Emergency Department (In)efficiency - Why patients wait 6 hours...and die in the waiting room.
I've worked at more than a few places...both EDs and urgent cares. I can finally say I now fully appreciate the difference between a 'physician efficient' ED and...one that's not.One of my gripes about working in the ED as a doctor is...the place isn't set up to maximize physician efficiency. Sure, they expect you to see 2.5 patients an hour...but when it takes 20 minutes to log into the various computer programs, trouble shoot the printing process, and then find said printout to sign and place with the chart (if you can find the chart)...there's no way the "goal" of 2.5 patients can be reached.Let's take last night......t...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Hood Mentality
The consequence of hood mentality.In the hood, lots of folks are looking for a payday. Be it by "falling down" at the grocery store, or selling things on the street that....sell. A great number of people bitch and complain about paying a $50 copay, but pull up in a pimped out Escalade with spinning wheels and a $400 cell phone. The ultimate consumers.Well, in medicine this trend continues. And, apparently, many of the frivolous lawsuits are initiated by people just looking for a payday at someone else's expense.At the Kingdom, there was this young guy...who was racing his motorcycle on the freeway. He fell, got crushed, an...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Letter to my peers on unionizing
(I will kindly *not* include myself in this)Doctors are stupid, because they have allowed this to happen.Still living in an era of the rich, private practice mentality...not accepting the fact thatmost physicians today are employees in one way or another. And instead of turning up their noses to unionizing, perhaps they should realize that they are now more like the average worker. They've allowed the nursing union to be the be the sole legislative voice on healthcare policy, to their detriment, and to thedetriment of their patients.As the nursing union shouts "patient advocacy," they are trying to implement healthcare pol...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Why are you here?
{walking into a patient's room}Me: "Hi Mr. Smith, I'm Dr. Gilman and will be taking care of you today in the ER. So, I reviewed your chart, and I don't see any significant past medical history. The nurses tell me you don't feel well. Tell me, what's the matter today?"Smith: "I'm sick"Me: "Okay, but what's wrong"Smith: "I don't f*ckin' know, you're the doctor."I hate,hate, it when a patient doesn't have a chief complaint when they come to the ER.Why are you here? Today? Right now? (i.e.why couldn't this wait until you could see your primary doctor). What changed? What are you afraid of? Specifically, what part of your body ...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Letter to my patient
These 'letters' were passed to me by colleagues. I guess I work with alot of...frustrated docs. (these were not written by me)Dear Patient:You came in at 11pm last night with a chief complaint of sore throat while munching on a sandwich at triage. Next time you choose a sandwich to bring with you to the ED, try something that will go down easier. Peanut butter and Jelly – while I’m sure was very tasty, made my ENT exam, well… a bit difficult. But alas, we did get through it and I got to see your very normal throat. While I was tempted to leave the diagnosis of “no real complaint” on your chart, after envisioning ...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Issues with Medicine
On the white coat.Everyone wears one. I wonder why. I think patients are starting to realize that it ’s actually those of us *without* a white coat that are the doctors.On Customer Service.How stressful would it be if you actually gave a damn about patient satisfaction scores. Not because it ’s not a worthy goal to be customer friendly; but because these scores are derived from so many factors that you, as a doctor, have absolutely no control over. Wait times, parking, whether or not you have access to old medical records. Think about it, if a patient in the ED waits 8 hours, cannot t ell the difference between a docto...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Senseless transfer, September 20, 2006
There was this patient...67 yo Hm transferred from outside facility where he presented at 8am c/o severe abdominal pain with N/V for one hour. PTA his niece called the advice nurse who recommended she call 911. In the ED at the outside facility his work-up was essentially negative, except he continued having severe abdominal pain. Transfer was arranged to our facility because their CT scanner was broken. At the time of transfer, although all tests were negative, he was becoming increasing hypotensive/tachycardic. In fact, per family, the other facility refused to give him more pain meds b/c "his BP was too low."Upon arriva...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
The ER doctor is only as good as her hospital allows, Nov 23, 2004
Continuing on with this lower GI bleed lady.She seemed okay after the questioning...and during rounds. But immediately after rounds she seemed to be sleeping. When the sheets were pulled back... ...she was laying in a mound of dark red clots of blood. Looked immediately up at the monitor, low and behold she was tachycardic and hypotensive. The juniors were all over it...and stabilized her with IVF, blood transfusions, and even got a tagged RBC scan to see where the blood was coming from...exactly.The RBC scan revealed a "sprinkler" in her descending colon. Surgery was called. They wanted an NGT lavage "the bleeding may be ...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Point of view, November 26, 2004
What ever happened to being responsible for yourself...owning up to your actions and mistakes, and holding yourself accountable for the circumstances of your own life? Sometimes I wonder, would people think I'm the most insensitive, uncompassionate, heartless doctor if they were privy to the ramblings of my internal monologue?At King we have lots of traveling nurses. Mostly I welcome their presence because they bring "new insight" that lots of the native King nurses lack. Yesterday RN Wendell told me that I was one of the best doctors he'd come across in his travels. Other staff frequently gives me similar compliments...an...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Perfect Job, perfect specialty??
