Wednesday, September 28, 2011
Friday, September 23, 2011
My DiCaprio Turn
"Catch me if You Can", right, the one with DiCarprio passing bad checks and faking being a pilot, doctor etc??
So it has been long enough since the actual incident to tell this story now, but being a doctor with a lot of in hospital experience DOES occasionally have it's unexpected benefits.
A patient of mine came in one day with pain.... Doesn't matter where.... suffice it to say that it concerned me very much because there was no injury and the pain was in a vascular distribution and I was very concerned about an aneurysm; but no one else was.... not a soul at the Military Treatment Facility could be bothered to see him in clinic and the ER, well, let's just not talk about them.
Fast forward one month. My patient, after some skillful maneuvering by moi, was transferred, based on MRI findings (which took three weeks to get), to one of the 'mini-meccas' down the road. It was a Friday. There was some concern that he needed an immediate neurosurgical procedure, but the neurosurgeon at the mini-mecca ran crying from the room after examining the patient (and the MRI and CT). And it was Friday, and Dr. Burned Hospitalist was in charge.
Scared neurosurgeon had requested transfer of the patient to the large mecca a mile and a half away... the one with residency programs in everything from pet psychiatry to psychic-gamma-knife-surgery. I call Burned Hospitalist on Saturday and explain that I am his patient's primary care physician and he tells me he is going to discharge him to follow up at the Mecca NS clinic on Monday because he 'can't transfer him on a weekend'. Fucking liar.
Well, he thought he had a weak sister on the phone but I asked Burned Hospitalist if my patient was,
1. Controlled on his pain medicine?
2. Set up with follow up with a particular physician?
3. Off all IV meds?
And the stuttering and stammering followed at which point he said he would just keep him there over the weekend until he could arrange a transfer on Monday (i.e. get someone else to do it).
Well, I don't live too far from the mini-mecca and I was in the area that night in pursuit of pleasure in the form of skillfully played live music, and after that bit of enjoyment I decided to drop by and see my patient. It was ten thirty in the PM.
The place was locked-down, but I called up to the floor and spoke with my patient's nurse and asked if they could bend the rules for me and she practically had me teleported up.
She was VERY happy to see me. "We have to get him transferred," she said, "He needs to be at the Mecca...." I agreed.
"Do you mind if I use your phone and do you mind if I, as his primary care physician (and with his consent and all) look at his chart?"
This I was allowed to do. And then I did this, I went to see my patient, I told him he was going to be transferred and I told him that when it happened he was not to answer too many questions. I extracted the same promise from the nursing staff. And I picked up the phone...
"Transfer center? Yes, hello, this is 911doc here and I am calling you from the mini-mecca... I have a patient that we would like to transfer to your Neurosurgical service.... No, tomorrow is fine... I just need to set it up.... yes, i will hold.... Oh hello Dr Superman, 911doc here.... yes.... yes... tomorrow is fine.... can I put you down as accepting? Thank you sir."
And it only took one more phone call the next day for me to affect the transfer of the patient on the weekend. Burned Hospitalist signed the papers and was none the smarter, but I'm still pissed he got paid for my skillful impersonation, but if you really think about it I didn't lie, I just Bill-Clinton'ed it... It's all in the parsing.
And by the way, the nurses high-fived me on the way out as they were not fond of Burned Hospitalist and could never get him to do jack shit. Imagine that...
So it has been long enough since the actual incident to tell this story now, but being a doctor with a lot of in hospital experience DOES occasionally have it's unexpected benefits.
A patient of mine came in one day with pain.... Doesn't matter where.... suffice it to say that it concerned me very much because there was no injury and the pain was in a vascular distribution and I was very concerned about an aneurysm; but no one else was.... not a soul at the Military Treatment Facility could be bothered to see him in clinic and the ER, well, let's just not talk about them.
