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Random Thoughts – Dragonisms, “They,” and Lemonbreasts

Dragon NaturallySpeaking is both good and bad for medical charting. On one hand it gives you real-time chart entries without having to spend an inordinate amount of typing. On the other hand, it is an imperfect science, leading to voice recognition errors I’ve dubbed “#Dragonisms”. A couple of the latest are as follows A guy was beaten up at a bar. He has injury to both feet when the assailant stomped on both of his feet. I dictate “no injury to patient’s knees.” Dragon spits out “no injury to patient’s niece.” True (at least I think). Wouldn’t it be ironic if the patient’s niece was involved in the bar fight. I dictate that a patient with abdominal pain has a history of “ovarian cysts.” Dragon somehow comes up with the patient having a history of “a brain systole.” Maybe a new way of describing seizures? *** We’re getting lots of referrals for emergency department evaluations from “They” lately. It used to be the evil “Sumdood” – as in “Sumdood just whacked me on the side of the head with a shovel” … which then led to a bunch of additional questions about why someone not singing “Hi Ho, Hi Ho” would be walking down a city street carrying a shovel over his shoulder to begin with, but that’s beside the point. Now it’s more of a vague group of people who are prompting emergency department visits all over the country. “They” said I look dehydrated. “They” said I have an abscess. “They” said this vomiting may be my appendix. Who are these mysterious medical advice savants? Who knows? When asked who “They” are, the patients respond with statements like “people” (meaning that they must be doing random polling on the streets alongside of the people asking whether Trump sucks), “my doctor’s office” (technically personifying a building, and, in addition when the people inside the building are called, they often disavow making any such statements to the patient), and then there’s “my Auntie” (which brings forth vivid pictures of a little old lady knitting a scarf while rocking in a rocking chair, hawking spittle into a spittoon and saying “your second cousin nearly died of appendicitis and all he had was vomiting – you should get that checked”). *** Came across a neat web site for women. Shows many different presentations of breast cancer by comparing boobs to lemons. Check it out. https://www.worldwidebreastcancer.org/ *** Oh. I’m going through my Medical Blog Links. Wow have a lot of blogs bit the dust in the past couple of years. If there are any medical blogs that you read which should be on the list, drop me an e-mail or leave them in the comment section. I’ll try to add them soon. Thanks!

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Helloooo … ooo … ooo [echo]

Lots of cobwebs in here. Heck. I don’t even recognize the new WordPress control panel. So I made a New Year’s resolution that I’ve already broken. I resolved to post once a week on this blog of mine. Here we are at Week 2 and … nothing. I counted. I have 24 pieces of paper sitting in a file on my desk with posts just waiting to be written. People have sent me stories to post and I’ve not been very good at checking e-mails, either. I’ve got another dozen or so half-written posts in an Evernote account. That’s enough for almost a year if I do one post a week. So what’s the holdup? I thought long and hard about why I stopped writing. The root cause of the problem was that I like writing about policy. What I think we should do in medicine and why. But writing a compelling post about a single topic sometimes takes all day. Time isn’t on my side in that regard. Family. Work. Disaster after disaster. But I miss writing. So I decided that instead of taking all day to write about a specific topic, I’d treat the blog kind of like an extended Twitter account. Twitter gets on my nerves any more. Yes, I agree that Donald Trump is a jerk. I don’t need a running account of his alleged inherently evil actions from every person who was upset that Hillary Clinton lost the election. Spend your energy on things more productive than the “Tweet” button. Give the guy a chance and see what he can do for the country. So I’ll just post short thoughts about things that cross my mind. Progress on health goals. Throw in some patient stories. Policy issues if I get motivated and have the time. Bring back the Open Mic days to see what’s on everyone else’s minds. I’m dictating things into voice recognition on my phone while driving. I tried it a couple of times and it works OK. Need to do quite a bit of spell checking, but it works. If nothing else, you’ll get some new #Dragonisms. I’m going to clean up the site a little too. When I get more time. There are a lot of old blogs to get off the “Links” page and a lot of new ones to add. What pushed me over the edge to get back to the keyboard was someone who just wrote me an e-mail thanking me for what I do for doctors. Here I am thinking I don’t do much of anything. But people apparently enjoy reading stories and they like someone who will write about what many people are afraid to write about. As in … how’s that Press Ganey bullshit going lately? We’ll see how this New Year’s resolution pans out. Don’t expect a lot … all three of you who still check this blog once in a while. At least I took the first step. Second step: My first patient post already written up. Check back tomorrow.

