And your question is?
Dr. Lofty: My question is, what information do you need to get this drug that I believe my patient should be on approved?
CSR: Yes (pause, looking up algorithm for questions to ask caller under 'Byetta protocol'), so why does this patient need Byetta?
Dr. Lofty: Because they have gained 20 pounds over the past year on Actos and glyburide and in my experience I can get this patient's hemoglobin A1c down about 1% with about 20 pounds of weight loss using Byetta and getting them off of these other drugs.
CSR: I see. And what is the medical justification?
Dr. Lofty: I just told you the medical justification.
CSR: Yes, well, I'll need to fax over a two-page prior authorization form that will need to be filled out completely along with the last three chart notes documenting failure to achieve control with....
SLIDE INTO TWILIGHT ZONE...
Dr. Lofty: Hey fuckhead with your G.E.D. diploma hanging on your cubicle wall, I went to fucking medical school for four years, did three years of residency training plus a chief resident year, and have been practicing diabetes almost exclusively for ten years. My experience tells me this patient needs Byetta and I want him to have it NOW! Losing weight and shrinking the waist probably reduces cardiovascular risk in patients with type 2 diabetes.
CSR: Sir, we really don't give a flying fuck if your patient loses weight. We would prefer he or she remain on the cheaper, generic drugs that they are currently taking.
Dr. Lofty: Well, the patient sure would feel better in the long run losing twenty pounds and losing about 2 gallons of fluid from their legs.
CSR: Again, don't give a shit about this patient's quality of life. Too expensive to use this drug. This person won't be on our plan in two years, so we could give a rat's ass whether or not they lose weight or feel better. They'll be someone else's problem in two years.
Dr. Lofty: You're a dirty fuck stick...I hope you gain 200 pounds today and develop type 2 diabetes. You'd be begging me to put you on Byetta and I would give you shitty drugs like glyburide and Avandia to make your fat ass fatter!
CSR: Whatever. You doctors are so arrogant.
Dr. Lofty: Hey, Einstein. Can I talk to your supervisor? I want to get the ball rolling on a prior authorization to come down there and kick your sorry little ass!
Let me tell you how it usually goes when I try to get a wonderful, newer drug approved for my patients. I love Byetta and prescribe a ton of it. It is the only commonly-used drug for type 2 diabetes that lowers glucose AND helps patients lose weight. Unfortunately, since Byetta is newer and more expensive than your typical, cheaper generic diabetes drugs that cause FURTHER weight gain in these already-obese patients, it often required pre-approval from insurance carriers. We'll start with how the prior-authorization call usually goes (in reality), then we'll slide into the 'Twilight Zone' where both me and the insurance company customer service rep say what we actually WANT to say to one another.
Dr. Lofty: Hi, I was asked to call to get prior approval for Byetta for my patient.
CSR: Yes?
Dr. Lofty: Yes?
CSR: And your question is?
Dr. Lofty: My question is, what information do you need to get this drug that I believe my patient should be on approved?
CSR: Yes (pause, looking up algorithm for questions to ask caller under 'Byetta protocol'), so why does this patient need Byetta?
Dr. Lofty: Because they have gained 20 pounds over the past year on Actos and glyburide and in my experience I can get this patient's hemoglobin A1c down about 1% with about 20 pounds of weight loss using Byetta and getting them off of these other drugs.
CSR: I see. And what is the medical justification?
Dr. Lofty: I just told you the medical justification.
CSR: Yes, well, I'll need to fax over a two-page prior authorization form that will need to be filled out completely along with the last three chart notes documenting failure to achieve control with....
SLIDE INTO TWILIGHT ZONE...
Dr. Lofty: Hey fuckhead with your G.E.D. diploma hanging on your cubicle wall, I went to fucking medical school for four years, did three years of residency training plus a chief resident year, and have been practicing diabetes almost exclusively for ten years. My experience tells me this patient needs Byetta and I want him to have it NOW! Losing weight and shrinking the waist probably reduces cardiovascular risk in patients with type 2 diabetes.
CSR: Sir, we really don't give a flying fuck if your patient loses weight. We would prefer he or she remain on the cheaper, generic drugs that they are currently taking.
Dr. Lofty: Well, the patient sure would feel better in the long run losing twenty pounds and losing about 2 gallons of fluid from their legs.
CSR: Again, don't give a shit about this patient's quality of life. Too expensive to use this drug. This person won't be on our plan in two years, so we could give a rat's ass whether or not they lose weight or feel better. They'll be someone else's problem in two years.
Dr. Lofty: You're a dirty fuck stick...I hope you gain 200 pounds today and develop type 2 diabetes. You'd be begging me to put you on Byetta and I would give you shitty drugs like glyburide and Avandia to make your fat ass fatter!
CSR: Whatever. You doctors are so arrogant.
Dr. Lofty: Hey, Einstein. Can I talk to your supervisor? I want to get the ball rolling on a prior authorization to come down there and kick your sorry little ass!
