sometimes there is nothing to say

Working in the emergency room puts you in positions that no one else is put in. For example, you might have to deal with somebody who did something horrific thing a criminal = a rapist, a murderer. There is no choice. There they are. You have to deal with them.

Then sometimes you are on the other side of the coin. Something horrible has happened to someone. Its not something that will get better. Ever. They will have to live with it and never be the same. Those are the times when you don't know what to say. There is nothing to say. You want to run away. Its too hard. Its ten times as hard for them. I guess all you can do is be present, treat them with respect. Listen to them.

Sometimes my job is really heavy and I carry it home with me.

no insurance: goodbye, good luck

You may have seen in the last day or so the results of a Harvard study saying that trauma patients who are uninsured die more often in the ER. I love this quote: "The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable". HAHAHAHAHAHAHAHAHAHAHAHA Yeah right.

Do you really think that if you don't have health insurance you are going to get the same care as someone with health insurance? Yeah and I have some swampland in Florida for sale.

Lets just say you aren't going to get the "Cadillac" tests. For example lets say you come in for an episode of numbness on the right side of your face. No insurance? You might get a CT scan of your head. If you have insurance, you might get an MRI which is a much more sophisticated and detailed test. Chest pain? Oh sure, you will get labs, EKG. If you have insurance and there is a hint of heart disease in your family? Off you go for a CT angio of your heart which gives a detailed picture of your coronary arteries.

That's the difference. Part of the difference is doctors not wanting to do tests that are probably unnecessary that you will be billed for personally. They don't have to worry about that if you are insured, so why not order it?

You are more likely to be admitted if you have insurance. For vague symptoms, for pain control. No insurance? Follow up with one of these community clinics which have sliding scale fees.

Its the reality of modern medicine folks. Its why everybody should have insurance.

joint commission on intimadation

So the joint commission on accreditation of health care organizations (JCAHO) came to our hospital last week. For those unfamiliar with JCAHO is an organization that makes sure a hospital is doing things according to standards. Medicare and medicaid require that we be accredited by this organization in order to receive reimbursement. They make unannounced visits every 2 years.

So starting last January, we were bombarded with information about everything we do and how we are supposed to be able to instantaneously regurgitate information if asked. Finally, we were told that if they don't come in the next two weeks, they will have to tell us exactly when they are coming. Well of course then they came last week.

There's a lot of pressure on us. Everyone fears being asked a question and not knowing the answer and screwing the whole thing up. We fear we didn't cross every t, dot every i in our charts and that they will pull it to look at. You hope you aren't there that day. Well of course I WAS there that day.

They didn't ask me a question. They focused on a patient in the department and asked that nurse questions. The guy was not nice. Seemed to get his jollies out of pointing out small details. The nurse was devastated.

My point in all this: Why is this done like this? The goal of this accreditation is to improve patient care quality. Why the intimidation tactics? Why does it feel like such a bad, scary experience. Is this what the government has in mind when they require accreditation from this group? To throw fear into the staff? Intimidate them? It doesn't make sense to me. By the way our hospital got an excellent review which makes me wonder even more...

darwinian theory in the emergency department

There are many a day in the ER I wonder to myself: Is anyone normal anymore? Are there any people who come to the ER who don't have a myriad of pre-existing conditions, social problems, mental health difficulties? This may seem obvious to all but I had one of those moments the other day where it dawned on me: THE MAJORITY OF PEOPLE WHO COME TO THE ER ARE NOT NORMAL.

I would give the "normal" person segement of the ER population 5%. These are people who come to the ER because they need the ER. They have trauma, chest pain, breathing trouble, etc. The other 95% are either crazy or neurotic, not too bright, or have abused their bodies with smoking, drinking, drugs, food and are now suffering the consequences of their bad choices.

If you are working, successful, happy, mentally stable you are not going to come to the ER unless you have a real emergency. You will go to a doctor for your common problems. You will use common sense about your health problems.

Phew, what a relief. After all these years I can relax. I can stop being frustrated by all the weird and bizarre people I see everyday. They are people on their way out of the human race, on the lower end of the evolutionary scale about to be instinct. Its all about survival of the fittest, and they definitely ain't the fittest.

on the other side of the bed

I worked in ICU 20 years ago and I worked nights so I didn't deal with doctors or families much. I've spent 2 out of the last 3 days sitting in the ICU. One thing I have noticed is that between the internal med, pulmonologist, infectious disease, nurse, respiratory therapist - everybody tells you something different.
On Saturday the infectious disease doc had my family scared shitless talking about some people didn't make it with the flu and pneumonia. My sister in law and my nieces sister went home and cried. I cried. SHIT. My niece is only 30. She has a one year old son.

Then that same night my brother called me and said that they were going to try and wean her from the ventilator today. WTF??? Yesterday, you are preparing us for a bad outcome and today she might be weaning off the vent?

Mixed messages from different doctors who come at different times. Were they trying to prepare my family for a worst case scenario? Is that what they do in this situation? If that's what they do, nobody told us. Doctors are very tight with what is going on. Is it because they think the family won't understand? Is because they are too busy to go into detail?

She is still on the vent after a weaning trial today. They will try again tomorrow. She has improved some. Its interesting and frustrating to be on the other side of the bed. It will probably my own practice.