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1209717_19610439The focus of this web site is medicine. In this blog, you’ll read about patient stories. The situations have been changed to be HIPAA compliant. Factual statements may or may not be true. I may change ages, gender or presenting complaints about patients. I may even entirely make up complete patient encounters from my fertile imagination. Trust me, if you think I’m writing about you, I’m not. There are billions of people in this world and readers send me stories about patients all the time. It isn’t you.
You’ll also read a lot about health care policy. I may throw in posts about life lessons, computers, and will even throw in family stories once in a while. If you’re looking for articles about politics, sports, or celebrities, you’re in the wrong place – unless the topics have some relationship to medicine.
If you want to add a guest post or to cross-post something from your blog, or if you have a patient story you want me to write about, e-mail me. See more information in the “About Me” page.

Dear Diary

It has been a long time, diary. I can’t even think of all the things that happened since I last wrote. Last time I left off, it was the squirrels. I’m happy to say that they’re gone. Mwuuuuuuhahahahaha. Actually, I’m a chicken shit. I got two types of traps. When I put peanut butter on to the lever of the live trap, I was able to catch a couple of squirrels. The other ones would simply knock the trap over and then grab at the peanut butter through the holes in the cage. So I got a couple of Ortho rat traps and caught the three remaining squirrels using those. One of them died. Two of them just got their legs caught. I made the mistake of telling my youngest daughter that I was going to go and “finish them off” after I caught them. She had nightmares for two days that daddy was killing the squirrels. In reality, I took them a half-mile away and let them go in the woods. What a sucker I am. But at least they’re gone and not chewing holes in my roof. Cracked a tooth while chewing a peanut. That was an experience. First, it happened on a Friday at work, so I couldn’t get into the dentist. I happened to have a temporary filling in my bag that I had purchased over the counter at a pharmacy. It worked amazingly well, and in fact I was considering just leaving it like that. Unfortunately, after visiting the dentist I needed a root canal. That was fun. Also had to have a superficial cancer burned off of my face. I went into the dermatologists office to have it looked at. Two minutes later, she’s putting on gloves and coming at me with a scalpel. That wasn’t too bad. Then she turns around, pulls some canister out of the closet and starts spraying me some Despicable Me – looking freeze ray mist. I think she called it “liquid nitrogen.” That stuff burns like a mother. Imagine the worst case of brain freeze you’ve ever had and then multiply that by about 10. That’s what this stuff felt like when it hit my skull. I could see this being used as a torture tactic when waterboarding stops working. So I got to make up about 15 or 20 different excuses as to why I had a chunk of skin removed from the side of my face. Dog bite. Squirrel bite. Patient attacked me. Son’s lacrosse coach at me with a stick. Shooting accident. Improvised explosive device prematurely detonated (don’t use that one at the airport). Most importantly though, when my fair-skinned kids argue with me about going outside without using sunscreen, I point to my face and ask them “do you want to look like this?” I don’t know whether their immediate assent to sunscreen use is a testiment to my good parenting skills or a reflection of their fear of growing up to look like me. Whatever. It works. Oldest daughter has now started driving. Dad has now started drinking before he takes her out driving to calm his nerves. Seriously. I just sit here and wonder whether or not I was as bad of a driver when I was starting out. I don’t ever recall running over curbs when turning a corner. I distinctly remember stopping very quickly when a crash is imminent. In our short time driving together, we’ve had several near misses. It is going to be a long time before she drives alone. And fortunately my life insurance is up to ...

