Healthcare Update — 07-24-2014
This study might suggest that mega-hospital care is better, but is immediate care in small volume emergency departments better than delays in care during travel to a mega-hospital … or no care at all because patients can’t get there?
This may explain why doctors are so good at practicing defensive medicine. During their careers, doctors spend more time in the courtroom than in the classroom.
The headline is misleading since during a lawsuit, doctors aren’t in the courtroom 40 hours per week as they are during medical school. The point is that for 11% of their careers, an average physician has a lawsuit ha...
Source: WhiteCoat's Call Room - July 24, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Healthcare Update Satellite — 07-14-2014
Practicing telemedicine may just get a whole lot easier. Federation of State Medical Boards creating an interstate “compact” that would reduce barriers by providing an “expedited license” to physicians who wish to practice medicine in multiple states. The physician has to establish a state of “principal license” and then may apply to the “Interstate Commission” to receive a license in another state after the “applicable fees” have been paid. The hundreds of dollars per year paid to each state to maintain licensure don’t appear to be one of the barriers that ...
Source: WhiteCoat's Call Room - July 15, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Quick Visit
A mother brought her son to the emergency department with a rather non-emergent complaint … chapped lips.
The registration clerk started taking the registration information.
“Can I get the patient’s name and date of birth please?”
“Yes, it’s Johnny …”
The clerk got distracted by the patient who first licked his lips, then smacked his lips, then rubbed his finger back and forth over his lips.
“You know, you shouldn’t do that. That’s probably why your lips are so irritated.”
Back to the mother.
“His name is Johnny Smith. His date of birth …&...
Source: WhiteCoat's Call Room - July 8, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Healthcare Update Satellite — 07-2-2014
Ve have vays of keeping you qviet. Halt den mund! Government-contracted security force who actually call themselves the “Brown Shirts” … threatens to arrest medical providers if they leak any information to media about all of the medical illnesses that are being seen at an illegal alien refugee camp in Lackland Air Force Base.
By the way, this story is from FoxNews, so everyone should just ignore it until you or your family members sit next to one of them on a bus or in a movie theater. Combine these kids on playgrounds with anti-vax kids? What could go wrong?
Nothing to worry about. Nothing at all.
New Y...
Source: WhiteCoat's Call Room - July 2, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
One Way to Cure a Drug Seeker’s Back Pain
A gentleman in his 40s limped into the emergency department for evaluation of severe back pain.
He had a chronic history of back pain, but had decided to forgo recommended surgeries because he was told that there was a chance his pain could worsen. He reportedly had multiple MRIs in the past … all of which showed “severely” bulging discs. He also just moved to the area the evening prior to his visit. In all of the excitement and heavy lifting, he strained his back, he couldn’t find his pain medications, AND he lost his wallet. That meant he had no ID and he couldn’t remember his address becaus...
Source: WhiteCoat's Call Room - July 1, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Hemoptysis Pearls
There was a nice article over at Consultant360.com by Drs. Laren Tan and Samuel Louie on hemoptysis pearls. Learned quite a few things.
200 mls of blood (about a cupful) is enough to fill the dead space in the lungs and is therefore generally considered the minimum amount of blood to make the diagnosis of “massive” hemoptysis.
Hemoptysis with chest pain – think pneumonia/pleurisy, PE with pleurisy, pulmonary edema from an MI, or lung cancer
Hemoptysis with dyspnea – think either exacerbation of patient’s underlying medical problem or a precursor to respiratory failure
Hemoptysis with fever ...
Source: WhiteCoat's Call Room - June 26, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Medical Topics Source Type: blogs
Healthcare Update Satellite — 06-23-2014
The right to carry a concealed weapon only exists if your doctor says so. Many states are requiring that physicians certify whether patients are competent to carry a concealed weapon. Some states require mandatory reporting of those deemed not competent to carry a concealed weapon. Of course, the natural extension of such laws is that if the doctors make an inappropriate determination, then the doctors can be held liable if the certifiee does something inappropriate with the weapon.
This New England Journal of Medicine article shows that many doctors aren’t comfortable making that determination.
Then again, I’v...
Source: WhiteCoat's Call Room - June 24, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Assistant Physicians Coming to Missouri
Missouri is planning to allow medical school graduates who have not completed residency to treat patients in underserved parts of the state. Bills that would allow medical school graduates to provide medical care have passed the General Assembly and are awaiting Governor Jay Nixon’s signature. The newly-minted physicians would receive “assistant physician” licenses and would be able to treat patients in collaboration with a licensed physician – much in the way a physician assistant does. However, the new graduates will be able to call themselves “doctor” while physician assistants will...
