Curbside Consult Thread

[San Juan Sun]

I never expected this, but the thing that keeps me up at night since becoming a real doctor...

I worry about messing people up. I wish I could talk more but, well, you know... Google and all.

[hostile]

I worry about messing people up. I wish I could talk more but, well, you know... Google and all.

Yeah, me too. Also, my pager going off keeps me up at night.

[CardiacCoug]

I never expected this, but the thing that keeps me up at night since becoming a real doctor (^_-) is trying to decide how to manage patients that have recommendations from specialists that I disagree with. I feel an absolute obligation to do what is right for the patient, but I totally worry about pissing off the specialist. So I end up doing this huge song and dance that takes me twice as long and I still worry. The patient walks out believing their specialist is amazing, so that is good. But the specialists probably don't appreciate it.

I didn't realize how controlling I am of my patients. Also, I am now recognizing the huge benefits, education-wise, of working at a teaching hospital. I miss residency.

So, my PCP colleagues, how do you deal with disagreements in management? More importantly, how do you keep a good relationship when you disagree? This is tough.

via a galaxy s3 far far away

My advice is just always do what you think is the right thing for the patient and don't worry at all about what other doctors may think. You don't need to balance an obligation to the patient with an obligation to another doctor. It's all about the patient. It's hard enough to get things right when you just focus on the patient so keep it simple.

Usually when I think somebody else has done something really wrong it's because I don't understand the entire situation so it never hurts to call another doctor and just ask him/her why something happened. Almost always you find there is some logical explanation for what previously seemed like a mistake.

[Pheidippides]

Every time I see someone on a new motorcycle, I smile and think to myself "There's a future patient."

Why do you think I'm selling mine? It's just not worth the risk to me anymore.

[doctorcoug]

My advice is just always do what you think is the right thing for the patient and don't worry at all about what other doctors may think. You don't need to balance an obligation to the patient with an obligation to another doctor. It's all about the patient. It's hard enough to get things right when you just focus on the patient so keep it simple.

Usually when I think somebody else has done something really wrong it's because I don't understand the entire situation so it never hurts to call another doctor and just ask him/her why something happened. Almost always you find there is some logical explanation for what previously seemed like a mistake.

Thanks for the advice. I really appreciate it. I want to be a good colleague and not burn bridges.

I'm not talking about mistakes, I'm talking about disagreements over management.
Some examples:

PSA testing
biennial mammography
statins for primary prevention
neurosurgery for mild disk bulge
lomotil with c diff (seriously)

It is really difficult

via a galaxy s3 far far away

[The_Douger]

I think the best you can do is follow current guidelines. You always have the literature to fall back on if they give you an angry phone call.

Being a physician's assistant, I occasionally get calls from doctors in our clinic who didn't like what I did, and I just refer them to the literature I used to reach that conclusion in a non confrontational manner. My supervising docs support me in that, and it has seemed to be fine.

When you have a bunch of high strung, type A personalities, there's going to be disagreements regarding the course of treatment. Just don't take it personal and maintain your professionalism and you should be fine.

[TalkyTina]

Every time I see someone on a new motorcycle, I smile and think to myself "There's a future patient."

Yesterday evening I drove by a fresh motorcycle accident. Fire/Paramedics were just arriving. A police officer was already there performing chest compressions on the driver.

[San Juan Sun]

Yesterday evening I drove by a fresh motorcycle accident. Fire/Paramedics were just arriving. A police officer was already there performing chest compressions on the driver.

A noble, but fultile, effort.

[TalkyTina]

A noble, but fultile, effort.

Yes...

Every year I take ARC CPR, AED and first aid. The instructor has mentioned that CPR alone w/o the AED is basically futile. Based on your reply I assume you agree? In your experience how effective are consumer grade AEDs?

[San Juan Sun]

Yes...

Every year I take ARC CPR, AED and first aid. The instructor has mentioned that CPR alone w/o the AED is basically futile. Based on your reply I assume you agree? In your experience how effective are consumer grade AEDs?

We're really talking about two different kinds of injury. A major blunt trauma causing cardiopulmonary arrest at the scene generally involves massive head trauma or great vessel (aorta, etc.) injury that CPR will never help. Unless that guy crashed into an operating room, he was dead.

I have no good information about consumer AEDs.

[doctorcoug]

Not certain if this should to here or in the correlation thread...

The vast majority of my patients aren't LDS, but I do care for a few in the ward. How this came up doesn't matter, but I had an LDS lady in clinic and I ended telling her to use a vibrator due to sexual dysfunction. She gasped and said she was worried that she would get excommunicated. I explained that she didn't need to worry, as I have already researched this out. She left very excited to explore.

Now, that story is pretty boring, but what makes it interesting is what happened to my clinic schedule the next week. It seems that lots of Mormon women have a misconception about vibrators and the LDS position on sex in marriage. And it also seems that they like to talk to each other.

I think the men in the ward owe me a steak dinner.

via a galaxy s3 far far away

[hostile]

We're really talking about two different kinds of injury. A major blunt trauma causing cardiopulmonary arrest at the scene generally involves massive head trauma or great vessel (aorta, etc.) injury that CPR will never help. Unless that guy crashed into an operating room, he was dead.

I have no good information about consumer AEDs.

And with some of those injuries, even if they occurred right outside the OR door, they aren't going to make it.

[ERCougar]

And with some of those injuries, even if they occurred right outside the OR door, they aren't going to make it.

Just had one of these. Literally happened at the intersection right in front of the hospital (trauma center in AZ where I work occasionally--not Cedar). We heard the ambulance call go out for a motorcycle vs minivan right outside the hospital--maybe 300 yards away--but no one could go out and just bring the guy in because of liability reasons. Guy was dead and unsavable anyway but it was really strange being able to see the accident from the ambulance bay but not being able to do anything about it.

[doctorcoug]

I'm kinda curious, how many vaginal exams does one undergo from a family medicine physician before she realizes something is cooky? Three visits is what I give you; if I'm still searching for a cause after three visits, you go to a specialist.

I'd be interested to see the timeline. Did she see him masturbate before or after the office visits?

http://m.sltrib.com/sltrib/mobile2/54964457-218/hillam-police-woman-orem.html.csp

via a galaxy s3 far far away

[TexTechCoug]

And with some of those injuries, even if they occurred right outside the OR door, they aren't going to make it.

Codes due to trauma equal DOA. Cardiopulmonary arrest from blunt trauma means you are done, it isn't like an arrest due to MI, the injuries that go with the trauma are too devastating.

Fournier's gangrene smells bad, good night.