Just say no

Dr. Big Work-Up: I really think nursing should start doing my review of systems. Nurses should really start doing some of this stuff. K, can do you do the review of systems? I'll pull up the note and you just click off the positive findings...Also, it's a pain in the butt to cut and paste the lab results into my note. Can you cut and paste the labs into my notes for me?

Me: No and no.

Weird blogging paranoia

As you all know, in my efforts to educate the globe on stuff that chaps my ass to no end, I talk constantly about Dr. Bloody Gloves, Dr. Big Work-Up, Dr. Controlfreak, etc. whether it's on the blog, Twitter, or on IM. Currently, I'm having paranoia that I may have charted a note to the effect of "Blah blah blah....Dr. Bloody Gloves informed."

Now, I will sit here and worry about it. Of course, if I open up the e-chart three days later to see if I did, in fact, chart such a note, and it gets audited, I will be in HR getting disciplined for reading a chart of a patient not currently in my department, so it's a classic lose-lose situation.

You know you ain't getting narcotics when...

...you admit on your last six visits occurring over the course of the last 8 days, including the current one, that you're "high on crack and drunk"...when I'm the nurse. Bloody Gloves, of course, initially wrote for 15 Percocet for his fake tooth pain.

You know you're ghetto when...

...the ER security officer is throwing you out at my behest for cussing out (F-bombs-a-flyin!) the two-month-old baby next door at the top of your lungs.

My salary

Patient: Do you make like one million dollars an hour for this?

Me: Yeah, and OH MY GOD, I'm closing on another mansion today, and I'm SOOOO stressed out about it!

Dr. Big Work-Up big work-up du jour

Athletic eighteen-year-old male with no past medical history and normal vitals except a low-grade temp comes in with....chest pain (for ONE MONTH!) worse with cough, vomiting, nausea, malaise, bodyaches, etc, etc. Does your right toe hurt? Yes! How about your brachial plexus? Yes! How about your hips? Right AND left? Great. Now, here's the important one...the left side of your left nostril? Yes! Heyyyy Macarena!

DRUMROLL PLEASE! AND NOW........The BIG WORK UP!

Cardiac monitor, 12-lead EKG (I was chastised for not immediately obtaining one*), aspirin 325 mg (on an 18-year-old vomiter!), saline lock (nope, sorry), chest XR, CBC, BMP, troponin (yep), CK, d-dimer

Wow, an acute coronary syndrome work-up and treatments for an 18-year-old with chest and Macarena pain for a month! Isn't that precious?

* = Whereby I dryly responded, "Sorry, I didn't consider acute coronary syndrome in this patient." That pissed him off and gave me a Happyesque, smug** sense of self-satisfaction.

**= Sorry, "Happyesque, smug" is redundant on second thought.

It's that time again...

Time to rip on something Happy says seeing as he's a pompous, self-important, yet emotionally- vapid ass and whatnot. Today's topic of discussion: People are too stupid to understand their own health care, so I'm just going to confuse them even more with my greasy, Brylcreem-laced explanations and used car salesman charm so they don't question me.

Can you imagine trying to explain the pathophysiology of stable vs unstable angina vs NSTEMI vs STEMI to 75 year old retired lady who can't even tell you where the heart is located. In this day and age where conversation is uncompensated and technology is viewed as the savior of our health care needs, it's no wonder why it's just easier to talk fast, sound important and recommend "tests" that make loud beeps, take fancy pictures and cost a lot of money, paid for by the Medicare National Bank. Perception is 90% of reality. And who's going to question the doctor when you don't even know where the heart is?

Yeah, I can imagine it, and you hopefully can too seeing as it's part of your and my JOB to help people to understand. I hate it when doctors feel the need to talk like Brylcreem, Wal-Mart cologne, and 10-year-old JCPenney suit-wearing fast-talking used car salesmen. Nothing is more anxiety-provoking for a patient than being in a situation where they don't know WTF is going on because people are rattling off unnecessarily-detailed explanations of catalytic converters or how troponin is attached to the protein tropomysin and lies within the groove between actin filaments in muscle tissue or some shit.

Your job is to help the patient---yes, you're in medicine to help patients, not look sexy and rattle off pathophysiology lecture notes---understand their disease and be totally into the really helpful tests and treatments that you're ordering. It shouldn't be an breathlessly unimaginably-foreign concept to you, Doctor. Guess what, conversations aren't compensated by the used car salesman's boss either; they only get paid when they make the sale.

Do you want to say the things that will help "make the sale", or do you want a frustrated little old lady giving you the proverbial double bird on the way to the Buick dealership where they explain everything clearly (or, worse yet, forget about "cars" all together because they're too confusing)? If it's the latter, don't get all holy and righteous when she doesn't "take care of herself" after your [wahhh] hard and tedious clear-as-mud explanations fail to impress.

Brylcreem, a little dab'll do yah, the gals will all pursue yah, but your patients will be anxious and die!!!!