Acute Incarceropathy
The chest pain patient was escorted back to a treatment room by not only the triage nurse, but also by a police officer. The patient was crying in pain. Agonizing pain. As the officer removed the handcuffs, the patient slowly and deliberately climbed onto the cot.
“I’m doctor WhiteCoat. What brings you to the emergency department today?”
Through her tears, she rolled her eyes and tilted her head toward the police officer.
“I see that, but why did the officer bring you here?”
“I – I – I am having PAIN! Pain all OVER!”
“The nurse said that you were having pain in your chest.”
“There, too! I have a com...
Source: WhiteCoat's Call Room - October 18, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
ACEP 2013 WhiteCoat Recap
I arrived at ACEP’s 2013 Scientific Assembly a day early to attend the Council Meeting and to meet up with some old friends.
The venue for the gathering was good. Transportation, hotels, dining, and shopping all within easy walking distance from the Convention Center. The Convention Center itself was rather oddly situated. Had to take escalators up four floors to get to lectures. Staff was uniformly pleasant and helpful.
Some of the issues at the Council Meeting that had the most vigorous debate seemed tangentially related to emergency medicine. If I hear one more proposed resolution about marijuana, I’m going to g...
Source: WhiteCoat's Call Room - October 17, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts ACEP Source Type: blogs
Healthcare Update Satellite — 10-09-2013
Government getting pissed because providers are beating it at its own game? When feds started pushing electronic medical records and threatening to penalize patient, a funny thing happened … the amount of money the feds spent on healthcare increased by billions of dollars. Now Kathleen Sebelius and Eric “Fast N Furious” Holder are warning that doctors that copying and pasting patient data between patient medical record entries should not occur because it risks medical errors and overpayments. They promise to “prosecute health care fraud” and will “consider future payment reductions as warranted.”
In other wor...
Source: WhiteCoat's Call Room - October 10, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Still Don’t Use These Abbreviations
Remember all of those “do not use” abbreviations?
I wrote a post about them a loooong time ago, but since then things have changed.
We went from written medical charting to almost exclusively computer [hack hack] generated medical records.
So the whole Joint Commission issue about a “>” looking like the number “7″ or the notation “cc” looking like two extra zeroes is – or at least should be – a moot point.
And I still believe that if someone can’t tell the differences in dosing between “MSO4″ and “MgSO4″ then they shouldn’t b...
Source: WhiteCoat's Call Room - October 5, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
Healthcare Update Satellite — 10-03-2013
Via @mdaware … ever wonder whether you need to prescribe two antibiotics for patients with uncomplicated cellulitis? EM Literature of Note’s Ryan Radecki pulls an article showing that there isn’t much difference in outcome/cure rates between treatment of uncomplicated cellulitis with only cephalexin versus combination treatment with cephalexin and Bactrim.
This is important. And it’s from Fox News, so you know it’s fair and balanced. Be very careful about how you sign up for the Obamacare exchanges. Experts expect that there will be a lot of hacking/phishing attacks using phony web sites to try to get unsuspectin...
Source: WhiteCoat's Call Room - October 3, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
More Unique Chief Complaints
The unique chief complaints keep coming. Maybe this should be a monthly topic …
The top and bottom half of my body are mismatched. No stroke. No weakness. No pain. Just “mismatched.”
Patient was discharged from hospital 12 hours ago for alcohol intoxication, unable to get into mother’s house because she has key and she’s at work. When informed that nothing could be done from the ED about a missing house key, stated he may feel like hurting himself if he can’t get into his mother’s home soon.
19 year old healthy-appearing female who had pain with urination and was diagnosed with a UTI in d...
Source: WhiteCoat's Call Room - October 1, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Healthcare Update Satellite – 09-25-2013
See more health care news from around the web on my other blog at DrWhiteCoat.com
Man found dead in parking lot of Detroit’s Grand Valley State University had just used the university computers to query Dr. Google on “pain and tightness of the chest and sweating.”
Wonder what happens if the web site he landed on didn’t tell him to call 911?
Maybe Google, Esq.?
North Carolina woman busted for drug trafficking and felony possession of controlled substances after going to multiple physicians and being prescribed 1,286 doses of Xanax and 2,330 doses of oxycodone/hydrocodone between May 2012 and May 2013.
Think closely...
Source: WhiteCoat's Call Room - September 26, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Medical Tourism Downsides
A patient comes into the hospital with dizziness and trouble breathing.
The story about how he developed those symptoms was a little more involved.
