Politically Incorrect Humor. Ignore if you are sensitive.

[sas5814]

We are getting crushed in the UC with cold and flu season. I work in Tyler TX which seems to be the hub of flu for the entire US by some reports. I am sooooo tired that I decided to vent, humorously, about it. If you suffer hard core political correctness you might skip this....

Feel free to add test questions.

 

Good morning. Today I am sharing the medical portion of the test all people are now required to take before being allowed to reproduce. You may use all 61 IQ points for this test….that will not be considered cheating today.

1. Your child has a runny nose for 3 hours. You:
A. Call an ambulance
B. Go to the emergency room
C. Throw him or her in the car, turn on your emergency flashers, and drive as fast as you can to the pediatrician.
D. Wipe it.
E. Teach him or her to wipe it.

2. Your child coughs once. You:
A. Call an ambulance
B. Go to the emergency room
C. Rush to the pediatrician
D. Spend 4 hours in the emergency room to get a prescription for Robitussin so you don’t have to spend $3 of your own money
E. Tell him or her to cover his/her mouth.

3. Your child has a temperature of 99 degrees. You:
A. Call an ambulance
B. Go to the emergency room
C. Call the on-call pediatrician crying hysterically and demand an antibiotic.
D. Go to the Urgent Care and call everyone idiots for not understanding your crisis.
E. Nothing. That isn’t a fever. (It is a temperature but so is 40 degrees.)

4. You go to the ER/Urgent Care/Pediatrician and don’t get what Dr. Google told you your child needs. You:
A. Call your Congressman
B. Call the police
C. Call the organization complaint line
D. Leave a bad YELP review with the word “bastards” in it at least 4 times.
E. Nothing. The people who studied medicine for 8000 years probably know something you didn’t discover in your Google search.

5. Your health care is free (paid for by everyone else). One of your kids gets a cold. You
A. Take the other 6 healthy kids in “just to get them checked.”
B. Take them all to the emergency room.
C. Call one of those ambulances they use for mass casualties.
D. Tell them all to wash their filthy hands.
E. Nothing.

6. You have 5 children whose fundamental health needs are as elusive to you as Sanskrit or the theory of relativity. You:

A. Ask people of experience what to do
B. Study up a bit so you can manage simple things.
C. Go to the doctor when necessary and follow the guidelines you are given.
D. Sue the government and your parents because it isn't your fault
E. Have more children.

[BruceBanner]

I work in college health---which I am convinced is the epicenter for all western disease---and we are also getting killed with colds and flu. I saw 16 in 3 hours yesterday morning.

1. You have had a sore throat without fever for 1.5 days. You:

a) go straight to University Health Service (but not until noon when you finally get up), wait for 2 hours, complain about the wait, and then ask the provider if there's "anything you can do".

b) Stay at home, take some Motrin, and be an adult for a week while you get better.

c) call the nurse line for advice, be told to come in (because that's nursing advice in a nutshell), and proceed to answer A.

2. You have cold symptoms for 4 days. You are congested and stuffy. You:

a) Go to UHS for treatment of your sinus infection

b) call your mom, who tells you to go to UHS for a Z-pack

c) wait out your cold like a man (or woman) and come in to see us if it's worsening after 7-10 days.

3. You've had a cough for "the whole semester". You:

a) Do nothing, continue to stay out late and party, cough all over everybody, then come into UHS at 4:30 pm before we close.

b) Wonder if maybe it's more of a benign cough than a 3 month "cold", take some OTC expectorants, and take care of yourself.

c) Come into UHS, cough all over everybody, then get p!ssy when we wont "just give you a Z-pack" like your mom said. Proceed to party and stay out late, go to rainy football games. Let your cough turn into PNA, then get admitted to the hospital. Call your mom who then proceeds to call UHS and file a formal complaint. 

[sas5814]

Z-Pack and steroids has become the punch line to a joke. Every time I hear that from a patient I look in the chart. Given by an NP 100% of the time so far.