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The Doctor That Took Care Of The Lawyer That Sued Him

By BirdStrike M.D.   I walk in for a shift and sign up for my first patient.  To my surprise the patient sitting on the bed is my friend and co-worker Dr. Jerry.  Before walking into the room, I notice from afar, his hand is grotesquely swollen, black and blue.  I walk in to the room and say with a chuckle, “Jerry, what the heck are you doing here?  You are supposed to be on vacation.  Wow, you must really love this place?” Jerry happens to be what we ER doctors refer to as a “machine.”  He can walk into an emergency department in chaos and seemingly singlehandedly bring it under control, with what at times seems like superhuman brute force.  Of all the ER doctors I’ve worked with, if anyone was truly born to be an ER doctor, he is.  “Close the door,” says my patient, Dr. Jerry. “What happened?  Did you fall?  Your hand looks horrible,” I ask.  “Good thing you’re on vacation starting today, because with that mangled paw you’re not going to be doing any suturing or any other procedures that require more than a stump for a hand for quite a while,” I add. “You can’t tell anyone.  It’s embarrassing.  You promise?” Jerry asks. “Sure man, no problem.  It’s between you and me and the HIPAA Gods.  What happened?” I plead. “You know my luck, and the black cloud that follows me, right?  Well, I walk in for an overnight shift a few days ago and the department’s dead.  For once in 10 years, there’s practically no one in the whole department.  In fact, there was no one in the whole department.  I sit down and I’m thinking: this is weird.  Maybe for once I’ll have a great shift and just sit on my butt all night and not get crushed with a constant onslaught of chaos.  Just then I look up, and into room 11 walks in,” says Jerry changing to a tone of doom, “Gary the Medical Malpractice Lawyer.” “Gary the Guillotine?  No way!  I thought we were the ‘most negligent group of physicians he’s ever seen in his career’?  Funny how he has sued, or attempted to sue just about every single doctor in this group and when he’s sick he comes here?!  You’ve got to be kidding me?  I’m sick to my stomach even thinking about it,” I say, trying not to gag on my words. “Yeah, it was unbelievable.  You should have seen this guy.  Yucking it up with Jane, you know, Jane the new nurse?” he says. “No.  I haven’t worked with her, yet,” I say. “You know, Jane, the one that just finished nursing school?”  Jerry explains, raising his eyebrows. “Oh…..Yes.  How could I forget?  Jane…,” I answer. “He was all over her like a dog on a rib-eye.  What’s he, 50 years old, and she’s what, barely of consenting age?  Anyways, I signal to her to get out of the room and come talk to me before I go in, because in NO WAY is it even remotely possible for me to go in the room and treat this guy objectively.  Do you remember what this guy did to me?”  Jerry asks. “He tried to sue you, like most everyone else at this hospital,” I answer. “Yes, and during a deposition, he asked me about the fact that I disclosed having been treated by a psychiatrist briefly, on my medical license application,” Jerry began to explain. “So what?  I think you mentioned that before.  You took Prozac for 2 weeks or something.  Big deal,” I say. “You’re ...

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The Case of the Bleeding Ear Takes a Bizarre Twist

