Healthcare Update 01-21-2013
Amount of medical malpractice in the military is “shockingly underreported”. To add insult to injury, the Supreme Court continues to deny injured patients the ability to sue the government for damages from medical malpractice in military hospitals under the Feres Doctrine.
Oh, and do you think that you’ll be able to compare hospital “quality” between military hospitals and other hospitals using the federal government’s web site? Think again. No data available for military hospitals. Walter Reed Army Medical Center doesn’t exist in Washington DC when you’re trying to see the quality of care that is b...
Source: WhiteCoat's Call Room - January 21, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Not Heart Failure
I wasn’t giving in to the patient who wanted a prescription for Levaquin after the standard ZeePack didn’t cure his cough. He had a normal chest x-ray and labs the day before but was convinced that he had pneumonia. I tried explaining the difference between bacteria and viruses. I used the “RAID doesn’t work on dandelions” routine. He wasn’t convinced.
“I NEED a stronger antibiotic to break this up. Levaquin has worked in the past.”
“You know, I think I’m going to start you on some heart medications, instead. Some nitroglycerin and some Lasix for your heart failure.”
“Whaaat? I don’t have heart pr...
Source: WhiteCoat's Call Room - January 18, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Ancient Shaman Ritual
On the way into my shift, I walked by a room and noticed that there was iodoform gauze packing hanging on the sign outside the room.
Why was it there?
Someone found it on the floor and put it there so no one would trip?
Ancient Shaman to ward off evil spirits?
Secret code showing the surgeon where his patient had been waiting for the past 6 hours?
Nope.
Turns out that the patient had a gangrenous foot that strongly smelled like rotting flesh. The iodine from the gauze almost acted as a barrier to the smell spreading. When the patient first arrived, the odor reportedly wafted through the entire ED. By the time I arrived for...
Source: WhiteCoat's Call Room - January 17, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
What’s the Diagnosis #15
An elderly patient presents with leg weakness over the prior two days. The day of presentation he also notices pain in his upper back which seems to be fairly persistent. His medical history includes diabetes and renal failure. He was dialyzed the afternoon prior to his presentation and his glucose was 264. The patient’s daughter stated that he “wasn’t acting himself.”
The patient’s physical exam was fairly normal. Perhaps a little weakness in his legs, but he still moved all extremities.
His current EKG (dark background) and another EKG faxed from a different hospital done six months earlier ...
Source: WhiteCoat's Call Room - January 16, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: What's the Diagnosis? Source Type: blogs
Healthcare Update 01-14-2013
Interesting facts about the human body. Did you know that your stomach acid can melt zinc? Your femur is 4 times stronger than concrete? In your life you make enough saliva to fill two swimming pools? More strange facts at the link.
If your stomach acid can’t dissolve it, then try some Coca-Cola. Study shows that Coke is quite effective in dissolving physobezoars (balls of indigestible plant material) in the stomach.
Having sex … in a hospital bed … with other people in the room … after just delivering a baby? Look for pictures on the internet – another patient’s family took the pictures and visitors ar...
Source: WhiteCoat's Call Room - January 14, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Sappy Dog Pictures
Just a couple recent pictures of our dogs that made me smile (post title from the late great William the Coroner – he’s been gone for more than a year now)
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(Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - January 14, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
Unnecessary Care?
It isn’t much of a case, but it created questions in my mind.
A mom brings her 8 year old daughter to the hospital for a nonproductive cough. No fever. No runny nose. Just a cough. The patient had started school again this week, and so the microbiome in her nasal passages had thus begun mixing with all of the other microbiomes on school lunch tables, desks, and childrens’ shirt sleeves. The end result was that now she was coughing for a couple of days – like a majority of other children in the school.
The child looked fine. I told the mother that she likely had a “head cold” and that it would ...
Source: WhiteCoat's Call Room - January 13, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Sage Advice
Some sage advice to my loyal readers …
When you’re cleaning up an old house, you move the stove, and you happen to a find a small metal pipe with an unknown substance inside of it, it’s probably not the best idea to take a break, pull up a chair, and smoke whatever is in the pipe.