Source: WhiteCoat's Call Room - June 22, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Source Type: blogs
Insecticide Poisoning From Aluminum Phosphide and Phosphine
There was a sad story about a woman who died from insecticide poisoning inside her home after family member sprayed agricultural insecticide inside the house earlier in the day. While the story was sad, the back story was quite interesting to me.
The poisoning was from aluminum phosphide. When exposed to atmospheric moisture or stomach acid, aluminum phosphate converts to aluminum hydroxide (which is used to treat excess stomach acid) and phosphine gas – which is highly toxic. Phosphine gas typically smells like rotting fish or garlic. Phosphine is explosive and is heavier than air, so it tends to collect in low-lyin...
Source: WhiteCoat's Call Room - June 19, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Medical Topics Source Type: blogs
Healthcare Update Satellite — 06-17-2014
Read more healthcare-related news from around the web on my other blog at DrWhitecoat.com
Oklahoma University Medical Center joins the growing ranks of hospitals that are requiring patients to pay a fee of $200 to be treated for non-emergency complaints. That amounts to an estimated 40% of OU’s emergency department visits. If patients do not want to pay for non-emergent care, they will be referred to nearby urgent care clinics.
This “triage out” protocol will eventually become a standard throughout US emergency departments. Count on it.
Emergency physician writes about how she almost diagnosed Lou Gehrig&...
Source: WhiteCoat's Call Room - June 17, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
14.5 Million Reasons Physicians Practice Defensive Medicine
Cleveland’s MetroHealth Medical Center and a staff physician were recently found liable for a $14.5 million medical malpractice verdict in what is commonly termed a “bad baby” case.
The case as described in the article involved 36 year old Stephanie Stewart who was pregnant with her second child. She went to MetroHealth several times for premature labor when the child was 22-23 weeks gestational age (a full term infant is 40 weeks) and was admitted twice, with labor being stopped using medication and bedrest. There were apparently discussions about her requiring a C-section since her first child was de...
Source: WhiteCoat's Call Room - June 16, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Defensive Medicine Medical-Legal Source Type: blogs
BMI Measurements Inaccurate But Still A Government Gold Standard
Everyone needs to read this NY Times article and then think about how inane the concept has become.
The Body Mass Index or “BMI” is used as a measure of a person’s body weight. If your BMI is between 18.5 and 25, you’re normal. More than 25 and you’re overweight. More than 30 and you’re obese. The measurement is based on a person’s weight and height, but it was originally created in the 1800s to measure human growth – not as a measure of a person’s ideal body weight or health. More recent studies show that people considered “overweight” using the BMI measur...
Source: WhiteCoat's Call Room - June 14, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: CMS Policy Press Ganey Source Type: blogs
The Effectiveness of Advertising
A cute little 6 year old boy was brought from home. He had autism and didn’t communicate much.
His mother stated that he would occasionally just stop eating and drinking. Then he would get dehydrated. Then he’d get constipated. Then it would be a big problem to attempt to get him un-constipated. He had to be hospitalized for dehydration a couple of times and he had to be manually disimpacted once. The mom estimated that he had gotten significantly dehydrated 4-5 times in the past few years. So the patient’s pediatrician sent him to the emergency department to get some IV fluids in order to attempt to avoi...
Source: WhiteCoat's Call Room - June 11, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Press Ganey Source Type: blogs
Healthcare Update Satellite — 06-10-2014
This study found no benefit in doing so. However, note that the study population was limited to patients with a “bending or twisting injury.” Patients were excluded if they had suspected nonmusculoskeletal etiology, direct trauma, motor deficits, or local occupational medicine program visits.
I’m still giving steroids for exacerbations of chronic pain and for radiculopathy.
Potential patients gone wild … Colorado man shot in emergency department parking lot after “confronting” police with a knife.
Lesson #1: Don’t run around in a parking lot wielding a knife
Lesson #2: Don’t ...
Source: WhiteCoat's Call Room - June 10, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Michael Kirsch, MD Redux
For the past 30 minutes, my cell phone has buzzed repeatedly, urging me not to climb out of this rabbit hole. “Come back,” it beckons, “we’re not finished yet.”
When KevinMD deleted my first comment about Dr. Kirsch, I decided to keep further comments on my own blogs so they don’t mysteriously disappear again. Now I’ve learned that I’ve been demoted: Instead of my comments on KevinMD posting immediately, I must receive prior approval before my comments can be viewed by anyone else on Kevin’s blog. All because I pull aside the curtain so people could see the real “insider.”
Next will be th...
Source: WhiteCoat's Call Room - June 9, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