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Dear Diary #21

So, diary, it’s been almost a month since my last post. I keep writing things down to post about, then when I make time to actually sit down and write the posts, something comes up – almost without fail. I’ve had five days off of work and today – the night before a string of shifts – I finally have a little time while the family is out doing errands. This whole 2016 year has been quite trying. I already went through some of the stuff that’s gone on in my last diary entry. The hits keep coming. Daughter WhiteCoat’s car needed almost $1000 in repairs. Then, within 2 weeks, it broke down again. Estimates were another $1500 to repair it this time. With 200,000 miles on the vehicle, we opted not to throw good money after bad. Instead, we financed a used Toyota with low miles. We surprised her with it and watching her dance around the yard yelling still makes me smile. We parked it in the driveway and parked her old car behind it. The following morning, she gets in to drive to school, forgets that her old car was behind her, and backs into the old car, gouging her rear bumper. She didn’t want to tell me about it, so she went to Sherman Williams and they tried to match the paint based on a picture she took on her cell phone. Now it looks worse than it did with the scratches. I am NOT replacing the bumper. I’ve got a used BMW that I got for a good price off of CraigsList. That is the first and last time I’m ever buying a BMW. I used to like to work on cars. Now you can’t do it unless you have a degree in advanced computer programming. Battery went bad about 6 months ago. Can’t just purchase a battery and replace it. Have to purchase a special battery and register it to the car. Cost: $500. Driving to work and suddenly get this message that pops up on the navigation screen. “Turbo output failure. Car is safe to drive. See dealer immediately.” Take it back to dealer. Nothing is wrong with the turbo. A total of four sensors went bad. Sensors, mind you. The cheapest one was $189. Most expensive sensor was $629. Total cost to replace bad sensors was more than $1500. Looks like I’m working a few more shifts in the emergency department next month. My trusty color laser printer took a crap on me as well. Purchased new toner and now it has banding on all the prints and the color looks like everything has been mixed with mud. So I take apart the printer, vacuum out the insides, clean the corona wires and the drum, put it back together, no change. Reinstall the printer drivers. No change. Fortunately, I have a second printer in the basement. Same brand and model. Had it at Mrs. WhiteCoat’s office for a while and then she went to a straight black and white printer. Lug that printer upstairs and switch it out with the first printer. Plug it in. Error message. Look error message up on internet. “Laser malfunction. Take printer to nearest service center.” In other words, throw both of the printers in the garbage. But wait! When you leave the printers on the curb, the garbagemen won’t take them. Even the shifty-eyed guys in the pickup truck that drive around the neighborhood before the garbage trucks get there and dump over garbage cans looking for loot won’t take them. No. We have to take the printers to the recycling ...

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CMS Announces New ICD-10 Code for Sleeping Nursing Home Patients

Wondering if GomerBlog has any openings … In its continuing effort to improve the accuracy of medical coding, the Centers for Medicare and Medicaid Services has announced a new ICD-10 code related to emergency department medical care. CMS spokesperson Marcella Skinner explains: We have noticed an increasing trend of payments for emergency department patients sent from the nursing home in the middle of the night for evaluation of lethargy and being difficult to arouse. Initially, this appeared to be an anomaly, but when we analyzed the data over the past 10 years, we saw that this phenomenon has been occurring even before implementation of ICD-10, but under a different billing code – V60.5 (patient caregiver wants an afternoon off). Of course, this new code will be paid at a lower level since all patients in REM sleep are difficult to arouse, but at least it helps us track the sleep/wake cycles of our nation’s nursing home residents. The new CMS ICD-10 code will be ZZZ317x – “Difficult To Arouse Due To REM Sleep – Nothing Really Wrong.” This code will supplement current ICD-10 codes of FULMA06c – Difficult To Arouse Due To Annoyance with Nursing Staff and OOPS08a – Difficult to Arouse Due to Previously Unnoticed Rigor Mortis. Dr. Laurence Carmichael, Director of the VA Medical Center in Plucksburg, VA applauded the new change. “For years we’ve been making up symptoms so we get paid when wide awake smiling nursing home patients get transferred to the emergency department in the middle of the night. Now the government has finally recognized our plight and has created this new easy-to-remember code so that we can be compensated for our services. What a great step forward!” Mary O’Leary, president of the American Nursing Home Association, had no comment. ———————– 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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Dear Diary #20

