First of all, I’m having blog withdrawals. Seriously. I wish I could make a living writing a blog. It would be my dream job to write blog posts and troll the internet. Maybe some day.
So a quick story before I go to bed for another long day tomorrow.
At one of the hospitals where I moonlight, many nursing homes refer patients to the emergency department for routine medical care. Stuff like “patient has a rash for a week” or “patient is agitated.” Normally, it doesn’t bother me too much, but one specific nursing home not only sends its patients in for routine medical issues, but it refuses to take the patient back unless we do the testing that their nurses want. If a patient with a history of agitation gets sent in for agitation but arrives calm, we can’t just send them back on the same ambulance. We have to do tests … special “agitation” tests … to rule out excess agitation levels, apparently. Rashes have to have skin scrapings sent. Patients found on the floor must have head and neck CTs. Haven’t had a positive one yet, but try sending a patient back without one and the ambulance will be sent back to the ED. I tried fighting it a couple of times. They’d send the patient back. I’d do another exam while the patient was on the ambulance stretcher, take vital signs, then send the patient back again. Then there would be the call from their medical director to our department chair. Bad doctor. How dare we practice proper medical care? Patient returns by ambulance for third time. Just do the friggin tests, OK?
So when patients come with
orders … er, um … requests … from this nursing home’s staff, regardless of how stupid the orders er, um requests are, we put the orders in to save time and to save administrative hassles.
Harry was the unfortunate soul who was drafted one Sunday morning. It seemed that the nursing home staff felt it was odd that Harry hadn’t had a bowel movement in two days. He probably had an obstruction. Needs an acute abdominal series and some labs.
I called BS. Harry had normal bowel sounds, no palpable masses, and no impaction on his rectal exam (sorry about having to do that on an early Sunday morning, Harry). Besides, it’s entirely normal for someone not to have a bowel movement for two days. We called the nursing home and told them Harry was coming back.
Nope. Need labs and an abdominal series.
Needless to say, the labs and the abdominal series were [gasp] normal.
So I asked Harry “Would you like me to give you something to help you move your bowels?”
Harry replied “Sure, doc. Always nice to have a good BM every day.”
We called the ambulance and made arrangements for transfer back to the nursing home … after being forced to fax them the lab and x-ray results.
So I’m curious. Would it have been mean for us to give Harry lactulose and Milk of Magnesia as the paramedics were loading him onto the stretcher to take him back to the nursing home?