The patient needed some major work done on his teeth. He was having a lot of pain and couldn’t take it any longer. So he sold his favorite Harley Davidson motorcycle and had about $6,000 available to fix his teeth. After calling around to multiple dentists and clinics, the best price he could get to have all of the work done in the US was about $14,000. He read about medical tourism in a newspaper article, so he made some phone calls and sent some e-mails and found a place ne...
Source: WhiteCoat's Call Room - September 20, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Healthcare Update Sattelite Edition – 09-18-2013
Copeptin levels may revolutionize chest pain evaluations in the ED. When standard treatment was compared with early discharge after normal copeptin levels were obtained, there was no significant difference in major adverse cardiac events at 30 days.
Need to review the study data, but this is a promising new test.
Marco Rubio calls federal government’s $8.7 million advertising campaign for Obamacare a “blatant misuse of federal dollars.”
International Longshore and Warehouse Union dumps affiliation with the AFL-CIO, citing support of Obamacare and immigration reform as two reasons for the disaffiilation.
Good thing to...
Source: WhiteCoat's Call Room - September 18, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Anatomy of a Tragedy and Healthgrades.com
Saul Elbein deserves a shout out for the article he wrote in the Texas Observer titled Anatomy of a Tragedy. If you haven’t read the article, you need to go get a cup of coffee, sit down and take it all in. I disagree with his suggestion that the problems raised in the article may have been the price of living in a “free market”, because a free market system would require more transparency, but I won’t let my disagreement with him on this point overshadow an excellent article.
The article chronicles how a neurosurgeon in Texas permanently injured and likely even killed multiple patients during surge...
Source: WhiteCoat's Call Room - September 9, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: News Commentary Press Ganey Source Type: blogs
Healthcare Update Satellite — 09-04-2013
Look for more updates on my other blog at DrWhitecoat.com
American Medical News ceasing publication due to decreasing ad sales. Now focusing on online and e-mail publications.
Too fat to rescue? Some patients weighing more than 350 pounds (and even some weighing more than 250 pounds) are being denied air transport due to their weight. Other services are spending millions of dollars to purchase helicopters that can carry patients up to 650 pounds.
What happens with a 750 pound patient, then?
University of Pennsylvania adding metal detectors to its emergency departments. They reportedly aren’t used in emergencies, though.
...
Source: WhiteCoat's Call Room - September 4, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Unique Chief Complaints
I’ve had a few interesting chief complaints lately. Here is a small sampling … from different patients, of course.
Someone broke into the patient’s house while he was sleeping and stole only his schizophrenia medications so that he would act up and then get arrested by police and have to be admitted to the hospital. Then the perpetrator could break back into his house and take all of his belongings.
There are two small dots near my appendicitis scar. I think something may be inside trying to crawl its way out.
I started having back pain after laughing too hard.
My left ear had been clogged after having sex 9...
Source: WhiteCoat's Call Room - September 2, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Healthcare Update Sattelite — 08-28-2013
Find more updates on my other blog at DrWhitecoat.com
British National Health Service now gives physical therapists and podiatrists the authority to prescribe medications to patients without physician supervision. Good for them.
I still believe that all drugs aside from antibiotics and perhaps narcotics should be over the counter anyway.
Not only the King of Beers, it’s the King of Emergency Department visits. One third of injury visits to Level 1 trauma centers were alcohol related. Personally, I think that number is low. Of the patients who admitted drinking before their injury, 69% were male and 69% were black. Of the...
Source: WhiteCoat's Call Room - August 28, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Head trauma workup
Patient’s chief complaint: “I was slapped on the back of my head with a file folder by a co-worker. I have a headache and I want a CT scan to make sure there’s nothing wrong on the inside.
In other words, “I really want to get my co-worker in trouble.”
Fortunately, it wasn’t one of those goth file folders with the spikes sticking out.
Danged if I didn’t have to consider a CT of the chest after putting my stethoscope on her chest to listen to her heart … and an MRI of her back after she laid on the table for the exam.
Sheesh.
And she’ll probably end up getting the Press Ganey survey tha...
Source: WhiteCoat's Call Room - August 26, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Healthcare Update Satellite — 8-21-2013
Look for more updates on my other blog at DrWhitecoat.com
Judge orders Colorado family to pay $340,000 in legal fees after losing the medical malpractice suit it brought against a hospital.
The family plans to declare bankruptcy. The family’s attorney, Stacy Warden, alleges that the hospital lacked compassion for “going after a family with a severely disabled child.” If attorneys file frivolous cases, perhaps the attorneys should be on the hook, not the families …
West Virginia couple is suing a physician for failing to diagnose an epidural abscess that later rendered the patient with permanent paralysis, in additi...
Source: WhiteCoat's Call Room - August 21, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
