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Medicine Can Be A Taunting, Vicious Profession At Times

By Birdstrike MD   Not too long ago, I was busy at work seeing patients. The secretary yelled, “Dr. Birdstrike, there’s a phone call for you.” “Alright,” I said. “Transfer it over.” I answered the phone. “Hello, Dr. Birdstrike, this is ***** ****** from the ****** State Medical Board,” said a jabbing, deep military sounding voice. “Uh…hello,” I said. I felt a jolt of electricity in my chest. This wasn’t a phone call I expected nor wanted. The state —-ing medical board? What, the…? “I’m calling to notify you, we’ve received a formal complaint about your medical practice and I’ve been assigned as the lead investigator.” At this point, the adrenaline was pumping through my veins, and my heart beating fast enough, that I didn’t hear much of what he said after that. He might as well have told me I had brain cancer and had 6 agonizing weeks to live. Although I have been sued before, though never convicted by a jury, of medical malpractice, I’d come to realize that whole process was more about one group of lawyers fighting with another group of lawyers, to get money from an insurance company, with a doctor and a patient as mere pawns in the game. It’s a game that can feel very personal, but ultimately isn’t, and is mostly about the trophy hoped for by the plaintiff’s attorneys: Award money. But a complaint from the medical board? It’s honestly something I never thought I’d have to face, having been someone that’s always performed at a very high level during my career, at all of it’s stages, not every having faced any significant concerns regarding my performance. Also, in my personal life, I am, for lack of a better word, a rule follower. After, the initial shock dissipated, his words gradually faded back into the ear of my consciousness. He gave me the name of the patient and the stated complaint. I remembered the patient, but I didn’t remember any particularly bad outcome, or any negative interaction or administrative complaint at the time. The accusation appeared out-of-place and baseless. He explained the process: I was responsible for providing a written response to the medical board within 15 days. After that, there would be an investigation. After an undetermined period of time, the complaint would either be dismissed outright, dismissed with a non-disciplinary letter of warning which would go in my medical-license file, or if neither of those, then I’d have to go before the medical board for a hearing. A licensing hearing? The entire thought of any of this was horrifying. News headlines of doctors who had lost their licenses for egregious and horrible misconduct flashed like shocking, intrusive, strobe-light banner-notifications across the home-screen of my brain. I did nothing wrong. Why is this happening to me? This is insane? What the —-? Am I going to lose my license? No way, I’m going to lose my license. I did nothing wrong. Nothing even happened. Wait, what happened? Did anything happen? No, nothing did. But what if I get some rogue medical board or the case is reviewed by someone with an axe to grind or from a totally different specialty? Miscarriages of justice happen all the time. Don’t they? Questions bounced around my brain like a silver pinball. I slowed my breathing down. I logged into the medical record scanning through charts and reports like a DVR player on fast forward. Wait….They have no case. THEY.   HAVE.   NO.   CASE. I started to get angry, very angry. Just like my lawsuit, where I was falsely accused of malpractice, ...

