Tag Archives: doctors

CYA culture run amok

One of my most hated things is going to the airport for calls. Some of the most ridiculous calls I’ve been to were at the airport. In short, airlines love passing the buck to 911 so they can cover their asses.

Obviously, many of you are familiar with this phenomenon of entities calling 911 so they can pass on the liability. Not just airlines, but doctor’s offices, schools, SNFs, dorms, rehab, shelters, group homes, buses, trains, taxis, etc. Basically everyone. Instead of THINKING, it’s easier to press a few buttons on the phone and let someone else take care of the problem. Just because it’s ubiquitous doesn’t mean it’s right.

By now I’m sure many of you have heard of The Great You-Can’t-Fly-Alaska-Airlines-If-You-Have-Cancer Incident. Basically, on Monday, Elizabeth Sedway, a woman with a 5-year ongoing battle with cancer, was kicked off her flight home after Alaska’s on-call doctors said she didn’t have a doctor’s note and wasn’t fit to fly. Of course, as usual, Alaska said it was “policy” to consult with their on-call doctors, who obviously remotely determined that she was too ill to fly. Good job. A monkey can do that. Stranded in Hawaii, she then missed chemotherapy back home in California on Tuesday, and her husband and kids missed work and school.

Like Ms. Sedway said, in more polite words, how the fuck did Alaska think she got to Hawaii in the first fucking place?

This is just like those stupid advice line nurses who insist everyone who calls them calls 911 instead.

So what if she had a doctor’s note? Is the note a guarantee that absolutely nothing bad will happen? Can you blame her doctor if something happens to her while having a note in her possession? What about everyone else on the plane who doesn’t have a note? Shouldn’t they have notes to guarantee that they won’t have a medical emergency? If airlines are so worried about safety, isn’t there more of a chance that some drunk asshole will disrupt the flight instead?

Who says you have to be smart to be a doctor?*

Code 3 for leg cramps. I’ll let you read the call notes instead of repeating the radio dispatch. I copied and pasted the notes because I was unable to bring myself to type this garbage.

RP IN MEDICAL MOBILE UNIT
2 PTS
ONE WITH CRAMPS
OTHER WITH SWOLLEN LYMPH NODE

What. The. Fuck.

Because it’s second-hand info, it’s non-triaged. Because it’s non-triaged, MPDS says it’s Delta. So it’s lights and sirens.

I’m not MPDS so I’m not responding lights and sirens. I dare them to fire me. So we drive VERY SAFELY over to this location for this bullshit.

Apparently this is a mobile medical clinic for the unbelievably large homeless population that this city hosts. A county-run clinic. A county-run clinic that is now overtaxing a county-overseen EMS system. An EMS system that is stretched to the limit. Stretched to the limit by endless bullshit calls. Like this bullshit call. These two bullshit patients.

The physician in charge of the clinic greets us, and at least he’s not so stupid that he can’t see that I am not hiding my displeasure with him.

“You people couldn’t arrange a van or something to drive them and you had to call 911 for what is obviously not an emergency?”

“Well…”

“You’re a county program that is abusing the EMS system exactly like the idiots the county, your employer, is actively trying to discourage from calling 911? You know the hot new topic in public health is how to get people to stop calling 911 and going to the ED, right? So all along your transport plan for these patients is to call 911? Why even have this clinic then? Why don’t you just stay home and tell them to call 911 directly?”

*Obviously, I meet a lot of doctors at work – at hospitals, clinics, concerts, first aid stations, etc. Oh, and the EMS medical directors who do nothing but cause me headaches. Let me just say that the notion that only very smart people can be doctors was long ago shattered into a gazillion pieces.

You can do whatever you want if you’re not EMS

Every 2-3 years, I have to take awful mandatory re-cert classes for CPR, ACLS, PALS/PEPP, ITLS/PHTLS* and God knows what else in order to keep my license. Not only are these classes a huge waste of everyone’s time, the instructors uniformly terrible and without actual street experience, but do you ever get the feeling we, EMS, are the only ones who actually have to follow the treatment guidelines set forth in these classes and subsequently adopted by local policies and protocols? I swear to God, I always see hospital staff doing whatever the hell they want and administering whatever drugs the ED attending can think of. And then they question all the up-to-date, by-the-guidelines treatment we did and did not provide beforehand.

*The timestamp for this link to an earlier post about re-certs is nearly 2 years old. I guess I do get really cranky around re-cert time.

Can’t ever win

Basic ED:

“Why didn’t you bring him to the trauma center?”

Trauma center:

“Why did you bring him here to the trauma center?”

You didn’t know this?

Code 3 for sick person with a headache and abnormal breathing.

Abnormal breathing? MPDS and its “priority symptoms” are really annoying.

A disinterested firefighter waves us down a long driveway, flanked on both sides by dilapidated living units.

“We come here all the fucking time.”

It’s a 30-year-old woman with a headache. She’s carrying her baby in a car seat and walking toward the ambulance from her residence with the rest of the fire crew. Apparently the second adult woman who hands her the car seat can’t watch the baby.

“She can’t watch the baby?”

“We already went through all that with her.”

“Sorry guys. Just asking. Get in.”

This woman is flat, impolite, doesn’t want to answer questions and obviously has some sort of mental and/or personality defect. I keep the interactions to a bare minimum and taxi her to the ED.

She walks into the ED, and a few minutes later, the charge nurse approaches.

“Can she go to the waiting room so we can fast-track her through Quick Care and get rid of her?”

“Of course.”

“OK, walk her out there, and let me just get the doc to make sure she’s OK with this.”

As the patient plays on her phone, the ED attending comes over.

“What’s she here for?”

“Headache.”

“People call you guys for headaches?”

“People call us for all kinds of unbelievably stupid stuff. You didn’t know this working in the ED?”

Everybody loves lawyers

We bring a new-onset dysarthria to the ED.

Everyone in the room knows this is a legitimate patient who should go to CT as soon as possible, tPA or not. The attending blows through the NIH Stroke Scale while the staff gets everything else ready.

“CT’s ready. I’ll take her there, OK?”

“No. We gotta scan P first. I wanted him scan yesterday, then this one can go next.”

Huh?

I do my paperwork, and then nudge one of the nurses in the ribs.

“Hey, what do you have in P that’s so interesting?”

“Nothing. Some anal retentive malpractive lawyer.”

Somebody needs some coffee

I’m standing at the counter at the nurses’ station doing my paperwork. We brought in a man with chest discomfort; he’s in a room just within earshot. He has a history of LAD occlusion. As is understandably common with such more educated patients, he said his discomfort has subsided, but was equivocal about it, calling it “zero to one-ish.”

The staff is getting him set up, and I can hear the hubbub of EKGs, him undressing, gurney rails clicking into place, etc.

“I’m Dr. <insert name>. Tell me what brings you to the ER tonight.”

It’s 3am. I zone out for a few seconds as writer’s block sets in.

“No! I will NOT accept that answer! It’s either yes or no! You either have discomfort or not!”

He sounds downright angry. A couple of nurses at the station and I exchange puzzled looks.

“Whoa… AH-GGREH-sive…”

I’m not a doctor, and I get that he’s trying to decide whether or not to medicate the patient, and he needs his history, but take it easy on the poor fellow. Grilling him about whether he’s subjectively rating his discomfort a zero or a one seems a rather academic exercise with this particular case. Given all the details of his complaint tonight, does his management really hinge so much on his rating of the discomfort that he needs to be yelled at as if he’s a willfully difficult teenager? This guy is, in all likelihood, probably barely keeping it together, wondering and worrying, first and foremost, if needs another cath, perhaps even fretting that he should have shaved*.

*His groin