September 11th, 2011 by Happy Hospitalist in Health Policy, Opinion
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Missed Diagnosis Lawsuit and the Dynamics of Age Related to Risk
Years ago I had the opportunity to care for Mr Smith, a 101 year old man who presented to the hospital with chest pain and shortness of breath. Besides having 101 year old heart and lungs that tend to follow their own biological clock, this man also had a massive chest tumor filling 85% of one side of his thorax.
Whoah really? What does that mean in a 101 year old man? Most folks this age have exceeded the normal bell curve distribution of life and disease. When you reach 101 years old, there isn’t a lot of chronic anything you can catch with the expected time you have left on earth.
Every now and then, however, we find patients who are the exception to the rule, such as the 101 year old guy that present with a new cancer diagnosis. That’s where being an internist comes in handy. Read more »
*This blog post was originally published at The Happy Hospitalist*
December 4th, 2010 by Shadowfax in Better Health Network, Opinion, True Stories
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I’ve discovered over the years that I really like economics. I never took an econ class in my entire life, since I was pretty focused on the life sciences, but I’ve picked up a fair amount informally over the years. Fortunately I have a strong background in statistics and math, and I’ve done a lot of reading on economics. I wouldn’t say that I have any special level of understanding or credibility on the topic. Perhaps it should be noted that my wife took away the checkbook for good reason. But I enjoy it as a topic, as something to read about and a powerful tool for understanding how the world works.
One consequence of being an ER doc is that you are pretty close to “the street,” and I don’t mean Wall Street. I mean the folks living and scrounging on the streets. As a matter of functioning in the job, you learn the street jargon, you learn what drugs people are using and why, and what the effects of those drugs look like.
The other day I saw a middle-aged guy brought in for acting really weird. Though everything in his social history argued against it, he just looked like he was on meth. I checked a tox, and sure enough, it came back positive. He strenuously denied any drugs, but eventually gave in and admitted the meth use.
I remember in residency walking through downtown Baltimore with a fellow resident and our spouses, and we amazed them by serially identifying the likely drug of choice of the various street people we passed, based on casual observation of their behavior. It’s just what we do. Baltimore was a heroin town. Read more »
*This blog post was originally published at Movin' Meat*
November 13th, 2010 by Shadowfax in Better Health Network, True Stories
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I wish I could say that every patient encounter worked out well, that all my patients went home happy and satisfied. It would be nice, but unfortunately that is not true at all.
There are many patients who present with unrealistic expectations or an agenda which is non-therapeutic, and I am relatively straightforward and unapologetic about correcting patient’s misconceptions about the care that is or is not appropriate in the ED. Unsurprisingly, this often though not always involves narcotic medications.
Which is not to say that I am a jerk. I try to be compassionate, and I try to find alternative solutions, and I have been told that I can turn away a drug seeker more nicely than any other doctor in the department. But when it is time to say “no,” I say “no” firmly and without evasions or excuses. People don’t like to hear that, and all the more so in this “the consumer is king” environment of customer-service culture we foster in the medical industry these days.
So when I do say “no,” as nice as I try to be, some people get upset. Sometimes they escalate. They hurl insults, spit, throw themselves on the floor and throw a fit or feign unconsciousness. Read more »
*This blog post was originally published at Movin' Meat*
August 6th, 2010 by Edwin Leap, M.D. in Better Health Network, Humor, Opinion, True Stories
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I have a new “smartphone.” It’s a Droid from Verizon. Pretty cool. I like what it can do, though it tends to enable me tendency to chronically check my email. I like the features, between ease of texting, voice dialing, etc. But it’s big, compared to me dear departed flipphone, whose corpse lies in state in my pickup truck.
But I noticed one day, as I reached around my side, that the large phone now on my hip felt remarkably like my revolver. Odd feeling that. I was in public and I remember panicking, wondering if I had forgotten to conceal my concealed weapon for some reason.
And as I pondered this, I realized that both represent fundamental differences in the way we view individuality. Maybe it’s a stretch, but I’m a writer so I’m supposed to stretch. Read more »
*This blog post was originally published at edwinleap.com*