Sunday, April 27, 2008
Sue Me
Ethics be damned, I finally did it. I worked the overnight recently and one of our executive class frequent flier patients showed up in the waiting room at 2am. Dr. Deborah Peel (the patient) was, evidently, prepared for the fact that our ER cocktail lounge had been closed for a bit so she tanked up prior to arriving. Her chief complaint was that she was "really going to do it this time", as in, she was really, honest to goodness, no kidding and no reversies, going to off herself. All she had done toward that end was polish off the better part of a fifth of Old Grandad with some valium as a chaser and yank out stitches one of my colleagues had placed in her wrist (very superficial wound) the week earlier. Apparently not happy with how quickly she had been brought back to a bed she 'fainted' out in triage and when I was called to see her in the room she had the "I've just seen a ghost" stare and was very good at it. Just as an aside I could well have said that it appeared that she had just had an encounter with the 'numinous', which is my favorite new word, but let me go ahead and tell the rest.
After I jammed a Q-tip most of the way past her turbinate (nasal passage) and she persisted with the stare I gave her narcan and she woke up a bit. Turns out narcan does occasionally have an effect on severe alcohol intoxication and this woman did not have opiates on board so that was interesting. It took about two minutes to figure out that she wasn't going to die within the next 5 hours so I felt a lot better. I ordered tests and meds and went to the next patient.
The next patient had his face mangled by a big dog. The patient and his girlfriend were extremely nice and I really enjoyed helping them out. The repair took me about 45 minutes and I had big flaps of facial skin to realign and the lip to put back together in two places.
As I was actually doing something worthwhile with the dog bite guy the aforementioned woman kept yelling that no one was doing anything for her pain. Debbie (as I call her now) denied being in pain when she 'woke up' so that, along with the fact that she was as drunk as Cooter Brown made it inadvisable to giver her pain meds. She would not leave her nurse alone though. Finally the nurse had to act so she came to me and I nodded conspiratorialy before she said anything.
ME (within earshot of drunk lady): "Wow, it sure sounds like she's hurting, better give her something strong... Why not try 650mg of paracetamol, but tell her not to take it unless she wants to sleep because it's so strong (wink, wink)".
NURSE: "Oh doctor! Are you sure???"
ME: "I think it will work and I think she needs it".
Paracetamol is tylenol (as the Brits call it). The patient asked what the pills were, she was told they were paracetamol and would make her sleepy etc... and like a good patient she swallowed the tylenol and promptly went to sleep.
Ethicists would probably say I abused my authority and engaged in deception. I don't agree as tylenol is a pain medicine and I would argue that I was setting the patient's mind up for successful treatment. In fact, I would argue that I was using CAM and that it worked like a charm.
The dog bite guy did well and he and his wife winked at me knowingly when the snores started from the adjoining room. CAM rocks!
Wednesday, April 23, 2008
At Amy's Request, 911doc's CAM Garb (and the POOPSTRONG vs CAM challenge)
I effectively use this "Complimentary and Alternative Medicine" costume to treat acute on chronic chronic fatigue syndrome, acute lancinating fibromyalgia, systemic candidiasis, universal allergic syndrome, non-specific overwhelmosis, and all Axis II disorders. It works just as well for these things as traditional "western" medicine.
One thing I have discovered with patients in sepsis who are hypotensive, is that if I jump in the room when they are not looking, that they become quite hypertensive quite quickly. Also, if I scream " OOOWA! OOWAH!" as I jump toward the patient the effect seems to be more pronounced. Unfortunately, in the case of these very sick patients, the immediate spike in thier systemic blood pressure is almost always followed by a massive intracranial bleed or a VFib arrest. The skull on a stick doesn't' work so well for that (unless I crack 'em on the chest with it and this HAS worked more than once to thump them out of VFib). Right now I am very pleased with my foray in to Complimentary and Alternative Medicine. It's awesome and fun.
One thing I have discovered with patients in sepsis who are hypotensive, is that if I jump in the room when they are not looking, that they become quite hypertensive quite quickly. Also, if I scream " OOOWA! OOWAH!" as I jump toward the patient the effect seems to be more pronounced. Unfortunately, in the case of these very sick patients, the immediate spike in thier systemic blood pressure is almost always followed by a massive intracranial bleed or a VFib arrest. The skull on a stick doesn't' work so well for that (unless I crack 'em on the chest with it and this HAS worked more than once to thump them out of VFib). Right now I am very pleased with my foray in to Complimentary and Alternative Medicine. It's awesome and fun.
aside: Manny Poopsalot, chariman and founder of our philanthropic sponsor listed in our sidebar, has called-out all practitioners of CAM and non-western medicine. A free POOPSTRONG FOR THE CHILDREN mug to anyone who can prove, using traditional western stuff like statistics and double-blind placebo controlled trials, that their methodology and interventions (in and of themselves) are any better at treating any ailment than the simple 100% organic latex wristbands that the POOPSTRONG folks sell (for the children). It's on CAM folks! You have been called out!
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