Go Out and Vote!

With the upcoming election, I going to do 1 post on voting. I am not going to try to sell you on who to vote for. I am not even going to talk about my views on healthcare, economy, taxes, foreign policy, gun control, etc… Most of you who have been following my blog already know which way I would probably go on these topics. Instead I am going to talk about something that has been weighing on me and I have to get it off my chest.

VOTE MORALS!!

This is how I am voting. I am lucky that the candidate that I am going to vote for also most represents my stance on the other issues as well. I would hope my convictions would be strong enough to still vote morals even if that candidate held different economic, healthcare, and tax views but still the same moral views.

In the end, I am voting my Christian morals. So I encourage you to do the same. I try to pick the candidate who best stands for the Christian morals I have – marriage, sexual preference and rights, abortion, character, etc…. No candidate is perfect – I know that. But I do feel that one is better than the other when measured up with these standards.

Please Vote Your Morals!!!!

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Best of Craigslist: Advice from an ER doctor to drug seekers

Below is a rant from an ER doc on craigslist: (I edited out the bad words, I may have missed 1 or 2)

OK, I am not going to lecture you about the dangers of narcotic pain medicines. We both know how addictive they are: you because you know how it feels when you don’t have your vicodin, me because I’ve seen many many many people just like you. However, there are a few things I can tell you that would make us both much happier. By following a few simple rules our little clinical transaction can go more smoothly and we’ll both be happier because you get out of the ER quicker.

The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like crap because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.

The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn’t require me to do a four thousand dollar work-up in order to get you out of the ER. If you tell me that you headache started suddenly and is the ‘worst headache of your life’ you will either end up with a spinal tap or signing out against medical advice without an rx for pain medicine. The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm. And while I am 99% sure its not, I’m not willing to lay my license and my families future on the line for your butt. I also don’t want to miss the poor guy who really has a bleed, so everyone with that history gets a needle in the back. Just stick to a history of your ‘typical pain that is totally the same as I usually get’ and we will both be much happier.

The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I’ve seen people in a 10/10 pain and you sitting there playing tetris on your cell phone are not in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8. That means to me you are hurting by you might not be lying. (See below.)

The fourth rule is never ever ever lie to me about who you are or your history. If you come to the ER and give us a fake name so we can’t get your old records I will assume you are a worse douchetard than you really are. More importantly though it will really really piss me off. Pissing off the guy who writes the rx you want does not work to your advantage.

The fifth rule is don’t assume I am an idiot. I went to medical school. That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.) However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy. So if I read your triage note and 1) you list allergies to every non-narcotic pain medicine ever made, 2) you have a history of migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart enough to read that as: you are scamming for some vicodin. That in and of itself won’t necessarily mean you don’t get any pain medicine. Hell, the punks who list an allergy to tylenol but who can take vicodin (which contains tylenol) are at least good for a few laughs at the nurses station. However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying douchetard who is scamming for vicodin. (See rule # 4 about lying.)

The sixth and final rule is wait your turn. If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are. You getting a fix of vicodin is not more important than the 6 year old with a severe asthma attack. Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you. Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances. And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen, I should be able to piss in a glass and make you drink it before you leave the ER.

So if you keep these few simple rules in mind, our interaction will go much more smoothly. I don’t really give a crap if I give 20 vicodins to a drug-seeker. Before I was burnt out in the ER I was a hippy and I would honestly rather give that to ten of you guys than make one person in real pain (unrelated to withdrawal) suffer. However, if you insist on waving a flourescent orange flag that says ‘I am a drug seeker’ and pissing me and the nurses off with your behavior, I am less likely to give you that rx. You don’t want that. I don’t want that. So lets keep this simple, easy, and we’ll all be much happier.

Sincerely,
Your friendly neighborhood ER doctor

Maybe a good idea?

http://www.washingtonpost.com/business/some-hospital-networks-also-become-insurers/2012/08/25/53e90a72-eb1d-11e1-b811-09036bcb182b_story.html

I read the above article and thought that this could be a good idea in healthcare reform. It takes the middle man out of the picture – the insurance company. If this system functions right, the patient would pay a flat rate every month to a "Hospital Group". Hospital Group is made up of outpatient clinics, specialists, and hospitals. With the monthly fee, the patient gets care whether that means in the clinic, the ER, or the hospital. It puts more skin in the game for hospital group. They are getting to get paid the same amount no matter what. Now they have to figure out if they would rather pay for outpatient care (which is cheaper) or inpatient care (ALOT more expensive). Of course, they would rather pay for outpatient and make more profit. At the same time the patient stays healthier. My only worry is that the patient still needs to have to put something more on the table than just a flat rate. There still is no incentive for some to go to their family doctor if everything in the end is going to cost the same. Maybe the rate could go up if you do not keep your preventative care appointments or not take your meds. That way the hospital is not paying for the patient not taking any responsibility for themselves. I have been under this kind of system before and it seems to work well.

It is not a DumDum

Today was great day in the ER (sarcasm).  I was working triage and we had over 90 patients sign in over a 9 hour period.  Working triage means that I try to get labs and x-rays going on the more complex cases and discharge the easy cases.  All the easiest cases fell into 2 categories: sick for 2 hours or sick for at least 2 months — except for one case.  I called a 42-year-old gentleman back from the waiting room.  He took a seat on my triage bed.  As usual, I asked “what brings you in to see us today?”  “I don’t feel good.”  I then questioned with “Oh, for how long and tell me the story.”  He goes on to tell me how he has had cold like symptoms for 3 weeks now and it is not getting any better.  He has not tried anything or sought medical care before now.  The reason he was coming in to the ER today was that he finally  got the day off and did not have anything else to do (this is the normal reason people come in at this ER).  So I start my exam.  I listen to his heart and lungs.  Then I look in his ears with an otoscope.  Everything is looking normal – surprise, surprise.  I then ask the patient to open his mouth so I can use the otoscope to look at his throat.  I position the otoscope, like normal, about 8 inches away from his mouth when I asked him to open up.  He proceeds to open his mouth and lean forward placing the entire head of the otoscope INSIDE his mouth and close his lips around it.  It looked like he had an extra-large dumdum sucker in his mouth.  After I pulled the otoscope out of his mouth, I just sat there looking at the otoscope wondering what I was going to do it.  At the same time, I was trying to think how many people’s ears it had been in and how many more people it will come in contact with.  I had never seen an otoscope used like a lollipop.  I included pictures below to see if you  can see any similarities that would make you want to stick an otoscope in your mouth.