Things that make me go hmmm

[ohiovolffemtp]

Even better, when the nurses say, "hey, did you see the labs/EKG/etc on xxx"?  They're watching their patients and know what to look for.  On the other hand, a call from the rad tech with "you need to see this!" is even more concerning than a call from the radiologist with a critical finding.

[ohiovolffemtp]

Yes, we all try to practice medicine according to Larry the cable guy: "just git 'er done".  BTW, much easier to do this working nights.

[debolechiroprac]

On 6/25/2021 at 7:47 PM, thinkertdm said:

These are some things that make me stop typing my note and make sure I’m not in bizarro world.

”my pain is 10/10.  Worst pain of my life”

”my chiropractor said…”

”my <family member> is in the medical ‘field’”

””I drink enough water”

”I couldn’t move from the bed for ‘x’ days”

”I’ve tried everything.  Nothing works”

”I decided to wait until my appointment today “

Hi!

I also suffer pain in my life. But thanks to the good services of a chiropractor, my back pain was gone. There is some chiro that has good services. All you can do is search their history or some feedbacks on the patience of their website.
 

[rev ronin]

On 8/30/2021 at 10:20 PM, debolechiroprac said:

Hi!

I also suffer pain in my life. But thanks to the good services of a chiropractor, my back pain was gone. There is some chiro that has good services. All you can do is search their history or some feedbacks on the patience of their website.
 

I think the point of the post is that chiropractors who are good at their job--MSK manipulation--don't give advice that would be relayed to a PCP.  They may talk posture, adjust, etc., but they stay in their lane. Every DC I've seen who trips the quack-meter seems to have some fascination with nutrition.  Sorry, but I ask RD's about nutrition, not DC's.

[ohiovolffemtp]

The nurses in my ED tonight pulled up various web sites listing the huge numbers of positions available.  Almost all of them pay > $100/hour when the travel stipend (not taxable) is included.  This includes a position available at my facility.  There are nurses at hospitals near where I live who with disaster pay/bonus/overtime are making ~$115+/hour.  They're earning it, but they're also making more than me.  Wonder if (only sort-of) if a PA/medic could fill these roles.

[ventana]

I have never understood the paying of sky high rates to travelers while a facility looses staff left and right.  Yes I know about long term expenses and a pay raise for an employee is for ever, and a traveler is not.  But it is so undermining to the staff to pay someone 2-3 X's to do less of the same job......

[rev ronin]

4 hours ago, ventana said:

I have never understood the paying of sky high rates to travelers while a facility looses staff left and right.  Yes I know about long term expenses and a pay raise for an employee is for ever, and a traveler is not.  But it is so undermining to the staff to pay someone 2-3 X's to do less of the same job......

Some HR people still have this myth that it's "impolite" or "disclosing confidential information" to share pay rates. Yeah, right.  Always assume everyone knows what everyone else makes, because it's just safer and more realistic that way.

[ohiovolffemtp]

16 hours ago, ventana said:

I have never understood the paying of sky high rates to travelers while a facility looses staff left and right.  Yes I know about long term expenses and a pay raise for an employee is for ever, and a traveler is not.  But it is so undermining to the staff to pay someone 2-3 X's to do less of the same job......

Every night the nurses and techs are talking about the bonuses they are getting at other facilities or how much they could make doing travel assignments - making 2-3x what they make here.  Can't blame them if they take travel assigments.

[ventana]

10 hours ago, ohiovolffemtp said:

Every night the nurses and techs are talking about the bonuses they are getting at other facilities or how much they could make doing travel assignments - making 2-3x what they make here.  Can't blame them if they take travel assigments.

I would be approaching HR (if I were an RN that could make 2-3x's as a traveler_) and asking for a  "retention bonus"

[Reality Check 2]

"The COVID vaccines caused my heart murmur"

Says the overweight 73 yr old with hx of CHF, HTN and uncontrolled diabetes.

"I read it does that to people"

Yeah, to children - very rarely.

You have aortic regurg.............................

"Yeah, but the vaccine caused it"

Echo ordered. No symptoms at this time.

 

[wilso2ar]

I understand what you're saying, but my wife had return of her SVT symptoms after it was successfully treated 15 years ago with ablation. 40 y/o otherwise healthy. She had tachycardia with mild exertion that would come and go, normal holter monitor and echo. electrophysiologist said she has seen this a few times in adults with the vaccine as well as with COVID. Seems to be worse in COVID patients.  So, vaccine still worth it. 

The vaccine is not without side effects, but the benefits of it still outweigh the risks. 

[sas5814]

Yesterday I had a 72 YO train wreck, CAD, COPD (still smoking),etc etc didn't want a statin for her 290 cholesterol because "my cardiologists told me not to take it because it might affect my brain. "

I told her her cards was an idiot and she needed a different one. Now...I know her cards didn't tell her that (at least I hope not) but I wanted to startle her...and I did.

 

 

[GetMeOuttaThisMess]

What happens when the cardiologist is told that he was called an idiot and what she repeated wasn’t in fact what she was told?

[CAAdmission]

56 minutes ago, GetMeOuttaThisMess said:

What happens when the cardiologist is told that he was called an idiot and what she repeated wasn’t in fact what she was told?

I would have told the patient something is not right and put out a call to the cardio office right in front of her. Most cardio guys I work with would add statins to our drinking water supply. 

[Reality Check 2]

I always say "let's get those records and make sure we are all on the same page. Office visits are often a bit overwhelming"

Then I get the records and call said specialist if their notes suck - not uncommon - to clarify the situation.

Due diligence - everyone gets the right info.

