Who does your medical transcription? Is it farmed out to a private MT or an agency, or is it in-house?
Out of all your gunshot/stabbing/assault patients, what percentage would you say were shot/stabbed/assaulted by “some guy” or “this one dude” while they were “totally minding their own business”?
How do you deal with frequent fliers that like to use keywords like “I’m having chest pain”?
What’s the worst slip of the tongue you’ve ever had in front of a patient?
StGermain- the Friday 5pm nursing home dump is usually believed by A&E staff to be because because the nursing home staff want a quiet weekend, and someone is threatening to put paid to that, but then A&E staff think that God invented snow just to make their lives more difficult!
I’m not sure if it happens as much in the US, but it happens here quite a bit.
The patient is usually one of the following:
Someone likely to die in the next 48 hours (usually someone with end-stage dementia and a DNR where all the hospital does is provide TLC…which could just as easily be done in the nursing home).
Someone who is being “difficult”- for example refusing to take meds, being sexually disinhibited or refusing to attend to their personal hygiene.
The homes seem to wait until late afternoon on Fridays to send these people in, usually with a scribbled note saying “The patient just isn’t themslves- sent to A&E on telephone advice of GP. To be checked over just in case, please see enclosed list of medications”, and the A&E staff is left to fill in the blanks in the history and presentation (because the patient usually can’t).
Unfortunately these patients require work ups to exclude new and/or reversible problems, which takes a lot of time and effort, and often by the point you have decided that they don’t need to stay in hospital it is too late to send them back to the nursing home (and you can’t just let them wait unaccompanied in the waiting area to get picked up) so they get admitted.
The cynic in me suspects this Friday phenomenon is also because most of the family visitors come at the weekends, and the managements don’t want them to witness residents dying, or behaving in inappropriate ways.
ShelliBean- The other docs may disagree, but IMO a good NP is worth their weight in gold. A bad one…ooh boy…they can make my life a million times harder.
In my experience nurses are fantastic at using protocols- doctors get bored with them and like to experiment. Nurses are also great at explaining things to patients and thinking of the wider social circumstances…doctors, not so much.
On the other hand- doctors are more comfortable working with a big degree of uncertainty and tend to be better at diagnosis and formulating treatment plans. If everyone works as a team and plays to their strengths it all works out, if not, not.
This of course is all anectdotal, based on personal observations and big generalisations. YMMV and you may disagree with all of it and I really won’t take offence!
Get queasy easily? DO NOT GOOGLE. :eek:
IANAD, but one of the first steps of the emergency protocols in Spain is looking for those. My sister in law is a doctor and one of the things she does is tell people with allergies or certain conditions (diabetes, renal history) to get bracelets/medals. The medical system is set in such a way that so long as you’re in a medical center that’s “local” to you, they have your info in the computer, but checking a medal is faster and there isn’t always a medical system computer at hand. Also, the presence of one of those medals or of an “emergency call” beeper is taken as a sign to “not do anything more problematic than apply a cotton bandage until you’ve checked the history.”
They assume that the medals will be incomplete and disregard blood group engravings.
Of course, in the US such things are available but people are reluctant to wear them, fearing prejudice. Show up at a job interview wearing such you are very unlikely to be hired.
All of our charting is computerized. So there is not transcription. We farm out our billing and coding.
We have PAs and NPs working for us around the clock. It’s a bit different in the ER in that the supervising physician is present at all times for consultation. I don’t mind when a consultant uses them either, because they typically are faster to respond and they don’t argue over the phone.
It’s very common for new grad nurses to be drawn to the ER because of the excitement factor. Definitely try to get an externship in the ED if you can. A big percentage of nurses who start out in the ED leave within a couple of years when they find out they aren’t suited for dealing with the patient population. There is a huge turnover rate in the ED which is unfortunate because we tend to have a lot of inexperienced nurses around most of the time.
I don’t usually ask, because I don’t care who it was. But we definitely hear that a lot, “I was standing on the corner, minding my own business, doc!”
If it’s clear they are only seeking pain medications then I say “I’ll be glad to evaluate your chest pain, but I’m not giving you narcotics”. If they are a frequent chest pain patient with actual cardiac disease, it is more problematic. I primarily want to sure they don’t have any true cardiac emergency. Those kind of people are going to die one day and it’s likely they will have been to the ER recently when they do. I don’t want to have my name on that last chart!
I can’t think of one off-hand. What kind of slip are you talking about? Like cursing or yelling or something?
Perhaps an example is in order.
My sister is a radiation oncologist. She was doing a pelvic exam on a patient with (IIRC) cervical cancer, and of course, the usual procedure here is to talk the patient through whatever you’re about to do before you do it.
Sister: “Ok, now I’m going to place one finger in your rectum and one finger in my vagina. … YOUR vagina!” :eek:
Fortunately the patient found this funny and retorted “what’s that gonna tell you?” 
Haha! If I’ve ever said anything that embarrassing, I’ve certainly forgotten it since.