Dear Diary This week has been hectic. Today capped it off. The emergency departments have been consistently overcrowded. We’re running at more than capacity lately. Patients are calling all the different emergency departments in the area to inquire about the shortest wait times. Some patients have even told me that they set their alarms for 3AM to wake up and come to the ED to avoid the wait. Still doesn’t work. The wait may be shorter, but there’s still a wait. And we haven’t even hit flu season yet. I’m worried what things are going to look like when that happens. One of the consultants on staff at our hospital is a jerk. I’m officially fed up with him and his attitude. He treats our secretaries and nurses like crap (which I didn’t know up until recently). I called him about one of his patients in the middle of the night. I’ve been practicing a while – longer than Craftsman the Consultant (see explanation below) – and had never seen a presentation quite like what the patient had. I described what was present on physical exam, labs, and x-ray, then gave him an idea of what I was thinking. He wigs out. “All you’re giving me is symptoms and physical findings. What do you want me to do about it?” “First, I also gave you x-ray and lab finds as well. Second, I’m looking for your help trying to figure this out.” “Well you have to admit you gave me a pretty piss-poor reading of the x-ray” “I’m not admitting anything. You want me to text you a picture of it so you can do a better job?” “No. That’s not the point! You’re supposed to be a doctor and you need to make a decision!” “Fine, I’ve decided that you need to come in and see the patient. Now.” “Who is your boss? Because I’m going to call him RIGHT NOW with this bullshit. You hear me?” “Don’t worry, you can talk to him when you’re explaining your attitude at the next Medical Executive Committee Meeting. I’m writing all of this conversation in the medical record and then forwarding a copy to the chair of your department and the MEC tomorrow morning.” “Whoa. Wait a minute. We’re obviously both a little upset. Now let’s figure this out.” “No, you’re upset and you’re coming in to see the patient so you can figure this out.” “I’m NOT coming in to see the patient. You can have her see me in the office in two days.” “Unacceptable. If you don’t come in to see the patient, then I’m admitting her and noting in the chart that it was because you wouldn’t come in at my request. Then you’ll get consulted on her for the morning.” “You do what you have to do.” “Don’t worry. I will. Have a nice evening.” The thing is, after the phone call, about four people magically appeared from around the corner and started high-fiving me. “That was great! Someone finally put him in his place.” “What a dick. It’s about time someone gave it back to him.” Only then did I hear about how miserable he’s been to other staff. So we decided to name him Craftsman – because he isn’t just a tool, he’s a power tool. Today pissed me off. I had planned to write several posts today, but it didn’t happen. First, Daughter WhiteCoat’s car wouldn’t start. When it did, it made some horrible grinding noise that sounded like the transmission is going bad. This is just after Mrs. WhiteCoat’s car needed $2000 in work (including new ...

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Prayers for Harold at Christmas

Some of the WhiteCoat family spent our holiday a little differently this year. I gave my oldest daughter some money. Usually I’ll go out and buy things for less fortunate people and donate them. This year, I gave my daughter the money. I told her she could spend it on whatever she wanted, but she couldn’t spend it on herself or her friends and she couldn’t keep it. Her brain went right to work. She spent $100 on food and lunch bags, then spent another $75 in two different Salvation Army stores purchasing all of the remaining hats, gloves, and blankets. And we got a slider whistle. Had to get one of those. We went to a pharmacy and got a few bottles of medications. Then we went to a department store and spent the rest of the money on toys. Once we got home, we wrapped all of the toys and put ages for the children on the outside of the wrapping. We wrapped up the medication in a bag and put a $50 gift card inside. Then we made about 70 lunch bags full of sandwiches and other food. My daughter made sure to write “Have a Merry Christmas. Someone is thinking about you” with red marker on every bag. We packed everything in the car, talked my son into joining us for the ride, and took off. First stop was an apartment complex. The grandmother to one of my daughter’s friends was having trouble paying for her medications. My daughter remembered what some of the medications were and picked up a few bottles of the over the counter meds. The grandmother had no idea who my daughter was when she knocked on the door. My daughter was wearing fake elf ears and told her that there were some medications in the bag and a gift card to purchase some more medications later. Merry Christmas! And she was off. Next stop was the nearby homeless shelter. We dropped off a bunch of wrapped toys for the children. A tear rolled down the face of the man at the desk. “This will mean so much to the kids. Thank you.” A tear rolled down all of our faces as we walked back to the car. The final destination was Chicago. More than an hour’s ride and we sat in a lot of traffic, but we finally made it into town. We got off on one of the exits and there were three people hanging out on the side of the street. I slowed the car down to hand a lunch bag to an older lady, but the light was green and the car behind me laid on its horn and flashed its lights. I pulled through the intersection and pulled over to the side of the road. The older lady was stuck on the other side of the intersection. The two other fellows ran up to the car and we gave them lunch bags. One of them took off walking while ripping the wrapping off of one of the sandwiches and stuffing it into his mouth. “Hey – can you give one to the lady across the street?” I asked the other fellow. “Sure. No problem. I’ll probably give her mine, too. She doesn’t have much.” We gave him a couple of extra lunch bags. We’d catch people hiding in alcoves. My son would jump out of the car with a lunch bag and some gloves, run into an alley into which few others would willingly venture, and come out with a big grin on his face. My daughter would walk up ...

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