Fast forward one month. My patient, after some skillful maneuvering by moi, was transferred, based on MRI findings (which took three weeks to get), to one of the 'mini-meccas' down the road. It was a Friday. There was some concern that he needed an immediate neurosurgical procedure, but the neurosurgeon at the mini-mecca ran crying from the room after examining the patient (and the MRI and CT). And it was Friday, and Dr. Burned Hospitalist was in charge.
Scared neurosurgeon had requested transfer of the patient to the large mecca a mile and a half away... the one with residency programs in everything from pet psychiatry to psychic-gamma-knife-surgery. I call Burned Hospitalist on Saturday and explain that I am his patient's primary care physician and he tells me he is going to discharge him to follow up at the Mecca NS clinic on Monday because he 'can't transfer him on a weekend'. Fucking liar.
Well, he thought he had a weak sister on the phone but I asked Burned Hospitalist if my patient was,
1. Controlled on his pain medicine?
2. Set up with follow up with a particular physician?
3. Off all IV meds?
And the stuttering and stammering followed at which point he said he would just keep him there over the weekend until he could arrange a transfer on Monday (i.e. get someone else to do it).
Well, I don't live too far from the mini-mecca and I was in the area that night in pursuit of pleasure in the form of skillfully played live music, and after that bit of enjoyment I decided to drop by and see my patient. It was ten thirty in the PM.
The place was locked-down, but I called up to the floor and spoke with my patient's nurse and asked if they could bend the rules for me and she practically had me teleported up.
She was VERY happy to see me. "We have to get him transferred," she said, "He needs to be at the Mecca...." I agreed.
"Do you mind if I use your phone and do you mind if I, as his primary care physician (and with his consent and all) look at his chart?"
This I was allowed to do. And then I did this, I went to see my patient, I told him he was going to be transferred and I told him that when it happened he was not to answer too many questions. I extracted the same promise from the nursing staff. And I picked up the phone...
"Transfer center? Yes, hello, this is 911doc here and I am calling you from the mini-mecca... I have a patient that we would like to transfer to your Neurosurgical service.... No, tomorrow is fine... I just need to set it up.... yes, i will hold.... Oh hello Dr Superman, 911doc here.... yes.... yes... tomorrow is fine.... can I put you down as accepting? Thank you sir."
And it only took one more phone call the next day for me to affect the transfer of the patient on the weekend. Burned Hospitalist signed the papers and was none the smarter, but I'm still pissed he got paid for my skillful impersonation, but if you really think about it I didn't lie, I just Bill-Clinton'ed it... It's all in the parsing.
And by the way, the nurses high-fived me on the way out as they were not fond of Burned Hospitalist and could never get him to do jack shit. Imagine that...
Monday, September 19, 2011
A Case for Discussion
Notice obvious nodules. distal to nodules you can make out, in this poor film, some lesions that almost look like comedones. All questions answered promptly. Fire away!
Friday, September 16, 2011
Fulminant Supratentorial Diathesis
You heard it here first. This is my new name for fibro- chronic fatigue- chronic Lyme disease - systemic candidiasis - 'I know there's something wrong with me damnit' patients. You know, pussies. You know, the people you will be paying for under Obama care.... people that won't pay their doctor or ER bill but will pay for LONGINEXX penis enlarger pills or quote THIS SITE in an effort to convince me that their Axis 2 disorder is due to a tick bite thirty years ago.
Now most of us on the science / medicine side of things say, 'show me', when someone proposes an explanation for a syndrome of disease. But most of the lay public just says, 'blow me, I've got fibro.' So be it! So you do! Yes! You have chronic Lyme disease and not poorly managed diabetes or thyroid disease or an undiagnosed Rheumatologic condition. Congratulations! Yes, you may apply for disability now.
But along the way, as science fails to back up the claims, it will become necessary to find the next "fibro".... and that's where I come in. It was tough between "Dense Cortical Slowing" and "Fulminant Supratentrorial Diathesis", but I pick the latter, sounds more Doctor-y. You heard it here first, and may I be the first to propose the diagnostic criteria for FSD....
Inability to work due to....
