Healthcare Update Satellite — 12-30-2013
More updates on my other blog at DrWhiteCoat.com North Las Vegas VA Hospital emergency department repeatedly “disrespected and mistreated” a 78 year old diabetic volunteer with more than 5,000 hours of service at local VA facilities. A few weeks after two visits for a colon problem, the patient died in a hospice. When the patient’s friend went to get video of the events from the emergency department, the footage had been erased. What types of things do Australian emergency departments see on Christmas? Stonefish stings, jet ski accidents, inhaled foreign bodies … not that different from the US, although I had no id...
Source: WhiteCoat's Call Room - December 30, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Amusing Nonsequitur
A patient gets brought in by ambulance for knee pain. The story goes that the patient was at a gas station and finished filling up his truck. He walked inside to pay for his gas and when he turned around to leave, he said that “his leg gave out on him” and he fell to the floor. He was able to stand back up, but he wasn’t able to put a lot of weight on his leg. So he hobbled back to his truck and sat backwards onto the seat, but he wasn’t able to lift his bad leg into the truck. The gas station attendant was watching all of this and ended up calling the ambulance. When the patient arrived, he appeare...
Source: WhiteCoat's Call Room - December 17, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite — 12-13-2013
More healthcare news from around the web can also be found on my other blog at DrWhiteCoat.com Vacancy rate for physicians at hospitals nearly doubles in four years and vacancy rate for nurses at hospitals triples in four years. NPs and PAs also in short supply. Even though I’m no Obamacare fan, I don’t think the provider shortage can be blamed on the new healthcare law as the Forbes article insinuates. But if the shortage is because fewer people want to go into the medical field, there are going to be large problems in the future. It takes 11 years of secondary education to train a doctor. That’s a long time to wait...
Source: WhiteCoat's Call Room - December 13, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Anchors Aweigh!
An otherwise healthy 38 year old patient was brought in by her family with vomiting and mental status changes from her pain medications. She had repair of a tibial plateau fracture performed four days earlier and was having a lot of pain. She didn’t like taking the Percocets that she was prescribed because they made her nauseous. She took one of them the day after her surgery and she was nauseous the rest of the day, so she vowed not to take any additional Percocets. However, her knee pain was worse that morning to the point that she couldn’t stand it any longer, so she took two Percocets … on an empty stomac...
Source: WhiteCoat's Call Room - December 10, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Medical Topics Patient Encounters Source Type: blogs

Healthcare Update Satellite — 12-04-2013
What are the busiest hospital emergency departments? An American Hospital Association survey from 2011 published earlier this year is surprising (link to .pdf file). The 25 busiest hospitals in the US see more than 5 million patients per year. Florida Hospital in Orlando is the busiest in the US and sees 407,000 patients per year – an average of 1,100 per day. Georgia Supreme Court rules that emergency physician’s to diagnose a pulmonary embolism in 15 year old football player who had arthroscopic knee surgery a week prior to ED visit can constitute gross negligence. The patient had pleuritic chest pain, a norm...
Source: WhiteCoat's Call Room - December 4, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

The Most Common Thanksgiving ED Complaints
When I first saw this article in Live Science about the strangest holiday ED complaints, I was interested in what other doctors’ perceptions were, but I first sat back and thought about what types of complaints I usually see more often on Thanksgiving than during other times of the year. I’ve given up on trying to time “strange” complaints. They occur so often that I lose track of any temporal aspect to them. Because Thanksgiving obviously occurs on a Thursday and because many doctors offices usually aren’t open the Friday after Thanksgiving, the holiday often presents patients with difficulty...
Source: WhiteCoat's Call Room - November 28, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Healthcare Update Satellite — 11-25-2013
See many more medical news stories from around the web over at my other blog at DrWhitecoat.com Nice synopsis by an Ohio State University emergency physician on how sinusitis can be mistaken for a primary dental problem … and how to use physical examination to help tell the difference between the two. Just don’t expect a sinus infection to get better with antibiotics. Why one California emergency physician weeps for the future. The patient scenarios that you read about at the link will probably frustrate you as well. Included are patients who come to the ED because they don’t want to wait for referrals or for doctor...
Source: WhiteCoat's Call Room - November 25, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

