Curbside Consult Thread

[San Juan Sun]

Why was she admitted in the first place? I'm not questioning you...it sounds like there is more to this story, which could be interesting.

Admitted where? We kept her overnight in our "short stay" not-really-admitted unit after her surgery. She was the last of 4 gallbladders (9 total surgeries) on Monday.

I have no idea why she was admitted at the other hospitals, because I don't work there. I only heard about it from my boss who does.

[San Juan Sun]

Do you think there would be less crazy if SS disability didn't exist. Number one reason not to be a pain doctor, crazy folk trying to get on disability.

I can imagine nothing I'd like to do less in medicine than deal with chronic pain patients. God bless the intrepid souls who do it.

I did a month with an ortho spine guy as a student. His practice was pure back pain. It was miserable.

[TexTechCoug]

I can imagine nothing I'd like to do less in medicine than deal with chronic pain patients. God bless the intrepid souls who do it.

I did a month with an ortho spine guy as a student. His practice was pure back pain. It was miserable.

I spent two full months working the chronic pain circuit and I can tell you it is 95% psychiatry. You know your interventions are whack when two of the factors predicting failure of your epidural steroid injection are 1. on workmen's comp and 2. seeking disability.

At best, the vast majority of interventions are a bridge to physical therapy, exercise, yoga, and weight loss.

Docs who prescribe narcotics long term are hurting themselves, and the evidence shows, really doing harm to their patients.

The big problem with pain in the modern world is the unrealistic expectation that we should all be pain free all the time.

[doctorcoug]

Admitted where? We kept her overnight in our "short stay" not-really-admitted unit after her surgery. She was the last of 4 gallbladders (9 total surgeries) on Monday.

I have no idea why she was admitted at the other hospitals, because I don't work there. I only heard about it from my boss who does.

Fascinating. Medicine is so regionalized. I've never heard of this short stay. Either in-patient or observation. The only gall bladders that stay overnight in my hospital are the ones who had complications. Come to think of it, the last one I saw went like this, "DC, I just took out a gallbladder on a patient. She has a lot of medical issues. She's up in ICU on a vent and neo; can your team assist me?"

In regards to pain management, bless their souls. My pain management group here, however, only does operative management. All medical management is referred back to PCP. This is, I think, because my lazy ass interns didn't take the time to manage the patient and over consulted druggies.

[CardiacCoug]

Docs who prescribe narcotics long term are hurting themselves, and the evidence shows, really doing harm to their patients.

The big problem with pain in the modern world is the unrealistic expectation that we should all be pain free all the time.

If you think the docs are hurting themselves, you're not thinking like a "pain specialist."

Instead of telling a patient to take NSAIDs and just deal with his temporary pain, you put him on oxycodone, then oxycontin, then methadone. Do that for a few thousand patients and you have created a patient population that is literally physically dependent on you and must pay for office visits to see you in perpetuity (or until they are dead).

That's how it works. Just ask Dr. Mackay here in Utah and a lot of other so-called "pain specialists."

[wuapinmon]

When I woke up after my gallbladder pain, I knew there was no way in hell I could even walk to the car. One night in the hospital, and I was fine, but there is absolutely no way I could've left that day. My first thought on waking was, "PAIN!"

Then I got pancreatitis, and the post-op pain paled by comparison.

[ERCougar]

I just did my fourth damn disimpaction this week.
I know things come in 3's, but can it be something else please? Anything else?

[San Juan Sun]

I just did my fourth damn disimpaction this week.

I feel you (not literally).

[Commando]

I just did my fourth damn disimpaction this week.
I know things come in 3's, but can it be something else please? Anything else?

I always thought a career in the medical profession would be more rewarding than law and felt some amount of regret... however, it appears it's not all sunshine and lollypops.

[ERCougar]

And...disimpaction #5!
This is seriously unbelievable. Un-effing-believable.

Also...on a completely unrelated note...these Saudi students at the university are the biggest bunch of pansies I have ever met in my life.

[San Juan Sun]

Beer bottle vs face

Winner: no one, although beer bottle arguably sustained the most damage. It was a Pyrric victory for the face and neck however.

(The victim, a 22 yo with HIV, was being sewn up by my junior resident. He called me because he couldn't get a small, very superior sternocleidomastoid muscular bleeder to stop. I arrived and helped him ligated the small vessel. Afterwards, I learned that he was HIV +. I was not too happy that both he and I were working in this wound without face protection, a sterile gown, and double gloves. It's just a dumb risk to take.)

[doctorcoug]

Beer bottle vs face

Winner: no one, although beer bottle arguably sustained the most damage. It was a Pyrric victory for the face and neck however.

(The victim, a 22 yo with HIV, was being sewn up by my junior resident. He called me because he couldn't get a small, very superior sternocleidomastoid muscular bleeder to stop. I arrived and helped him ligated the small vessel. Afterwards, I learned that he was HIV +. I was not too happy that both he and I were working in this wound without face protection, a sterile gown, and double gloves. It's just a dumb risk to take.)

I walked in my patient's room one morning and lab was drawing blood. The phlebotomist had ripped his index finger glove off so he could better palpate the vein. I gently reminded him that the patient had a blood borne infection (hep c, but he didn't need to know that) and that he might want to continue with universal precautions. Shock on the face of this twenty year-old.

Why oh why OSHA caves to HIPAA and doesn't allow us to put "blood borne" bands on patient's arms has always baffled me. Universal precautions is just not enough, in my opinion. We put DNR bands on patients, we put name bands on patients, we even put "no phlebotomy" bands on dialysis patient's arms. All these to protect the patient. Why can't we protect our hospital employees?

The new idea is that we should be double gloving all cases in the OR and I'm trying to get used to that. But what about phlebotomists like this?

[Surfah]

Gidget wants me to ask about cough syrup for our 2 year old that had a cold that has gone into her chest. She's having trouble sleeping because of coughing fits. I say give her children's cough syrup even though it says not for use under 4. Am I endangering my child's life?

[CardiacCoug]

Gidget wants me to ask about cough syrup for our 2 year old that had a cold that has gone into her chest. She's having trouble sleeping because of coughing fits. I say give her children's cough syrup even though it says not for use under 4. Am I endangering my child's life?

Sounds OK to me -- I would just use half the dose it says to use on a 4-year old.

[hostile]

The new idea is that we should be double gloving all cases in the OR and I'm trying to get used to that. But what about phlebotomists like this?

I can't remember the last time I wore single gloves in a case - maybe it's just an ortho thing. Even with double gloves I end up occasionally with a tear through both layers.