[thinkertdm]

1. While you are waiting to have your sore throat evaluated in a full waiting room, you see an ambulance arrive, then haul someone away.  When your turn finally comes:

A.  Lay down on the exam table, then respond as to level of pain "bad enough to wait two hours"

B. Complain to the administration that you had to wait forever, and you wish a "real" doctor was working.

C. Nothing, because you are at home with honey, salt water gargles and tea

[GetMeOuttaThisMess]

Z-Pack and steroids has become the punch line to a joke. Every time I hear that from a patient I look in the chart. Given by an NP 100% of the time so far.

 

Here’s one that isn’t an NP. Most PND odynophagia is due to the acidic nature, thus I start with OTC liquid antacids (may also help with nocturnal coughs, again due to the acidic nature of the PND and the thick chalky characteristic of the solution). Where I do use steroids is for anti-inflammatory effect with primary odynophagia from non-URI sx (I’m currently comparing 8 mg dexamethasone P.O. single dose, which was a study dose, compared to 20 mg prednisone bid for 48 hours, compared to APAP). Steroids clearly show beneficial effect in my setting as was also noted in the study I’m referencing. Since I’m not a fan of RST and can’t culture, if sx resolve in 48 hours and patient presented w/i 48 hours of sx onset then probably not an infectious etiology. If sx not resolved in one week then trial of abx is encouraged per ENT.

[sas5814]

I read a couple of studies that a single dose of steroids, as low as 10mg of prednisone, can often reduce or eliminate sore throat pain. I have started giving my sore throat folks a 20mg prednisone in clinic. Because we are UC I haven't gotten any feedback but it gives the patients a sense we are doing something affirmative for them.

[11BtoPA]

3 hours ago, sas5814 said:

I read a couple of studies that a single dose of steroids, as low as 10mg of prednisone, can often reduce or eliminate sore throat pain. I have started giving my sore throat folks a 20mg prednisone in clinic. Because we are UC I haven't gotten any feedback but it gives the patients a sense we are doing something affirmative for them.

I'm starting a per diem job in UC after working in neurosurgery at a level 1 trauma center for the past few years and part of my evaluation is patient satisfaction so this is a helpful tidbit.

[GetMeOuttaThisMess]

If you want to blow your mind go back and read the follow up reviews of the strep study from ‘48 by the USAF at Warren AFB. This is where the “OMG I have strep” fear came from. There have been several follow up reviews of the study and one of the better follow ups was written by J. Hoffman et al in response to the recommendation to culture all negative RST. I think you’ll see the world in a new light.

 

[Boatswain2PA]

But then there is this:

It's the height of influenza season (not that you are aware of that) and you, a 24 yo woman, have two days of worsening fever, HA, and extreme myalgias.  You didn't get the flu shot.  Do you

A) Alternate ibuprofen and apap

B)  Wait till 2200 before coming to the ED, deny you have any neck pain, abd pain, vag d/c, or hx of IVDA.  Refuse to undress and put on a gown "because your body hurts too bad to change".  After your pulse comes down to 115 (from 145) and your fever comes to 101 (from a legit 103.5) you are re-examined and you still deny abd pain, vag d/c, or hx of IVDA.  Not until after the influenza A/B test comes back negative do you agree to be put into a gown and the PA sees your track marks on your arms do you disclose you shot up meth 10 days ago.


 

[south]

5 hours ago, Boatswain2PA said:

After your temperature comes down to 115 (from 145) 
 

LOL'd

you got some pretty hardy patients 

[Boatswain2PA]

3 hours ago, south said:

LOL'd

you got some pretty hardy patients 

Whoops!  Pulse down from 145, lol!

[Will352ns]

9 hours ago, Boatswain2PA said:

But then there is this:

It's the height of influenza season (not that you are aware of that) and you, a 24 yo woman, have two days of worsening fever, HA, and extreme myalgias.  You didn't get the flu shot.  Do you

A) Alternate ibuprofen and apap

B)  Wait till 2200 before coming to the ED, deny you have any neck pain, abd pain, vag d/c, or hx of IVDA.  Refuse to undress and put on a gown "because your body hurts too bad to change".  After your temperature comes down to 115 (from 145) and your fever comes to 101 (from a legit 103.5) you are re-examined and you still deny abd pain, vag d/c, or hx of IVDA.  Not until after the influenza A/B test comes back negative do you agree to be put into a gown and the PA sees your track marks on your arms do you disclose you shot up meth 10 days ago.


 

Option B seems a popular choice....

[sk732]

43 minutes ago, Will352ns said:

Option B seems a popular choice....

Like any multiple choice test, go with the longest/most complicated answer :-D

[thinkertdm]

You have been having nasal congestion for the past day.  Your ears feel full.  You know have a fever, well, because.  The clinic thermometer is probably broken.  You have a cough.  Which antibiotic do you demand?

A.  Azithromycin

B. Zpack

C. "the five day one"

D.  "the little one"

[GetMeOuttaThisMess]

You have been having nasal congestion for the past day.  Your ears feel full.  You know have a fever, well, because.  The clinic thermometer is probably broken.  You have a cough.  Which antibiotic do you demand?
A.  Azithromycin
B. Zpack
C. "the five day one"
D.  "the little one"

You left out “E” which is any of the above AND it has to be cheap and/or on my insurance.

[thinkertdm]

I am happy to announce that today I put in my 90 day notice where I leave the "walk-in" with up to 40-65 patients a day.  I don't know much about the place I am going, but hopefully I can use my little gray cells again.

[Wish1pa]

22 hours ago, sas5814 said:

I read a couple of studies that a single dose of steroids, as low as 10mg of prednisone, can often reduce or eliminate sore throat pain. I have started giving my sore throat folks a 20mg prednisone in clinic. Because we are UC I haven't gotten any feedback but it gives the patients a sense we are doing something affirmative for them.

A single dose of 20mg?

[Wish1pa]

If you can't laugh at this you shouldn't be a PA imo...

Whenever I have a patient thats had a runny nose x -1 day I want to throw a chair across the room. Seriously??

And I had a lady today who had a temp of 99.0 who wanted Tamiflu despite a negative flu test..

 

 

[Acebecker]

My favorite was the 20 yo male who c/o sore throat.  In usual thorough fashion I asked, "How long has this been going on?"

"2 hours."

"Any reason for you to be worried that this would be strep or mono or something bad?  Like, do you have any major medical problems?  Been around anybody who has those things?"

"Nope.  Nope.  Nope.  I just didn't want to miss a throat infection."

I was worried for the future of the world in that moment; someday he'll be in charge of something.

[mgriffiths]

Happened today: 31yo male with a mild learning disability walks in with history of a sore throat from 3 days ago...note this is not a sore throat for the last 3 days, literally he had a sore throat 3 days ago and now asymptomatic.  I understand the patient had a learning disability, but his college educated mother is the one who brought him in "just to be sure."  (insert the biggest eye roll you can possibly imagine)

[sk732]

Was doing my off service notes last night and had a brutal sinus headache (my plague is returning) and commented my sinuses were killing me...the nurse at the station, that I am convinced is a combination severe burnout/borderline PD, looks at me and says I needed some Levaquin.  I politely noted that it was a nuclear bomb for something needing a flyswatter and mentioned that was a reason I have prescriptive authority and not her.  All this after she tells a guy I treated yesterday for wussyitis/thoracic facet syndrome that bounced back, that he "needed" an MRI (after a couple days of pain/spasm) for which nobody is going to do anything about.  This chick literally freaks out at the simplest things and tries to make it sound like the sky is falling.  

There is a reason I'm almost able to view my cerebellum.