I remember how difficult it was for me to choose a specialty. Initially (as in before medical school), I wanted to be a dermatologist. I loved cosmetics and hair products, and as a college student I thought I'd go into some sort of 'beautifying' medical specialty.Once in medical school theyforced upon us that primary care crap tried to encourage us to consider careers in primary care. And I did...seriously. I really, really liked the idea of family practice. The doctor that sees the entire family, and watch the kids grow up, and have continuity of care, and keep the family healthy, yadda yadda yadda.Then, I started having ...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Emergency Department (In)efficiency - Why patients wait 6 hours...and die in the waiting room.
I've worked at more than a few places...both EDs and urgent cares. I can finally say I now fully appreciate the difference between a 'physician efficient' ED and...one that's not.One of my gripes about working in the ED as a doctor is...the place isn't set up to maximize physician efficiency. Sure, they expect you to see 2.5 patients an hour...but when it takes 20 minutes to log into the various computer programs, trouble shoot the printing process, and then find said printout to sign and place with the chart (if you can find the chart)...there's no way the "goal" of 2.5 patients can be reached.Let's take last night......t...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Hood Mentality
The consequence of hood mentality.In the hood, lots of folks are looking for a payday. Be it by "falling down" at the grocery store, or selling things on the street that....sell. A great number of people bitch and complain about paying a $50 copay, but pull up in a pimped out Escalade with spinning wheels and a $400 cell phone. The ultimate consumers.Well, in medicine this trend continues. And, apparently, many of the frivolous lawsuits are initiated by people just looking for a payday at someone else's expense.At the Kingdom, there was this young guy...who was racing his motorcycle on the freeway. He fell, got crushed, an...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Letter to my peers on unionizing
(I will kindly *not* include myself in this)Doctors are stupid, because they have allowed this to happen.Still living in an era of the rich, private practice mentality...not accepting the fact that most physicians today are employees in one way or another. And instead of turning up their noses to unionizing, perhaps they should realize that they are now more like the average worker. They've allowed the nursing union to be the be the sole legislative voice on healthcare policy, to their detriment, and to the detriment of their patients.As the nursing union shouts "patient advocacy," they are trying to implement healthcare p...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Why are you here?
{walking into a patient's room}Me: "Hi Mr. Smith, I'm Dr. Gilman and will be taking care of you today in the ER. So, I reviewed your chart, and I don't see any significant past medical history. The nurses tell me you don't feel well. Tell me, what's the matter today?"Smith: "I'm sick"Me: "Okay, but what's wrong"Smith: "I don't f*ckin' know, you're the doctor."I hate, hate, it when a patient doesn't have a chief complaint when they come to the ER.Why are you here? Today? Right now? (i.e. why couldn't this wait until you could see your primary doctor). What changed? What are you afraid of? Specifically, what part of your bod...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
Letter to my patient
These 'letters' were passed to me by colleagues. I guess I work with alot of...frustrated docs. (these were not written by me)Dear Patient:You came in at 11pm last night with a chief complaint of sore throat while munching on a sandwich at triage. Next time you choose a sandwich to bring with you to the ED, try something that will go down easier. Peanut butter and Jelly – while I’m sure was very tasty, made my ENT exam, well… a bit difficult. But alas, we did get through it and I got to see your very normal throat. While I was tempted to leave the diagnosis of “no real complaint” on your chart, after envisioning ...
Source: EM Physician - Backstage Pass - September 8, 2015 Category: Emergency Medicine Authors: Taylor Source Type: blogs