Have you ever snapped at a patient? I’m thinking of a scene in ER where the bald doctor delivered a baby of a druggie. The baby wasn’t crying and the woman started screaming, “What’s wrong with my baby?!” And then the doctor yelled at her that it was her fault for being on drugs. Or something like that.
Have you ever seen a clear case of abuse: elder, child, domestic, other?
Have you ever seen what appeared to be abuse but turned out to be something else?
How often do drugs and alcohol play a part in why you’re seeing patients? Either self-inflicted or causing injury to someone else because of impairment?
StG
In Spain they’re normal jewelry. Get a religious medal or a medal with the profile of your region, engrave “Ale. Antib.” on back: they’re not big enough for details, but the important message is “check the medical history” anyway. Get a “nomeolvides” (lit forget me not), which is a chain bracelet with a large plaque, engrave the wearer’s name on the outside and key data on the inside. The bracelets have that name because the other traditional use is to engrave the name of the wearer outside, the name of the giftgiver inside; I know couples who exchanged a pair as engagement gifts. Since they’re not exclusively for medical uses, nobody knows that you’re using it that way just by seeing you have one.
The beepers are designed to be discreet; of course if someone wears a beeper bracelet and shortsleeves you’ll see it, but with long sleeves you won’t. And they’ve become common enough that it doesn’t draw attention unless you see them on someone under 40 or so.
Sorry to revive this old thread, but I got an email today, presumably through SDMB and related to this thread asking some questions related to ER work for a sci-if story. I’d prefer not to reply from my real email address so I’ll post the email and answer here in hopes he will see it.
Well this is very difficult to answer without more details about what was going on when she “dropped dead”. For instance if she was found dead and cold, she wouldn’t come to the ER at all.
If she had a witnessed cardiac arrest, she would most likely come in by ambalance. In the best case the paramedics would have already put a breathing tube in, started chest compressions, shocked her heart if indicated, placed an IV and given cardiac medications such as epinephrine and atropine. The ER staff would continue with the medications, chest compressions, heart shocks etc depending on response.
I can help with the dialog if you can give some more details because each case is different. In any case, cause of death would be determined by medical examiner if it isn’t clear from her history or if there is any concern for “foul play”. Definitely not the ER doc.
That’s an interesting request!
My sister is a pharmacist, and for a Western we were writing online in Cafe Society I called her up to ask “How much laudanum would be a lethal dose for an adult man?” There was a pause and then, in a rather hushed ton she replied “Why do you need to know?”
http://boards.straightdope.com/sdmb/showpost.php?p=3306731&postcount=90 This is a link to the post where I used the knowledge. “One itty bitty spoonful“, or twenty drops, was enough for relief, but more would be bad.
I was really confused how you bumped this today when I’d been reading a link from it for the last few days and I don’t think I’d stumbled upon it before, but then I remembered the shitty situation you’re in dude, for which you have my total sympathy, and in the insanely unlikely event that I can do anything about it please let me know (the only scenario that would make sense at all is perhaps because ye and me have never interacted before, I’m just some nut thousands of miles from you, and you can unload on me with confidentiality assured - but I say it just in case).
Oh, and on the link I’m reading? It’s the student doctor thread about things that patients have taught them. It’s fucking brilliant - as I type this I’m up to post #2890. But anyone reading this post who hasn’t started yet - you need to start here - it’s gold. I’m a** fucking dedicated **message board lurker and it’s definitely in my top ten threads. Maybe top three.
Oh, and to ask a question legitimately - if I relapse, what’s the best complaint to fake to get delicious opioids? I have no idea how to fake an injury - the one time I went to an A&E (as they call them this side of the pond) it was for “dihydrocodeine withdrawal” (which was entirely correct btw) and that experience didn’t go well for anyone. Found it bizarre I was treated as if I was making it up… surely a dishonest drug seeker would pretend to have something else… but er, yeah, in future if that does happen I promise to be completely dishonest and do my best to get loads of drugs, so what’s the method? The weirdest thing is in that thread a load of them are drug seekers (obviously) yet are still being given things by the docs.
P.S. I consider opioid withdrawal a perfectly legit thing to go to A&E about btw, even if no one else does. Even ignoring the unnecessary hell and suffering caused to me from opioid withdrawal , I missed a few days of work until I got some opiates. Not good for the economy!
P.P.S. I don’t consider making up injurys for opiates a legit thing to do. It just may be the least bad of many options. Although I am now unemployed so it probably isn’t at the moment, at least so long as I don’t kill myself. Except that’s also irrelevant because I’m prescribed shitloads of opioids atm legimiately. I just like to have an option C as well as B 
Besides, yer gonna poop yer pants anyway.
The canonical answer to your question can be found on Craiglist.
In the US it is a felony to lie to a health care provider to receive controlled substances.
That was fantastic
Your negativity just set off my fibromyalgia. Also my chronic back-head-ache-pain.