November 6th, 2009 by GruntDoc in Better Health Network, Opinion
1 Comment »
Kevin, MD linked to this, and I really must comment.
Here’s the abstract, and I hope you’ll read it all:
For years I’ve heard friends describe experiences of being caught in a web of excessive and unnecessary medical testing. Their doctors ordered test Z to investigate a seemingly incidental finding on test Y, which had come about because of a borderline abnormality on test X.
I often wondered why test X was done in the first place. As a primary care physician, I would have treated them for the likely diagnosis and done diagnostic tests — especially a series of diagnostic tests — only if they didn’t respond as expected…. Read more »
*This blog post was originally published at GruntDoc*
October 22nd, 2009 by GruntDoc in Better Health Network, Opinion
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EM at its finest:
Ending a shift with a bang.
I write a nice note trying to capture the essence of what I did and why I did it. Can’t write “decided to go big or go home” so I wrap it up in that nice, sterile and intentionally understated medicalese which makes it seem like the decisions were clear cut, and based on solid information, when the truth is that they were largerly judgement calls based upon spotty and/or inaccurate information.
I sign out and then I punch out.
In EM we often don’t get to wait for the test result, or for a period of observation. Curse, and beauty, of the job.
*This blog post was originally published at GruntDoc*
October 12th, 2009 by GruntDoc in Better Health Network, News
1 Comment »
EMS/ED frequent fliers are both a bane and (supposedly) another cost of doing business for EMS systems. Maybe not.
My city of Fort Worth is trying to do something about it, proactively and correctly (emphasis mine):
MedStar program sends paramedic to homes of some repeat callers before they dial 911 | Fort Wor…
FORT WORTH — Last year, MedStar was called more than 800 times by 21 people.
Those “frequent fliers” weren’t necessarily facing life-threatening emergencies. Some may have needed primary care but didn’t have a regular doctor or transportation. Read more »
*This blog post was originally published at GruntDoc*
October 6th, 2009 by GruntDoc in Better Health Network, True Stories
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I sent a guy with a normal EKG to the cath lab. Let me tell you my side of the story.
Dude was minding his own business when he started having crushing, substernal chest pain. I see dude by EMS about 45 minutes into his chest pain. He’s had the usual: aspirin, 3 SL NTG’s an IV, a touch of MS (I can abbreviate here, as it’s not a medical record) and is continuing to have pain.
He describes it like you’d expect (elephants have a bad rep in the ED), and looks ill. Frankly, he looks like a guy having an MI. Sweaty, pale, uncomfortable, restless but not that ‘I’ve torn my aorta’ look. The having an MI look.
Every EM doc knows the look. I didn’t ask about risk factors.
On to the proof: the EKG. EMS EKG: normal. ?What? Yeah, maybe there’s some anterior J-point elevation, but not much else. Our EKG: Normal. Read more »
*This blog post was originally published at GruntDoc*
September 11th, 2009 by GruntDoc in Better Health Network, True Stories
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From an old HS buddy (also a Navy Man) now in healthcare:
Texas law makes almost any item with a doctors prescription exempt from
sales tax.
(most details at : RULE §3.284 Drugs, Medicines, Medical Equipment, and
Devices (Tax Code §151.313) Item 11 is the sort of catch all.
What is most odd item you have been asked for a prescription for purely for
tax-free purposes?
Sellers of the Select Comfort beds, and hot tub/spa dealers are very aware
of this law. Presciption needed for bed, letter and presciption needed for
hot tub/spa.
Oddest request received at clinic where I work: one for in ground pool,
heated and deep enough for water aerobics.
While I don’t notice it on that list, food for helper animals is exempt
from sales tax.
Interesting also, repair parts for devices are exempt, but not
*improvements*. If you replace like for like wheel on a walker, it is tax
free. Replace with improved wheel-taxable.
I’ve never been asked to write a prescription for anything like that in the ED, but I’d be willing to bet my office-based colleagues have. Care to share?
*This blog post was originally published at GruntDoc*