Have had to question a specialist a time or two - "Wow, that must be new guidelines. Can you tell me where that info is?" with knowledge that it came from an orifice and I need to do my own literature search.

Do right by the patient, avoid bus wheels unless absolutely necessary and try to educate the patient.

If the source was some whackadoodle source from patient - I call it out - can't promulgate medical myth. 

[sas5814]

1 hour ago, GetMeOuttaThisMess said:

What happens when the cardiologist is told that he was called an idiot and what she repeated wasn’t in fact what she was told?

I'll call him an idiot personally.

One of the nice things about being old....people aren't surprised when you are blunt.

 

Edited November 4, 2021 by sas5814

[GetMeOuttaThisMess]

34 minutes ago, sas5814 said:

One of the nice things about being old....people aren't surprised when you are blunt.

 

I agree that there are advantages to being older.  I’m more free to speak my mind now.

[ANESMCR]

W/u chronic diarrhea. Diagnose EPI and advise routine CT A/P revealing large pancreatic cyst. Endoscopic ultrasound reveals mixed IPMN with PD involvement, elevated CA 19-9. Hepatobiliary referral, recommend whipple. S/p whipple, path reveals carcinoma in situ and ipmn with HGD. (dude prob had 6 months max). Today, 3 weeks out post whipple, the guy and wife are upset with me bc the procedure made the diarrhea worse. 
 

Edit: Basically, I save this man’s life. Literally first time I see him since saving his life, he’s complaining of intermittent diarrhea that I inadvertently caused by having his plumbing rerouted. No thanks, no nothing. Just complaints. 

Edited November 9, 2021 by ANESMCR

[jmj11]

On 6/25/2021 at 8:21 AM, Reality Check 2 said:

Dr Oz said - anything, anything at all and my head hurts

I want a whole body MRI because I had a headache once (can't make this up)

I am very sensitive to all medications and you are giving me too much thyroid (TSH 4)

This has bothered me for a long time but I haven't said anything - TEN notes in the chart from 4 specialists finding nothing

My hydrocodone is for my back - my knee is what hurts now

Why would you say I am anxious? - bouncing knee, fidgeting, fifth visit for vague sx and constant worry

I don't want to take an anxiety medicine everyday - those are dangerous. Just something when I need it - like Xanax....

And the full moon was last night and the spaceship just landed out back with all my morning patients in it

Godspeed everyone

I was in Morocco a few years ago and there was an ad on TV that kept running where Dr. Oz was promoting a supplement that caused an adult man to grow up to four inches (in height you dirty minds) and it featured a man about 3 inches shorter than his girlfriend and then after three months on the supplement, he was taller than her and she was looking at him with stars in her eyes. It was dubbed over in Arabic, but it was clearly Dr. Oz promoting this worthless crap there. At that moment I realized he would sell his soul for a dollar.

[Gizmo]

“Yes, but in high school biology class, the teacher said…” (patient’s daughter arguing with the surgeon I worked with. I loved that surgeon and learned so much from him about keeping calm and buttoned-up…but I think this tested even him.)

“When can I sit astride my husband and ride him again?” (Her husband had c-spine injury; couple was in their upper 70s.)

”Woman, I am the captain of my ship!” (This was the husband’s response to the question she definitely wasn’t asking him. I barely made it out of the room and immediately cried from laughing.)

”I don’t believe in that science stuff.”

“When can I get back on my motorcycle?” (Following c-spine fracture from motorcycle accident.)

”I don’t think cigarette smoking is as big of a deal as everybody says it is.”

”I’m pretty sure medications are the work of the devil.”

”Is there a different way to get those labs done?” (Patient attempting to avoid a blood draw for CBC, BMP, etc.)

Let’s see…Had a patient pull the fire alarm during a PT session. That may be my favorite. 

 

 

[ohiovolffemtp]

Had a patient who was about to lose a testicle from it being crushed by a bull he fell off of while bull riding in a rodeo ask me when he could go back to the rodeo circuit.  All I could do was to ask him, "you realize you just lost your only spare????"

[Reality Check 2]

I saw the bull riders in Texas all the time.

Lose a testicle - no big deal….     

Gored in the chest and inches from the heart - meh, ready to ride again

Stomped and compartment syndrome in the leg or foot - just a normal day

I had to resign myself to the idea that they were out of the gene pool - usually. Because the next incident would likely be fatal and the tight jeans and bucking were not sperm friendly. 

Similar issues with my motocross folks. One BENT the IM rod in his tibia when he hit a tree - AGAIN. And wanted a boot instead of surgery or cast - he could still ride…..

I have to use the mantra - give good advice, document the hell out of it, hope they make good decisions 

Deep sigh 

[SedRate]

Walked into a pt's room to discuss surgery and before I could even introduce myself, she instructed me to change the channel until it settled on an acceptable news station. 

Another pt's son asked some questions regarding the specifics of the surgery we performed on his mom. As I was explaining, he kept turning his head to look at the TV.

[DiggySRNA]

On 9/3/2021 at 10:15 AM, ventana said:

I would be approaching HR (if I were an RN that could make 2-3x's as a traveler_) and asking for a  "retention bonus"

Tried that. They laughed. My laugh was louder since I gave them my two weeks notice 3 days later and now a travel RN.

Now I only pick up shifts at my former ER if they offer critical pay (which is still less than what I make as a traveler). No critical pay? I already have plans

 

[SedRate]

11 hours ago, Diggy said:

Tried that. They laughed. My laugh was louder since I gave them my two weeks notice 3 days later and now a travel RN.

Now I only pick up shifts at my former ER if they offer critical pay (which is still less than what I make as a traveler). No critical pay? I already have plans

 

Good times. I've never really considered becoming an RN until Covid happened.