What’s The Diagnosis #17
A 26-year old female seeks your care for a bee sting to her thumb that occurred just prior to her arrival. She states that she reached into her purse looking for her car keys and felt a sting to the pad of her thumb. She came directly to the emergency department after the incident because she is allergic to bees … and she always carries an EpiPen with her (shown below). She’s currently having moderate pain in her thumb, but no other symptoms. What’s your diagnosis and how would you treat this patient? And take a guess how much it will cost the patient to refill her EpiPen. (Source: WhiteCoat's Call Room)
Source: WhiteCoat's Call Room - November 23, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: What's the Diagnosis? Source Type: blogs

Healthcare Update Satellite — 11-20-2013
This report says that mental health patients make up almost half of the emergency department patients at Denver Health every weekend. When you cut funding for psychiatric care by 20% and cut the number of psychiatric beds by 30%, the patients with psychiatric problems don’t just disappear. When they can’t get help, they end up in the emergency department, in jail, or even worse. Could the Columbine or Aurora shootings have been prevented by expanding psychiatric care? Probably not. But one emergency department physician noted that for every “high-profile event that everybody knows about, there’s a hundred that were...
Source: WhiteCoat's Call Room - November 20, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite — 11-14-2013
See more news from around the web over at my other blog at DrWhitecoat.com An example of the downside to government-run health care. Patients in Venezuela can’t get proper medical care. 300 cancer patients were just sent home when supply shortages and “overtaxed equipment” made it “impossible … to perform non-emergency surgeries.” 70% of the radiation therapy machines are inoperable. Basic supplies such as needles, syringes, medications, operating room equipment, X-ray film, and blood needed for transfusions are all in short supply. There is no anesthesia for elective surgery. Patients can no longer get organ d...
Source: WhiteCoat's Call Room - November 15, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Dragonisms – Voice Misrecognition Contest
I like the Dragon NaturallySpeaking program. I like tequila, too. But I try to use both with caution. Dragon’s speech recognition is good in that it saves a lot of time and costs in transcribing medical records, especially in complicated patients where it would take a long time to type out the patient’s history and the patient’s course. The problem with Dragon NaturallySpeaking is that it isn’t perfect. Sometimes the difference between a doctor’s dictation of “no murmur present” and the Dragon transcription of “murmur present” can make a big difference in a patient̵...
Source: WhiteCoat's Call Room - November 7, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

Healthcare Update Satellite — 11-04-2013
See more medical news from around the web on my other blog at DrWhiteCoat.com 72 year old Connecticut patient awarded $9.3 million after being hospitalized for UTI, then given overdose of Lovenox. She developed intra-abdominal bleeding and required several surgeries and blood transfusions to correct the problem. She also developed a large abscess at the site of a central line insertion. Attorneys for the patient say that it was “an understatement” to say that the standard of care was violated. One of the ideas behind providing more patients with “insurance” (not with “health care,” mind you) is that the insured...
Source: WhiteCoat's Call Room - November 5, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Some Joke
If you haven’t been threatened by a patient, you haven’t been working in an emergency department very long. It’s a common occurrence that shouldn’t be so common. You can read about “patients gone wild” on this blog almost every week – and those are just the incidences that make the news. Little threats come even more often than that. Most of the time we just laugh the threats off. One patient was a little more convincing than some of the others, though. It wasn’t just some idle threat. This overly intoxicated patient repeatedly yelled at the doc in a loud voice reminiscent of Yosemite Sam that “I’m goin...
Source: WhiteCoat's Call Room - October 30, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Healthcare Update Satellite 10-28-2013
According to this study of 1165 homeless Canadian patients in the American Journal of Public Health, when compared with a control population, homeless patients used the emergency department 8.5 times more often, were hospitalized 4.2 times more often for medical/surgical problems, and were hospitalized 9.2 times more often for psychiatric hospitalizations. According to this accompanying study, the average ED utilization for homeless patients was 2 visits per year, but 10% of the sample population accounted for more than 60% of all ED visits. Drug seeking behaviors permeate emergency medicine. Opiate overdoses resulted in m...
Source: WhiteCoat's Call Room - October 29, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Healthcare Update Satellite – 10-21-2013
Setting the record straight about EMS myths. Well … really one myth … going to an emergency department by ambulance doesn’t mean you’ll go to the front of the line. The places that I work will frequently have patients who come by ambulance go directly to the waiting room. Other times when it isn’t as busy, the patients would have gone straight to a bed regardless of how they arrived. Calling an ambulance to try to game the system isn’t worth the expense. One of the things people don’t think about when filing a lawsuit is called “subrogation.” If insurance has paid for care that is related to your lawsuit,...
Source: WhiteCoat's Call Room - October 21, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs