Politically Incorrect Humor. Ignore if you are sensitive.

[mgriffiths]

13 hours ago, CornellSPA said:

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

OOOH!!! A new place to send these patients!  Let's be honest, needing a surgery consult would make the patient feel important, which is the point anyway....right!

[BruceBanner]

16 hours 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.

Oh yeah. The worst is when parents get involved in an ER visit. Most of the kids here are from affluent backgrounds, so their parents naturally demand "the best" care....whatever that means. Being an urgent care we send people to the ER fairly regularly with PTA, appendix, etc. They always call their fecking parents right there in the room so I'm on the hook. Oftentimes dad is a physician and I proceed to get the 3rd degree on my decision-making, my credentials, and "how it got to this point". Parents I've learned naturally want someone to blame when their child is ill enough to go to the hospital. It cant possibly be their own child's ignorance or non-compliance...so it's clearly the PA who is trying to make the best decision for them in the moment.

 

[GetMeOuttaThisMess]

And now to increase your walk-in volume, case report out of Cali of misdiagnosed influenza which was actually strep bacteremia with a fatal outcome.  First patient this morning will be a patient wanting the "strep flu" test.  In all seriousness, there seems to a clue that with GI sx. this wasn't the seasonal influenza.  Multi-organ failure doesn't help.

At the risk of sounding sexist, I breath a sigh of relief when I have a peds patient with dad as opposed to mom.  Dads seem to just go with the flow a lot more than the moms do.

 

[AlteredBeast]

3 hours ago, BruceBanner said:

Oh yeah. The worst is when parents get involved in an ER visit. Most of the kids here are from affluent backgrounds, so their parents naturally demand "the best" care....whatever that means. Being an urgent care we send people to the ER fairly regularly with PTA, appendix, etc. They always call their fecking parents right there in the room so I'm on the hook. Oftentimes dad is a physician and I proceed to get the 3rd degree on my decision-making, my credentials, and "how it got to this point". Parents I've learned naturally want someone to blame when their child is ill enough to go to the hospital. It cant possibly be their own child's ignorance or non-compliance...so it's clearly the PA who is trying to make the best decision for them in the moment.

 

Sorry that made me laugh.  They call their parents in the room!? Ok, your situation is far worse than mine, I can't complain about my job anymore.

[AlteredBeast]

18 hours ago, sk732 said:

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

Ok, I'm beginning to really appreciate working in a very poor part of the country, I've never had a student's parent call me on anything, and I've seen some life threatening things here.  The students generally take my word for it when I tell them simple URI viral etiology etc, and don't push me for abx or scheduled meds like out in "the real world".  But hot damn, it must be too easy to get an appointment here because there's a lot of runny nose/ sore throat  x 1 day...... my brain, i feel the atrophy.

[CAdamsPAC]

On 1/7/2018 at 11:36 AM, sas5814 said:

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.

Z-Pak, they'll be back!!!

[GetMeOuttaThisMess]

Ah, not if you have the stipulation as printed on your discharge instruction sheet that any further perceived need for follow up needs to go through the patient's PCP and not us!  I have perfected the "House of God" non-bounce back turf.

[sk732]

57 minutes ago, GetMeOuttaThisMess said:

Ah, not if you have the stipulation as printed on your discharge instruction sheet that any further perceived need for follow up needs to go through the patient's PCP and not us!  I have perfected the "House of God" non-bounce back turf.

We have a note we fax to the FMD to follow up within "X" days with a copy of the ER front sheet.  I tell people that if they don't hear within 2 days, call the office and find out why.  

SK

[thinkertdm]

In epic, first I type in my specific instructions, like steam, yadda yadda yadda, then this:

Quote

*WARNING: taking antibiotics can rarely cause a life threatening colon infection called C. Difficile**

You have been evaluated at a Walk-In Clinic.  Please follow up with your primary care provider, for both the condition you were seen for today as well as any condition that may be ongoing that we did not discuss today.

It is your responsibility to ensure that a follow up appointment has been arranged. 
Stop at the front desk on leaving
Call your primary care provider
See a member of your treatment team
Go to the emergency department or return to the clinic if your condition worsens

We can assist you in establishing with a primary care provider if you do not have one

It is not a substitute for complete medical care.

We can assist you in establishing with a primary care provider if you do not have one. 

It is important to note that no ongoing doctor-patient relationship was established by this visit today. 

Antibiotic resistance:  Antibiotic resistance is a very real problem caused by over prescribing of antibiotics for conditions that do not require them, such as viral illness and allergies.  It is estimated that 100,000 people admitted to hospitals die due to one of these resistant organisms.  Many of them were healthy prior to their being admitted.
 
These conditions include:
Clostridium difficile, a potentially fatal colon infection
Neisseria gonorrhea
Methicillin resistant staphylococcus aureus
Fluconazole resistant candida
Many, many more

All of these are very serious and in many cases can be fatal.   You can prevent the spread of these by the following:
Not asking, demanding, or threatening for antibiotics
If an antibiotic is prescribed, asking if it is necessary
Completing a prescribed course of antibiotics as directed

These conditions include:
Clostridium difficile, a potentially fatal colon infection
Neisseria gonorrhea
Methicillin resistant staphylococcus aureus
Fluconazole resistant candida
Many, many more

 

My favorite part is this:

Quote

You can prevent the spread of these by the following:
Not asking, demanding, or threatening for antibiotics
 

 

[SedRate]

You hurt your knee being a young weekend warrior. Do you:

1. Proceed to the UC because you must've done something reeeaall bad to it even though you can still walk on it

2. Walk it off and see how it does with OTC meds and RICE. If no improvement, you proceed to your PCP for evaluation

3. Proceed to the ER because you must've done something reeeaall bad to it even though you can still walk on it. Get told you have a knee strain but no fracture and you receive a referral to an orthopedist. (What?!). Discuss with orthopod who does not identify fracture or ligamentous instability on exam but orders an MRI due to your continued reported pain 1 week later and demands that "there must be something wrong." Get MRI and discuss results which show literally nothing wrong, not even an effusion, lig strain, or arthritis. And then you decline PT because you "don't have time."

[GetMeOuttaThisMess]

You hurt your knee being a young weekend warrior. Do you:
1. Proceed to the UC because you must've done something reeeaall bad to it even though you can still walk on it
2. Walk it off and see how it does with OTC meds and RICE. If no improvement, you proceed to your PCP for evaluation
3. Proceed to the ER because you must've done something reeeaall bad to it even though you can still walk on it. Get told you have a knee strain but no fracture and you receive a referral to an orthopedist. (What?!). Discuss with orthopod who does not identify fracture or ligamentous instability on exam but orders an MRI due to your continued reported pain 1 week later and demands that "there must be something wrong." Get MRI and discuss results which show literally nothing wrong, not even an effusion, lig strain, or arthritis. And then you decline PT because you "don't have time."

Or next option which is demand an A/A since Dr. Google says the MRI can miss things.


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[SedRate]

5 hours ago, GetMeOuttaThisMess said:

 

Or next option which is demand an A/A since Dr. Google says the MRI can miss things.


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A/A = arthrocentesis/aspiration? I'm not familiar with that abbreviation.

[GetMeOuttaThisMess]

Arthroscopy/arthroplasty


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[sk732]

I can think of only one knee injury I've come across where an MRI actually changed the treatment course...the first question I ask people when they demand an MRI for something that will likely resolve itself before they get the test is "And what are you expecting it to do?".  Most can't answer anything other than "My best friend's cousin's girlfriend's sister's boyfriend's mother in law is a health care aide and she said I needed one."  How can you argue with that (sarcasm on)?

SK

[thinkertdm]

Your son was at a friends house for a sleep over, and he called you late at night- apparently he hit his head pretty hard, "everything went dark", he vomited a couple of times, he's nauseated.  