Should you ignore this advice, you might just see nonexistent bugs wearing Harry Caray glasses buzzing around your head and notice a cadre of hot women spies surrounding the house you were in before you called 911 for a police escort to the hospital.
As a side note, it is not within the purview of an emergency department to send...
Source: WhiteCoat's Call Room - January 9, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Healthcare Update — 01-07-2013
Colorado Medical Society files suit to prevent chiropractors from administering medications. The Chiropractic Board of Examiners created a rule permitting such actions after chiropractors complete 24 hours of study and a certification exam.
I go against the grain on this one. Let chiropractors prescribe medications. After patients start experiencing bad outcomes because the 24 hour course chiropractors take doesn’t teach them about drug interactions or side effects, patients will learn to appreciate doctors a little more. Then throw a few chiropractors in jail for administering too much pain medication and see how many o...
Source: WhiteCoat's Call Room - January 7, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Comic Relief
Another cartoon courtesy of Mednificent Comics.
Winter break … yeah I think I remember those days.
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. (Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - January 6, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Funny Source Type: blogs
Picture my vocal cords
Dammit Shadowfax. You had to re-tweet the whole “taking pictures of your larynx with an iPhone” meme, didn’t you? Started with tweet by @traumagasdoc. Then @Shadowfax retweeted it. Then @maggiemay419 got involved.
I don’t have an iPhone. I upgraded to a Samsung Galaxy which is larger, so it’s a little more of a chore to jam the thing in the back of your mouth. The first time I tried it, my 6-year-old daughter looked at me and yelled “Mom! Dad’s eating his phooone!”
After a few dozen tries and several episodes of making myself retch, the best that I could do was a picture of...
Source: WhiteCoat's Call Room - January 5, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
WTF Moment #1036
While performing CPR on a patient for the third time in the four hours that the patient was waiting in the ED for an ICU bed, a family member shows up. The family member was invited into the room to watch us perform CPR on his grandmother.
A nursing supervisor asked him whether or not the patient would have wanted to be resuscitated and remain on a ventilator.
The grandson’s response:
“She was into even numbers. If her heart stops beating again, then you can stop because that will be the fourth time that it happened today and four is a powerful number because it is even and it is the total of two even numbers m...
Source: WhiteCoat's Call Room - January 4, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
The WhiteCoat Year in Review
I was going to post this yesterday but I got all fired up over the whole Press Ganey thing. Sorry about that.
What has happened in the past year?
My humble little blog has quite a few visitors over the past year. Depending on the source, last year I had between 700,000 and 780,000 unique visits and nearly 1.4 million page views. I just shake my head and say “dang.” That’s a lot of eyeballs. Hopefully that means we’ve been doing something right.
The most popular posts over the past year paralleled the top search terms leading people to this blog.
Ten times as many people linked directly to the home p...
Source: WhiteCoat's Call Room - January 3, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
Press Ganey Mantra: Suck It Up
“It’s a case of good intentions gone badly awry – and it’s only getting worse.”
Prophetic words in a Forbes Magazine article by Kai Falkenberg titled “Why Rating Your Doctor Is Bad For Your Health.”
According to the article,
Survey “response rates have been dramatically declining over the past decade,” says Paul Alexander Clark, founder of SmartPatient, a health care analytics company. He should know: Until 2007 Clark was in charge of Press Ganey’s patient-satisfaction improvement group. The response rates, he says, are now “too low to produce reliable results.” Insiders have known t...
Source: WhiteCoat's Call Room - January 2, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Press Ganey Source Type: blogs
That’s Some Serious Constipation
By Birdstrike M.D.
“Help. Help! I need something for the pain!” I hear a woman wailing from Emergency Department room 4.
“What’s that all about?” I ask Veronica the nurse. “I guess I need to see that one first, don’t I?”
“No. She says she’s got constipation and no other problems. You need to see room 7 first, which is a 70-year-old male with back pain, hypertension and a family history of abdominal aneurysm. He might have an actual emergency,” answers Veronica.
“Definitely, and thanks for letting me know,” I say, as I walk in to see the possible abdominal aortic aneurysm (AAA) p...
Source: WhiteCoat's Call Room - December 31, 2012 Category: Emergency Medicine Doctors Authors: Birdstrike Tags: Guest Posts Source Type: blogs