1. Being really tired all the time.
2. Having pain especially in the morning all over the place.
3. Having been treated very poorly by family or strangers.
4. Being misunderstood and unappreciated.
5. Crying because of that person on Oprah yesterday.
6. You just need some time to yourself.
7. Having once been near a tick, a person with a virus, or mold.... especially black mold.
8. Having to go the the ER every other day for acute exacerbations of any or all of the above especially if accompanied by dizziness, mild nausea, and nearly throwing up thirty times.
Having any four of the above major criteria or any three of the above major criteria with a previous misdiagnosis or fibro, chronic fatigue syndrome, systemic candidiasis, or chronic Lyme disease shall be considered diagnostic of Fulminant Supratentorial Diathesis and shall be immediate grounds for giving the patient a handicapped parking placard, and a fast track to disability/ SSI
Or you can just give them two grams of Vagisil IV and be done with it.
Now most of us on the science / medicine side of things say, 'show me', when someone proposes an explanation for a syndrome of disease. But most of the lay public just says, 'blow me, I've got fibro.' So be it! So you do! Yes! You have chronic Lyme disease and not poorly managed diabetes or thyroid disease or an undiagnosed Rheumatologic condition. Congratulations! Yes, you may apply for disability now.
But along the way, as science fails to back up the claims, it will become necessary to find the next "fibro".... and that's where I come in. It was tough between "Dense Cortical Slowing" and "Fulminant Supratentrorial Diathesis", but I pick the latter, sounds more Doctor-y. You heard it here first, and may I be the first to propose the diagnostic criteria for FSD....
Inability to work due to....
1. Being really tired all the time.
2. Having pain especially in the morning all over the place.
3. Having been treated very poorly by family or strangers.
4. Being misunderstood and unappreciated.
5. Crying because of that person on Oprah yesterday.
6. You just need some time to yourself.
7. Having once been near a tick, a person with a virus, or mold.... especially black mold.
8. Having to go the the ER every other day for acute exacerbations of any or all of the above especially if accompanied by dizziness, mild nausea, and nearly throwing up thirty times.
Having any four of the above major criteria or any three of the above major criteria with a previous misdiagnosis or fibro, chronic fatigue syndrome, systemic candidiasis, or chronic Lyme disease shall be considered diagnostic of Fulminant Supratentorial Diathesis and shall be immediate grounds for giving the patient a handicapped parking placard, and a fast track to disability/ SSI
Or you can just give them two grams of Vagisil IV and be done with it.
Wednesday, September 14, 2011
Grand Rounds Fo Free
We welcome a brand new blog to the medical web. THIS SITE offers to discuss your medical questions, gratis, jump in before they get crushed. Interested to see the results.
Saturday, September 10, 2011
Fandom
An interesting thing.... fan-dom. I pick a team to cheer for, maybe because I went to the school... maybe because I like their uniforms. What is it, my psychology friends, that makes being a 'fan' so addictive? I actually think the answer is more in the realm of theology than psychology or psychiatry, but let me know what you think. And I understand all the pat statements about the attractions of a vicarious experience.... of being able to take some credit when your guys win and defend them (or not) when they lose.
All I know is that Frank Drackman is about to drop a post here about a game my team should have won and gloat about a game his team should have lost, and I'm 48 years old, and I didn't play today, and yet, on alumni weekends I see people thirty years my senior show up and yell and scream and, if you are a Georgia fan right now, cry (and I know Frank, Auburn fans don't cry, they go burn cars or get in fights or drink until they puke and all), but there's something here that is very interesting.
Good luck, Coach Richt, wherever you may land.
All I know is that Frank Drackman is about to drop a post here about a game my team should have won and gloat about a game his team should have lost, and I'm 48 years old, and I didn't play today, and yet, on alumni weekends I see people thirty years my senior show up and yell and scream and, if you are a Georgia fan right now, cry (and I know Frank, Auburn fans don't cry, they go burn cars or get in fights or drink until they puke and all), but there's something here that is very interesting.
Good luck, Coach Richt, wherever you may land.
Thursday, September 01, 2011
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