A.  Pick him up, then let him him sleep it off over the week end

2. Pick him up, let him sleep it off, then take him to a walk-in clinic that can only do xrays.  Four days later.

3. Tell him he's fine

D. suddenly become concerned that your somnolent, nauseated, vertiginous teenager "isn't right" after being told you should take him to the ED.  

It's not really a cold and flu case, and in some circumstances, people just don't know where to go or what to do.  I understand that.  But the ED does more than pregnancy tests.  But I'm wondering where along the line people forgot that the thing above your shoulders and under your chest are the most important, and if they hurt, maybe do. something. right. away.  But a sore throat!?  good god, run to the walk in! 

[thinkertdm]

Today I had the pleasure of not seeing a very unpleasant woman who, when she was checking in, asked specifically to not see me. Because apparently I told a family member they had a viral illness, and she did NOT want to be told this, she wanted an antibiotic- and those were her exact words.  Now, I have never seen this particular "lady" before, but I am assuming this is the one who left screaming that I was a "fucking asshole" for not prescribing her granddaughter a zpack.

My last day is April 9, and it can not come soon enough.  The second someone comes in and states which bacteria they are targeting, I will change my diagnosis.  

Unfortunately, according to my poor colleague who did see her,  s was apparently positive for strep, which I personally suspect is colonization rather than infection, but no doubt validates that she was right.

[GetMeOuttaThisMess]

1 hour ago, thinkertdm said:

Today I had the pleasure of not seeing a very unpleasant woman who, when she was checking in, asked specifically to not see me. Because apparently I told a family member they had a viral illness, and she did NOT want to be told this, she wanted an antibiotic- and those were her exact words.  Now, I have never seen this particular "lady" before, but I am assuming this is the one who left screaming that I was a "fucking asshole" for not prescribing her granddaughter a zpack.
My last day is April 9, and it can not come soon enough.  The second someone comes in and states which bacteria they are targeting, I will change my diagnosis.  
Unfortunately, according to my poor colleague who did see her,  s was apparently positive for strep, which I personally suspect is colonization rather than infection, but no doubt validates that she was right.

 

Someone actually thinking here! I love it. You see the same colonization with mono. Stick to your guns. Loved ABC News tonight who actually stated the flu test (referencing a 5 minute one which I’m not personally familiar with, we have the 15 minute nasal swab test) is only 50% reliable. I love science sometimes.

 

[sk732]

One of my less than favorite times of day is taking up to 90+minutes out to go through the unsigned labs and culture reports that come back here instead of to the PCP (because the labs won't accept the cc without full addresses, faxes, etc - they have access to a database that even our ER clerks don't have but feel that takes too much time) and I've been noticing that the rapid PCR tests they (the Provincial lab) are using for Flu A/B and RSV are coming back with a high level of false negatives but with positive cultures.  All the more reason to use your noggin.

SK

[Boatswain2PA]

On 1/14/2018 at 8:29 PM, sk732 said:

I can think of only one knee injury I've come across where an MRI actually changed the treatment course.

Maybe not changed the treatment course but it might hurry it up, at least here in the states where surgeons require imaging before violating the epidermis (as I'm sitting here icing my knee with a bucket-handle tear of meniscus)

[sk732]

It took a month for the one I got for my hip - only because it was an MRA and the stars had to align between the rad injecting the contrast and the MRI clinic at another facility...but I waited a good 5 months after injuring it (thought I had a labral tear and tried to physio and tough it out).  Turned out it was a tendon injury...and because I was (a) in the Army and (b) over 40, it took awhile longer to heal.

I got into it here with the clown running the provincial diagnostic services cabal a few years back because I couldn't order an MR - but, as I told him, "I can nuke you until you light up all of Winnipeg with CT's but can't order an inherently safer test"...honestly, if I'm ordering an MRI on you, you've likely got some horrendoma like cauda equina or some other awful spinal disorder, MS, metastatic cancer, some wacked out stroke or a brain tumour.  Otherwise, tincture of time and let sports med or ortho make the call - not everyone is the surgical candidate they like to think they are, lol.

SK