April 9th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, True Stories
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With the attention rightly focused on patient safety, what about healthcare workers? It’s somewhat of a hidden phenomenon, but attacks on doctors and nurses are on the rise.
Rahul Parikh writes about this in a recent Slate piece. He cites data from the Bureau of Labor Statistics, which found “healthcare workers are twice as likely as those in other fields to experience an injury from a violent act at work, with nurses being the most common victims.”
In the article, Parikh goes on to detail an attack on a physician who initially refused to give his patient opioid pain medications. Read more »
*This blog post was originally published at KevinMD.com*
April 7th, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays
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Overuse of the emergency department is commonly discussed during the healthcare conversation, especially with the lack of primary care access shunting patients with seemingly routine symptoms to the ER. But is this a myth? That’s what two emergency physicians contend in a piece from Slate.
The emergency department is functioning just fine, they say: “Just 12 percent of ER visits are not urgent. People also tend to think ER visits cost far more than primary care, but even this is disputable. In fact, the marginal cost of treating less acute patients in the ER is lower than paying off-hours primary care doctors, as ERs are already open 24/7 to handle life-threatening emergencies.” Read more »
*This blog post was originally published at KevinMD.com*
February 23rd, 2010 by Shadowfax in Better Health Network, Opinion, True Stories
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The first seven patients I saw today were in the ED for:
- Dental Pain (ongoing for three years)
- Back Pain (third visit in one month, 18 in 2006)
- Migraine Headache (six visits in a month, and second ED visit in 18 hours)
- Back Pain (this one was legit)
- Chronic Recurrent Abdominal Pain (ran out of Oxycontin and doctor “out of town”)
- “Cyclic Vomiting Syndrome” (in which only narcotics stop the vomiting)
- Oxycontin withdrawal
Sometimes I wonder why I bother. I occasionally wish my job demanded something more than a valid DEA license, and decision-making skills beyond “yes narcs” and “no narcs.” It just drains the carpe right out of your diem to start the day off in a series of ugly little dogfights over drugs with people whom, to put it charitably, you have concerns about the validity of their reported pain. Read more »
*This blog post was originally published at Movin' Meat*
January 20th, 2010 by Shadowfax in Better Health Network, True Stories
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The ER is a highly effective bottom-filter for society. When you work in the ER you are in daily contact with the worst that mankind has to offer: addicts, sociopaths, criminals, and the many many varieties of personality disorders with which a loving God has imbued humanity. I say this not as condemnation: they are my people. I know them and accept them for who they are. I am here every day to serve them in their various needs, from the heroin addict who is dropped off blue and apneic to the homeless guy who just wants his unwashed feet looked at.
One of the refreshing features of many members of the lumpenproletariat is their candor regarding their habits. Sure, it’s by no means universal, but it’s entirely common for me to ask someone quite directly: “Do you use meth?” and have the patient respond in the affirmative and without the least trace of self-consciousness expand on the degree and nature of their drug use. The hardest question for me to learn to ask without blushing was “do you ever have sex for money or drugs?” (And yes, I do ask that of both men and women, when it seems potentially relevant.) But people on occasion forthrightly admit that they turn the odd trick to support their habit. Read more »
*This blog post was originally published at Movin' Meat*
August 16th, 2009 by Shadowfax in Better Health Network
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The sense of smell is a very powerful sensation. A distinctive fragrance can stir up a long-forgotten memory, or put you in a place you haven’t been in years. There’s a certain clean, dusty smell that always reminds me of the cottage on Wisconsin’s Lake Koshkonong, which we used to rent every year when I was a kid. There’s a perfume that always reminds me of a girl who I briefly dated in high school. The girl was forgettable but the aroma was not. We all have these triggers and associations.
All this occurred to me last night as I hunched over the face of an intoxicated gentleman who had lost a fight with the pavement. He was unresponsive, and I was painstakingly stitching back together the tattered pieces of his lips and forehead. Every time he exhaled, I was subjected to an intense and pungent smell of dried blood, saliva and alcohol. It’s an acrid scent, sour, with an overlying cloying sweetness. Very distinct and unpleasant.
And that, my friends, is the smell of the ER.
At least for me. I will never be able to smell that in my life without being immediately transported back to this place and activity (repeated so many times over the years). Fortunately, I am unlikely to ever experience this particular smell outside of the ER. Later, after the ER emptied out for the night, I discussed this with a few nurses & others. Not surprisingly, there was quite a diversity of opinion. One nurse insisted that the smell that, for her, screamed “ER” was that of melena (bloody stool from a brisk GI bleed — also very pungent) It can fill the entire department when you have one GI bleeder. You come into work, smell the melena the moment you walk in, and you just know what sort of shift it’s going to be. A tech said that the scent he thinks of as “ER” is the sweet plastic smell of freshly opened oxygen tubing. Another nurse came up with an inventive and hysterical bit of slang that I just can’t bear to repeat for, um, how shall I say it, the ammonia and fishy smell of unclean or diseased lady parts.
Ultimately (of course) we came up with a list of “Smells of the ER”:
- Alcohol, Saliva & Dried Blood
- Fresh Plastic Tubing
- Melena
- Feminine Issues
- A Freshly Incised Abscess
- 80-proof Vomit
- Clostridium Difficile (a GI illness producing a distinctive smelly diarrhea)
- “Hobo Feet”
- Coffee Grounds in a tray (used by nurses to freshen the air and cover some smells)
Surely there are more — perhaps you can contribute some in the comments. It’s gotta be distinctive to the ER, though, or at least a medical setting. Just poop or vomit doesn’t cut it. And, like the plastic tubing, it doesn’t have to smell bad, necessarily.
So what do you think?
*This blog post was originally published at Movin' Meat*
