Two patients both in their 40's. Both present with similar symptoms of burning chest pain. Both have negative histories. Both have normal EKGs and normal VS.
Patient number one is seen by doctor A - gets cardiac labs which are normal and a GI cocktail which completely relieved the pain. Discharged home after 1 1/2 hours with a prescription for Protonix.
Patient number two is seen by doctor B - cardiac labs, IV, EKG, Sublingual nitro x 3 followed by a nitro drip, IV lopressor q 5mins x 3, chest xray which was normal oh, I almost forgot - a slightly elevated d-dimer so the patient had to go for a chest CT to r/o PE. Discharged after 7 hours when the hospitalist refused to admit the patient.
Guess which doctor managed to see all of my patients today?
Please pass the wine.
Wednesday, October 1, 2008
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16 comments:
I'm sure Dr B had the uninsured pt who cannot a afford a thing. If we had alot more of Dr A's, healthcare wouldn't be so expensive and our job would be alot easier. (no angry pt's complaining about the loooong wait for their "emergent" knee pain for the last 2 years)
We don't see much of Dr. B. When we do, s/he's usually a younger doc who hesitates to bear the burden of decision-making (send 'em home) without 10 validations or confirmations. Our older docs are cautious, but what you described here is way over the top if it really happened. A little observation maybe; but the drugs? CT? ???
I know this is completely OT but I was wondering if you could help me out with something. AOL Journals is being deleted as of Halloween and most of those over there that have blogs are moving to blogger. The question I have (and I tried figuring it out on my own without bothering you) is how did you get the subscribe via email gadget? There are several of us who would like this put on our new bloggers but I'm having trouble finding the gadget for it. Thanks so much. Even though I rarely comment, I read frequently and kept subscribed to you, even when you temporarily quit blogging in a hopes that one day I would receive that email. ;)
Hmmm- you have to case by case. Occasionally there is SOMETHING that makes you worried about a patient and you wind up doing an excessive workup. The difficult part is being like Dr A most of the time but knowing when to become a temporary Dr B.
Jamie, the subscribe via email comes from feed burner, check out their website.
ERP - Dr. B is doctor B all the time. Dr. A knows when to be Dr. B.
jeez, are you SURE I don't work with you and I haven't met you yet?
We have Dr Cell Phone - reachable at all hours, amenable to suggestions, actually comes in and LOOKS at his patients....
And Dr Page? what page? who has said, more than once, "She's old. She's crazy. I don't care what you do with her" when called about a patient in resp. distress.
I am a nurse from Spain, but patients are patients around de world.
I agree with ERP "Occasionally there is SOMETHING that makes you worried about a patient" and I recognize the stress in this " The difficult part is being like Dr A most of the time but knowing when to become a temporary Dr B.specially when you are working many hours. Many things to choose in a little time.
Man, we have a few Dr. B's in our ER that make me want to scream. When we have three or four Dr. B's on, I have to get ABGs on everybody, nebulizers times three for people who coughed one time earlier, and so on.
Then I'll come in on a day where we have a bunch of Dr. A's on...and I'll do half as much work.
It's amazing.
Wow- you sure describe any given shift for me. We have about 3 Dr B's, and some great Dr A's. But you forgot to mention the Dr C's- the ones who are so bent upon making ALL the decisions, that they refuse to go in to see a patient if you tell (ask) them to, doesn't like anyone to do verbal orders, gets slower the minute he gets busier, gets crabby if you ask them 5 times to 'please' go see the LOL on 7 who can hardly breathe and has a huge cardiac history. Guess what- if that patient crumps- whose fault is it- mine. I have carpal tunnel from charting how many times the doctor was informed of pt status. I hate control freaks.
I agree- if more doctors used prudent judgment to become Dr B's only when needed, then our poor patients wouldn't be strapped with a $3K workup for a pulled muscle. Everyone is afraid of getting sued. That's a big one.
Labs, CT, IV, meds...you guessed it! Dr B works up a toothache in our Fast Track! Makes ya wanna turn around and walk out when you see Dr B at the desk when you walk in for your 12 hour (soon-to-be) shift from H**L!
We have doctors that order CT's and the full work up on everyone. We solved that problem by having an ED observation area that we send pt's awaiting serial cardiac enzymes and stress tests to. I have a doctor who thinks he is god. Yesterday I had a pt that was diverted from a hospital that I had left because overcrowding. I knew this pt well and she had chronic pain. The pt was very lathargic but her vitals were fine and she was being monitored. The problem was my doctor decdied to give her narcan. I asked him why and his only responce was the hospitalist will want to know why I didn't. The pt woke up in severe pain moaining and yelling. She could be heard through out the ED and when I asked the doc to go reassess his pt he refused and told me to give her some ativan. What a joke. This guy is just wrong.
Hi, I could really relate to this post! So many times you just have to shake your head when you see a particular doctor working up a patient and you KNOW that they will over-investigate x1000 and the stay will be soooo long for the patient..
Frustrating stuff! I know one doctor in particular that just has to have CT on just about all his patients, just in case!
that is so true.....we have about 3 Dr B's in my ER....the days they work.....it sucks!!
I swear. Every ER is exactly the same. Exactly.
I feel your pain.
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