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I Remember You

By Birdstrike M.D.   I walk out of the patient room.  My eyes stare at the computer screen.  I’m behind, way behind.  I roll my head on my neck.  My neck feels tense, and I have a headache.  It’s been a long week.  I need a vacation.  Hurry up, click-click-click this computer, I think to myself.  Dammit, is this EMR really freezing up again? I look up.  A man walks out of a patient room across the hall.  Our eyes lock.  I quickly look away.  Ouch, my neck.   There are patients waiting. I need to get moving, or I’ll never get out of here, I think to myself.  I put my head down and turn to walk away. “Doctor.  Doctor.  Are you Doctor Bird?” he calls to me with urgency. Crap, I think to myself.  I’m never going to get caught up.  He does look familiar.  I hope he’s not mad at me.  Who is this man?  He probably wants to sue me, or maybe he’s angry I didn’t prescribe him those pills he wanted.  Man, my neck. “Yes?” I answer, hesitantly. “Did you work at —– —– Medical Center about 10 years ago?” he asks. He looks so, so familiar, but I can’t place him. “You won’t remember me, but you took care of my son,” he says, with a faint, but warming smile. Right then, it hits me, like a ton of bricks. “My son had cancer,” he says. “Brain cancer,” I answer, and right then my mind goes back 10 years at warp speed, back to room 10, during a chaotic shift at my first job out of residency.  I’m looking at a 12-yr-old boy laying in bed.  His eyes are sunken and gaunt, skin pale, hair blond. He’s dying of cancer and all treatments have failed.  I had never seen a child so sick, so ill appearing, yet still alive.  He looks like he’s in terrible pain.  There’s nothing left to do, but to try to make his last few days, hours and moments as painless as possible. He needs IV fluids, some pain and nausea medicine and needs to be made comfortable.  In a chair next to him is his father, dying inside.  My heart sinks.  “I remember you, and I remember him.  I even remember the room you were in.” “He died shortly after that.  But I still remember you.  You really took the time to ease his suffering, if only for a short time.  That meant a lot to me.  Most of all, you seemed to actually care,” he says. I felt a little dizzy.  I felt like I was having a flash-back of the PTSD sort; so vivid and real. I remember the chaos of the shift.  Walking down the far hallway, walking in the room and closing the door.  As the door closed behind me, the noisy chaos behind disappeared, and it was stark quiet.  I remember feeling the heart-wrenching sadness of this man sitting next to his dying son, so helpless.  I felt equally helpless.  I remember thinking, I don’t care how many patients are waiting.  I don’t care how long the wait is, or what chaos is swirling outside that door.  I need to pause and try to at least listen, if only for a short time.  I need to at least acknowledge what this boy, his father and family are going through.  I need to try to find some way, no matter how small, to make things a little better, or a little less painful for both of them, if I can.  At the very least, I need to ...

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Bloated Healthcare Costs: Are Emergency Physicians to Blame?

By Birdstrike M.D.   In an article entitled, ”Why the ER Admits Too Many Patients,” Dr. Michael Kirsch tries to explain that Emergency Department admissions are inflated due to Emergency Physicians acting in their own self-interest.  Many Emergency Physicians have read this and taken offense, feeling that his assertions point unfair blame on them for a significant portion of excesses in medical care and costs.  I share this visceral reaction in part, but such a reaction blurs some very important points worth examining.  Let’s give the benefit of the doubt for a moment, that the author may in fact be pointing the blame not at Emergency Physicians personally, but at a broken “system” instead. First, he claims that due to fears of potential lawsuits, Emergency Physicians when in doubt, cautiously err on the side of admitting a patient and ordering tests, rather than discharging them with minimal work up.  How any Emergency Physician can deny that this happens baffles me, as almost every one I’ve ever known will say in private they think about, and are motivated to avoid the threat of lawsuits (except for possibly a few in the handful of states with strong tort reform).  Physician surveys seem to support this, with at least one showing >90% of physicians across multiple specialties admitting to such.  This speaks to the greater issue of defensive medicine and the need for tort reform, and should not be seen as an indictment of Emergency Physicians.  Tort reform is an issue where the American people just plain need to decide.  Do they want to keep their cake uncut, or to eat it?  You absolutely cannot cling to the pipe dream of reducing unnecessary medical testing and expensive overly-cautious admissions while holding true to the good old-fashioned American past time of suing the pants off of a doctor who sends a patient home, only to have something unexpected go wrong.  Decide: Do you want, A-Doctors to send you home, cancel your test, and throw caution to the wind when you might be sick to save costs for the “greater system,” and give up the right to sue if something goes wrong, or, B-Do you want to retain the right to sue in court for hundreds of thousands of dollars (or even millions) if you have a bad outcome and have doctors admit you when in doubt and order every test (expensive or not) that they think they need to keep that from happening? You cannot have both A and B.   For the most part, and in most states in the land, the American people, their elected politicians and the plaintiff’s attorneys that support them, have already decided in favor of option B.  The right to sue has always come out on top (in most states) and there’s no sign that’s about to change any time soon.  To those who will respond with “science,” “data” and articles claiming the threat of medical malpractice doesn’t alter doctors’ practices or inflate healthcare costs, don’t bother.  Most physicians are not interested in hearing evidence or “data” to show oxygen isn’t needed for breathing, or that 2+2 isn’t 4, either.  There are some things we as doctors know to be self-evident.  To the extent that one blames such a drive to err on the side of admitting patients on a dysfunctional medical malpractice system, is the extent to which he is correct.  To the extent one points the finger specifically at Emergency Physicians, who have no choice in this day and age but to admit patients with the utmost of caution when in doubt, is the extent to which ...