By Birdstrike M.D. My shift is over and I’m ready to head out the Emergency Department door.  When I walked in 12 hours ago, the department had 20 waiting patients.  I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds.  My partner Dr. Jim looks at me and says, “Get out of here.  Don’t even think about staying late.  You can’t save the world.”  With me leaving, the department will drop to single coverage with Jim taking the reins alone the rest of the night.  Despite his words, the dejected look on his face reads, Help! It’s going to be a long and grueling overnight shift for Dr. Jim. I look up at the monitor and it says, “Ruptured eardrum.”  That’s easy, I think to myself.  I’ll stay late and see at least one more patient to help out.  I walk in the room and it’s a 16-year-old girl, in a green and white basketball uniform, with her mom and dad, who looks like he could be a retired football linebacker.  “I got hit in the ear with the ball.  I can’t hear at all, and my ear’s bleeding.  This is the second time, it’s happened.  Last time I couldn’t play basketball for a week,” she says. “Okay, let’s take a look,” I say.  I put a couple of drops of peroxide in the ear to soften up the dried blood.  Hmm?  There are no bubbles.  I clean out the ear and…what is that smell?  Do I smell raspberry jelly?  I clean out the ear more and look at the ear drum.  It’s perfect.  There’s no rupture and no laceration in the canal.  Her ear is completely normal. “I won’t be able to play this weekend, will I?” she asks.  “Just put me on the injured list this weekend, and we’re good to go,” she says with a bubbly smile.  Being that she’s 16, and still a minor I ask her parents if she and I can talk in private for a minute.  They say okay, I have a female nurse come with me, and we close the door.  “Did you put something in your ear?” I ask.  “Like raspberry jelly or something, to make it look like blood?” “Yes,” she says, looking deflated.  She then confesses that she doesn’t want to go to the tournament and concocted the whole story to have a reason to be injured, so she could go to her boyfriend’s party, instead.  I thank her for her honesty.  “Can I go now?” she asks. I discharge her and on the way out the dad comes back in, “Doc, she faked it didn’t she?  I know she doesn’t want to play in the tournament.”  Without speaking, I gave a half nod.  He smiled and walked out.  Even though I was dog-tired after working 12 1/2 hours and staying late, I finished the shift a little lighter, with a simple case where no one died, no one bled out, or inappropriately demanded narcotics. A week later prior to a shift, our ED director Dr. Bob comes to me and says, “Hey Bird, how’ve you been?  I’ve got some good news, bad news and ugly news.  Which do you want first?” “None of it,” I answer. “Okay, the good news.”  Then, with the phrase no ER physician ever wants to hear, “Remember that kid you saw last week?  The one with the bleeding ear?” “No.  Wait, do you mean the one with raspberry jelly coming out ...

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How to Get Tazed Out of Spite

One of the “regulars” comes into the ED. He has a long rap sheet of pain medication prescriptions on the state database from multiple different providers and is complaining of back pain for which he is requesting a prescription for more pain medications. The 30 Percocet that he filled three days ago have mysteriously vanished. The emergency physician tells him he’s on “The List” and tells him that he’s going to get Naprosyn and like it. The patient tells the nurse that he doesn’t want Naprosyn. The nurse responds that she can only administer the medications that the doctor orders — and the doctor ordered Naprosyn. The patient then spit on the nurse. The nurse screamed. A “code white” is called and half the hospital comes running to the ED. The patient then realizes that he kicked the proverbial hornet’s next, so he pulls a Little Jack Horner, sits in the corner, and won’t leave. He tries to kick anyone who comes near him. Police are then called. Four burly cops come busting through ambulance bay doors like it’s a bank robbery. They go in the room and tell the patient to leave. He still won’t move. When they try to pull him out of the corner, he kicks one of the officers. OK, now he’s going to jail. One of the officers runs back outside and brings in a German Shepherd on a leash with drool dripping from its fangs. “If you don’t come out of the corner, I’m going to turn the dog loose on you.” The patient sits there with his arms folded. Police have everyone leave the room. “OK, ATTACK”. Then the patient leans forward and starts talking baby talk to the dog. “Oh, there’s my wittle doggie. How’s my good doggie? Commere, boy.” The dog walks up to him and sniffs his hands. “ATTACK!” yells the police officer. The patient reaches out, scratches the dog’s cheeks, and says “That’s a good doggie. Sit, boy.” The dog sits down. “ATTACK!” Yells the police officer even louder. The dog wags its tail and stays seated. Dog gets taken from the room. Police pull the curtain. A bit of scuffling and all you hear next is the patient’s muffled yell and the rapid “pop pop pop pop pop pop pop” of a Taser being deployed. Then the curtains fly back open and the patient is dragged out of the emergency department backwards with one officer on each arm saying “Where did my widdle doggie go?” “But wait!” the nurse yells behind him, “you forgot your prescription for Naprosyn!” While Elmer Fudd speak happens to be one of my pet peeves, this incident was pretty damn amusing. ———————– This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on Dr. Whitecoat.com, please e-mail me.

