Cache Cows! Who needs a (General) Conference?

[Coach McGuirk]

I'm hearing lcl tear.

So is everyone with a twitter account.

[Commando]

http://www.coachroblowe.com/injuries-lower-knee-lcl-overview.htm

hmm

[doctorcoug]

Customer satisfaction. The x ray is right there. It's very hard to send someone home without one. People think that smart doctors order lots of tests--I've stopped fighting this battle.

Plus, tibial plateau fractures can look a lot like a ligament. But not in a college QB.

My patient population is totally different than yours. I get smiles when I can say no imaging is needed, RICE, and get ready for next week.

Unfortunately the ER has become the vast abyss of absolutely unnecessary testing. I was a second year resident before I learned I could clear a c-spine without imaging, and that was because we had only one doc following evidence based guidelines at the time.

This knee injury is just so sad. I'm really really upset at the coaches right now. Those final calls were crazy. Who calls the option when trying to protect the ball?

via a galaxy s3 far far away

[fusnik]

So is everyone with a twitter account.

lol. BNS.

Where's KC and KL to correct everyone?

[ERCougar]

My patient population is totally different than yours. I get smiles when I can say no imaging is needed, RICE, and get ready for next week.

Unfortunately the ER has become the vast abyss of absolutely unnecessary testing. I was a second year resident before I learned I could clear a c-spine without imaging, and that was because we had only one doc following evidence based guidelines at the time.

This knee injury is just so sad. I'm really really upset at the coaches right now. Those final calls were crazy. Who calls the option when trying to protect the ball?

via a galaxy s3 far far away

Not to threadjack (ha), but I still clear plenty of c spines because the other option is irradiating a thyroid (with a big dose if you're ct'ing)--I do have some standards. But a knee x ray is fast, relatively cheap, and harmless. And our patients ARE different just by self-selecting and coming to the ER.

Really...it's just not worth the fight.

[Coach McGuirk]

Not to threadjack (ha), but I still clear plenty of c spines because the other option is irradiating a thyroid (with a big dose if you're ct'ing)--I do have some standards. But a knee x ray is fast, relatively cheap, and harmless. And our patients ARE different just by self-selecting and coming to the ER.

Really...it's just not worth the fight.

Do people really demand X-rays?

[USUC]

And now just shoot me,

@drewjay: Apparently, Riley Nelson has told several people at LDS Conference priesthood session tonight that he will definitely start on Sat. #BYU

This tweet is troubling to me. So Nelson is already running his mouth? I'm starting to think this kid is toxic.

[ERCougar]

Do people really demand X-rays?

Well, depends on what you mean by 'demand'. Yes, some demand. But a lot more just complain later that you didn't 'care' about them or that you were a crappy doctor. It's absolutely true that more testing equals less complaints, even though it also generally means bad medicine.

Knees aren't quite as bad once you explain that x rays only show broken bones (Ill try this with the more reasonable ones--who realize that nothing is likely broken). But ankles are the worst. We have very good guidelines on when an x ray is needed. I used to follow them, but it was so rare to have a patient actually be fine with no X-ray for their sprain that I just eventually gave up.

[Commando]

This tweet is troubling to me. So Nelson is already running his mouth? I'm starting to think this kid is toxic.

What do you mean? Isn't it common knowledge that Riley's the starter, given his health is cleared? Running his mouth? Toxic?

[Coach McGuirk]

Well, depends on what you mean by 'demand'. Yes, some demand. But a lot more just complain later that you didn't 'care' about them or that you were a crappy doctor. It's absolutely true that more testing equals less complaints, even though it also generally means bad medicine.

Knees aren't quite as bad once you explain that x rays only show broken bones (Ill try this with the more reasonable ones--who realize that nothing is likely broken). But ankles are the worst. We have very good guidelines on when an x ray is needed. I used to follow them, but it was so rare to have a patient actually be fine with no X-ray for their sprain that I just eventually gave up.

Interesting. I stopped going for ankle sprains at 16, When I realized they were just going to be negative and say ice and heat/stim. So I guess the smart ones self regulate and you're left with everyone that shows up in the ER.

[doctorcoug]

Interesting. I stopped going for ankle sprains at 16, When I realized they were just going to be negative and say ice and heat/stim. So I guess the smart ones self regulate and you're left with everyone that shows up in the ER.

Yup, that is it. About twenty percent of my practice is sports med and that is the huge difference between seeing me in clinic or on the field and seeing the EM doctor. I actually see negative ottowa rules (knee and ankle) in clinic and on the field. the patient in the ED is often higher acuity, but they are often a bunch of babies as well.

via a galaxy s3 far far away

[The_Douger]

Seriously? I know you work in an urgent care, maybe you are overusing the x-ray. If you get that many negatives you need to work on history and physical.

via a galaxy s3 far far away

The Xrays aren't for me, if you know what I mean.

I'm kind of the the point ERCoug is. Few and far between are the patient's that are ok with the explanation about Ottawa rules, at least where I work.

[Pheidippides]

Interesting. I stopped going for ankle sprains at 16, When I realized they were just going to be negative and say ice and heat/stim. So I guess the smart ones self regulate and you're left with everyone that shows up in the ER.

I was unaware that people went to the ER for ankle sprains. Okay, not totally true - my wife went in once for a really bad one because it was bad outside of our experience and we were worried. But that's once in a cumulative 70 years for us.

[Coach McGuirk]

I was unaware that people went to the ER for ankle sprains. Okay, not totally true - my wife went in once for a really bad one because it was bad outside of our experience and we were worried. But that's once in a cumulative 70 years for us.

Well back in the 80s I used to gt crazy sprains playing ball. Like extremely sick looking. And back then if it was past seven pm your option was the ER or waiting it out. Turned out I had very loose ankles (that's what the sports med dude called them), something to do with a triangle of tendons and ligaments on the outside of the ankle. First time, I was like this has to be broken, second time I had no swelling or bruising and I was like this has to be broken. Third time I was like get me some ice and some tape.

[Pheidippides]

Well back in the 80s I used to gt crazy sprains playing ball. Like extremely sick looking. And back then if it was past seven pm your option was the ER or waiting it out. Turned out I had very loose ankles (that's what the sports med dude called them), something to do with a triangle of tendons and ligaments on the outside of the ankle. First time, I was like this has to be broken, second time I had no swelling or bruising and I was like this has to be broken. Third time I was like get me some ice and some tape.

Yeah, that's what my wife's ankle looked like, so I can't second guess that one. Looked nasty.