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Cat Lady

By Birdstrike MD   “She talks to angels, they call her out by her name.” – The Black Crowes. . . The radio crackles alive, “County General…we’ve got a 20-something female……just picked her up…..bagging….we’re at your back door…” Boom! They slam through the double doors, and roll into room 8.  Lying on the stretcher is a young thin woman.  Beneath the mask over her face is a full head of golden wavy hair.  I get to the head of the bed, and get ready to intubate her.  I grab the bag and mask and start bagging her myself.  “What have you given her, so far?  Any narcan?  D50?” I ask. “No,” the paramedic says.  “We just scooped her up and had just enough time to get her here and pop an IV in.  Just lost pulses a few seconds ago.  PEA.” “Okay, give her some narcan and D50, while I get ready to intubate.  Resume compressions!  Etomidate, sux, scope…” roll off my tongue.  I look down at the patient’s face again……blond, so young, hair and face like a movie star, except for the pale-bluish dying hue.  She reminds me of Cat Woman from the old Batman comics.  She’s just about dead and much too young to die.  I don’t think I can handle another young patient death this week.  I’m filling with dread, not from anything that has to do with the medical “case” in front of me, but because somewhere out there is an unsuspecting mother, husband or child that I’m going to have to tell that she is dead.  There’s no way to candy-coat that news, and no matter how many times I do it, it still gives me chills. The nurse has just given narcan.   She starts to move.  Is she trying to breath?  I look at her face, it’s pinking up.  Did we restrain her before the narcan?  Damnit….we didn’t! She VIOLENTLY sits up, blasting upwards towards my head, ripping the mask off her face, ripping out her IV and heaves forward.  I’m looking straight at the back of her head and torso and she’s heaving forward violently grabbing at her own neck, making an awful guttural noise, contracting rhythmically.  That noise, what’s that noise?  I’m hearing my cat, she’s trying to vomit.  Is this lady trying to gag up a hairball?  Cat Lady. “Blahhhhaaaaaacghck…..blaaa…..ughggh!” I look beyond her and the nurses are staring back mortified, at the patient.  “Ahhhhhh!     Ahhhhhhh!    Ahhhhhh!” this Cat Lady is screaming.  “I’m dying here!  Help me!!!  Oh, the pain, s—t, the pain!!!” I step around out from the head of the bed to the front of the patient to see what the nurses are looking at, and on the patient’s lap is a big, gooey, mucous-covered ball of something on her lap.  Whatever it is, this patient was choking on it, it almost killed her and now she’s alive and well, though ready for vengeance. Why the heck is she screaming, now?  This thing, whatever it is, is out of her, and she’s awoken from the dead. I pick up the ball of goo and examine it.  I start picking it apart.  Why do I have to do this, this is disgusting?  I should’ve been an accountant.  Hairball, I think to myself, laughing a little bit inside.  Just like my cat.  It seems like a ball of wadded up plastic.  What the heck is this thing?  There’s writing on the plastic.  What is it? Is that an “F—–, Fe—“? “Fentanyl!  Fentanyl!” yells one of the nurses looking over my shoulder, who can obviously read through bloody mucous much better than me.  Fentanyl ...

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