SK

[thinkertdm]

1 hour ago, sk732 said:

Was doing my off service notes last night and had a brutal sinus headache (my plague is returning) and commented my sinuses were killing me...the nurse at the station, that I am convinced is a combination severe burnout/borderline PD, looks at me and says I needed some Levaquin.  I politely noted that it was a nuclear bomb for something needing a flyswatter and mentioned that was a reason I have prescriptive authority and not her.  All this after she tells a guy I treated yesterday for wussyitis/thoracic facet syndrome that bounced back, that he "needed" an MRI (after a couple days of pain/spasm) for which nobody is going to do anything about.  This chick literally freaks out at the simplest things and tries to make it sound like the sky is falling.  

There is a reason I'm almost able to view my cerebellum.

SK

Sometimes if you run 'em through the machine a few times it helps.  Turn it to 11.

[AlteredBeast]

On 1/7/2018 at 8:30 AM, BruceBanner said:

I work in college health---which I am convinced is the epicenter for all western disease---and we are also getting killed with colds and flu. I saw 16 in 3 hours yesterday morning.

1. You have had a sore throat without fever for 1.5 days. You:

a) go straight to University Health Service (but not until noon when you finally get up), wait for 2 hours, complain about the wait, and then ask the provider if there's "anything you can do".

b) Stay at home, take some Motrin, and be an adult for a week while you get better.

c) call the nurse line for advice, be told to come in (because that's nursing advice in a nutshell), and proceed to answer A.

2. You have cold symptoms for 4 days. You are congested and stuffy. You:

a) Go to UHS for treatment of your sinus infection

b) call your mom, who tells you to go to UHS for a Z-pack

c) wait out your cold like a man (or woman) and come in to see us if it's worsening after 7-10 days.

3. You've had a cough for "the whole semester". You:

a) Do nothing, continue to stay out late and party, cough all over everybody, then come into UHS at 4:30 pm before we close.

b) Wonder if maybe it's more of a benign cough than a 3 month "cold", take some OTC expectorants, and take care of yourself.

c) Come into UHS, cough all over everybody, then get p!ssy when we wont "just give you a Z-pack" like your mom said. Proceed to party and stay out late, go to rainy football games. Let your cough turn into PNA, then get admitted to the hospital. Call your mom who then proceeds to call UHS and file a formal complaint. 

I also work in college health, I was hoping these particular IQ lowering incidents were unique to my university.......nope.  Do you ever get the (I'm an anatomy/ pre-med major/ my parent is a doctor/nurse/bane of my life)  patient that demands inappropriate care, usually abx of course.  Or an excuse note for class.

[sk732]

1 hour ago, AlteredBeast said:

I also work in college health, I was hoping these particular IQ lowering incidents were unique to my university.......nope.  Do you ever get the (I'm an anatomy/ pre-med major/ my parent is a doctor/nurse/bane of my life)  patient that demands inappropriate care, usually abx of course.  Or an excuse note for class.

I had a kid's dad (allegedly a physician) when I worked at the military college call demanding why his kid had a horribly sore throat and why weren't we doing anything about it...kiddy called and  told him he had mono (he did) and the dad was freaking.  My boss called asking about it and I told him he had mono...and that dad should maybe revisit the textbooks to refresh on symptoms.  In retrospect, I'm wondering if they were a "there's a fracture, I must fix it" sort.  Had another that didn't want to do his dressing changes as we scheduled for his ORIF of his wrist that had exposed pins - "My Mom's a trauma radiologist, so I know everything by amnionic transfer..." - I looked at him and suggested he call Mummy and ask her what osteomyelitis was and how it might affect the remainder of his year and commissioning if it developed.

A funnier one was the kid that showed up in crap order (literally - had horrible gastro) as we were closing up - wearing a rowing crew jacket of my high school's athletic rival.  "Dude, today isn't your lucky day, you should have been here 8 hours ago; oh and is that XYZ School from my hometown?"  "Yes."  "Then you're really phuqued buddy, since I'm from ABC School".

SK

[CornellSPA]

I am so thankful none of these choices say "Surgical consult!" Enjoy the flu season!