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Blog Feedback

This new WhiteCoat Version 2.0 blog has taken a back seat for a month or so as my attention was focused in several other places. I’m finally getting to a point where I can start focusing more on this blog again. I’m going to ditch this website layout and set up another one. But I want to get WC 3.0 right. And I need your help. I need to know from all of you what works well and what doesn’t work well for you with this blog the way that it is set up now. The math problem CAPTCHA login for comments is a source of a few negative comments. Here’s the problem: I get so many spam comments that I can’t keep up some times. It was getting to the point that many spam comments were getting through the Akismet filters and ending up in the legitimate comment queue. The spam comment folder previously had several thousand comments inside. Using the math CAPTCHA, it’s down to a few hundred comments – and that’s including use of the Akismet plugin. I haven’t had to remove any spam comments from the legitimate comments queue since adding the math problems plugin. The more time I spend deleting spam comments, the less time I have available to write posts. So that’s a tradeoff I have to make. The other option is to prevent people from commenting unless they register on the site and confirm their e-mail – which is another option. However, I think that may effect the willingness of people who wish to comment anonymously. What’s better? [poll id=”2″] I’m aware about the “read more” links and the frustration with clicking several links to get to a page to read content. I tried fixing that within the theme I’m using, but wasn’t able to do so. In retrospect, the theme I purchased seemed geared less toward a blog and more toward a static web site. I was having problems implementing the picture slider because it kept crashing older browsers (something about HTML 5 instead of HTML 4), so I removed it. Now the site is kind of bland. I’m testing out other WordPress themes now. Trying to focus more on “magazine” formats. Have a couple that look promising and will hopefully have a new one in place sometime in the next week or so. When that happens, the site will be offline for a day or two and afterwards will hopefully look different and better. I had a couple people write me that they were getting frustrated with all the clicking they had to do from an RSS reader in order to get to the post they want to read. I’m hoping that the theme update will make it less of a hassle. To fully address that issue, though, I need to explain a few things. Right now, the only way that the site earns income is when readers view and/or click on ads. That can only occur when people visit the site. On one hand, I want to make it easy for people to read the content, on the other hand, I’m going to start paying authors to write content. So to encourage more good authors, I need people to visit the site to make that happen. I also want the site to be interactive and want people to comment on posts. Part of a blog is establishing a community – kind of like hanging out at a bar and watching a game and talking about things that interest you. Sure, there’s that guy that always has good stories, but after ...

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Pierce An Ear, Or Save A Kid?

By Birdstrike MD I took my kids to the pediatrician today for their routine check ups.  I was surprised when they tried to sell me on “Medical Ear Piercing” for our kids. It turns out even Pediatricians now are forced to dabble in their version of cash-pay cosmetics and other non-medical side projects, to be able to continue the “luxury” of actually continuing to treat patients. An example (not my kids’ actual pediatrician): If you’ve got cold hard cash, “We charge, $80 for the piercing, which includes the earrings and local anesthetic.” Heck, why stop there? Bring your doll to the office and we’ll pierce her ears, too, for an extra $14! Get your doll’s hair done for an extra $25, add the doll-spa deluxe package for $12, and get your doll a facial for $5 with the Pampering Plus Package, like they do at AmericanGirl!  Let’s make some real money. We’re up to $136 now! What does New York State Medicaid pay a Pediatrician to actually treat a child? $37 – (CPT 99213, typical follow-up visit) What does New York State Medicaid pay an Emergency Physician to see a child in the ED? $56 – (CPT 99203, typical new pediatric patient visit) With an average cost of medical school of $278,455 at private schools and $207,868 at public ones with student debts reaching up to $400,000 in some cases, is it any wonder doctors, including Pediatricians now are bailing out of the traditional practice of Medicine in favor of more superficial endeavors involving cosmetics and non-clinical careers? Is this next for Pediatric Emergency Departments: “Go to the front of the line: Bilateral Ear Piercings for $80 cash, in 15 minutes or Less, Guaranteed!” (Oh, and by the way, we take care of emergencies, too! )

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