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Tag Archives: Guest Posts

My Secret Addiction

By an Anonymous Emergency Physician Hi. I’m Anon. I’m a 44 year old emergency physician. And I’m an addict. My addiction came to light when my Press Ganey scores plummeted after I started to stand up to the chronic pain and frequent ER patients. The fact that I have an addiction was reaffirmed when I went to my state’s Prescription Drug Abuse Summit. When I saw so many professionals from varying fields (medicine, law enforcement, pharmacy, education, etc…) assembled, I realized my problem: I’m addicted to prescribing pain medications. As with any addiction, the first step in treatment requires acknowledgement of the problem. I thought back to how my addiction began. Coming out of medical school, there is a certain power that comes on the first day of residency. You suddenly have the power of the pen. You can write prescriptions for low blood pressure, high blood pressure, low blood sugar, high blood sugar, too many bowel movements, not enough bowel movements.  The list goes on and on. But one of the largest ways in which we can help patients is by treating their pain. Controlled substances. Yes, the new physician quickly learns that the pen wields an awesome power and an awesome responsibility. This feeling fades quickly in the face of an 80+ hour work week. Fast forward 5-10 years. You are seeing 10-12 patients at the same time, all the chest trauma goes across town, and you have a waiting room that is 20 patients deep, and you already know the medical history of ten patients waiting to be seen on the tracking board. Hospital administrators pressure you to make sure that all nonemergent patients are treated and released within 90 minutes. All admits must be up to the floors within 240 minutes … if only the medicine consultant would get down and actually see the patient. It’s not uncommon to see 40 or more patients in a shift. I make it a point to look up the prescription/controlled substance database our state has. This has been an absolute lifesaver to me and to several patients I have confronted. The problem is that it takes time: – 2 minutes to look up the patient and print off the list – Another minute to count up the number of prescriptions (it does take time to count to 50 or even 72 – my personal best record for one year) – Another 3-5 minutes to go to the room and confront a patient who has an issue – Then a few more minutes to sit down and document the conversation. So I have 10 minutes to evaluate a patient, create notes in an arcane electronic medical record, and discharge the patient. Yet all of that time can be taken up by doing what is right with drug seeking patients. I cherish the ability to “catch” someone who is diverting drugs, to be able to sit down with them and have that “aha” moment. I have even had a few patients come back and thank me for confronting them. But my worth is partially measured by the number of patients I see per hour. My worth is also partially measured by my patient satisfaction scores. It’s not all possible. Why do I and so many other physicians have this addiction? NOT providing the prescription is very hard. It takes time to do the research on the patient. Confronting the patient with a problem is emotionally draining. Doing it 5-10 times in one shift is not only a reality, it is downright crippling. It sucks out last bit of energy out of ...

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It Didn’t Feel Like A “Win”

By Birdstrike M.D.   My kid and I are outside in the front yard blowing bubbles, enjoying the blue skies and 70 degree weather when she says, “Cool Daddy! Look, there’s a police car coming down the street. Oh, cool! I think he’s coming to see us!” Uh, oh, I think to myself. Despite my kid’s excitement, I know that rarely does anything good come delivered by a policeman. My wife is inside, my one kid is with me and my other is inside, so they’re not coming to give me some tragic news. Or are they? My parents….my siblings….is everyone okay? Why is a sheriff pulling into my driveway? I exhale for a minute. Maybe it’s Jim, the officer that lives in the neighborhood, I think to myself. He’s probably just stopping by to chat or say, “Hi.” As the car rolls closer, squinting to look beyond the window glare I see that it’s not Jim. It’s an officer I’ve never seen before. Clearly none of us has done anything to get arrested…. “Daddy! I wanna go see inside the police car! Daddy, will he give us a ride? Ooh, ooh, can I see his gun? Cool!” says my kid, jumping up and down with excitement. “Let’s see what he wants,” I answer. The driver door opens. A huge officer gets out, in grey uniform, bulletproof vest bulging underneath, with black wrap-around sunglasses, and a toothpick in his mouth. “Are you Dr. Bird?” he asks, as serious as a heart attack. “Yes, sir,” I answer. “I got a present for ya,” he says, as he pulls a thick rolled up stack of paper from under his arm and hands it to me.  “Here’s your subpoena,” he says. “My what?” I stammer. “What’s this all about?” “You’re getting….” he starts before, “Daddy! Daddy! I wanna ride in the police car. I wanna see the lights go on! Yay!” says my little one. “…sued,” I finish the sentence for him. “Yes, sir. You and every other doctor in this county it seems like. I’ve got about a dozen more to go serve. These lawyers are unbelievable. (laugh) I happen to know this one will sue you for breathin’ and win, too. You know, the one on the back of the yellow pages? You ever run into any trouble, though, you call him. Trust me, he got me out of a jam one time,” he says with another grunt-laugh. “Wow. Thanks for that wonderful advice. You’ve really brightened my day,” I snark back at this guy, who apparently thinks it’s hilarious to be part-time process server and part-time comedian. “Oh, don’t take it personally. It’s just business,” he says chuckling, as he spits out the same old lie and cliché I’ve heard a thousand times from doctors who’ve been sued. “That’s great. Thanks. Anything else I can do for you today, officer?” I ask, dejected. “Oh, yeah, I’m gonna have to give you a ticket for parking your car on the street overnight….Just kidding!” he says, and give’s a snort-laugh. This guy’s unbelievable, I think to myself as I turn to walk away. “Don’t worry, Doc. You’ll win that case. That lawyer will sue a dead dog if he could get it to settle for a bone and a biscuit,” he says. “Uh, thanks for your…uh, support,” I say, shaking my head in disbelief. Yep, it happened. After about 30,000 lawsuit-free patient encounters I finally got hit with a lawsuit. I guess 29,999 out of 30,000 isn’t bad, I think to myself. What’s that, 99.99% accurate? Well, it’s still not perfect; still not ...

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Comic Relief

Another cartoon courtesy of Mednificent Comics. The answer to the question at the end … “absolutely”

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That’s Some Serious Constipation

By Birdstrike M.D.   “Help.  Help!  I need something for the pain!” I hear a woman wailing from Emergency Department room 4. “What’s that all about?” I ask Veronica the nurse.  “I guess I need to see that one first, don’t I?” “No.  She says she’s got constipation and no other problems.  You need to see room 7 first, which is a 70-year-old male with back pain, hypertension and a family history of abdominal aneurysm.  He might have an actual emergency,” answers Veronica. “Definitely, and thanks for letting me know,” I say, as I walk in to see the possible abdominal aortic aneurysm (AAA) patient.  I glance at his vital signs.  They are totally normal.  I walk in the room and he’s sitting on the stretcher eating a triple cheeseburger, smiling and says, “What’s up doc?” “What brings you in here today, Sir?” I ask. “Oh, nothin’.  My back hurts.  I think I pulled a muscle,” he says. “Have you ever been told you have an abdominal aneurysm?”  I ask. Out of room 4 and into my ears, blast some more primordial screams, “Oh.  Oh!  Ooooooohhh!” “No, I’ve never had one, but my dad died of an aneurysm.  I’ve got high blood pressure, though.  You better go see that lady, doc,” he says.  “I’ll be fine.  You go check on her.” “Let me feel your abdomen,” I say.  I can’t feel any pulsating mass.  I push a little deeper: still nothing.  I feel his radial, femoral and foot pulses: they are all normal.  I finish my exam and put in an order for a CT aortogram,  along with the rest of his workup.  “Sir, I need you to put the cheeseburger down, until we get this checked out, okay?  We need to keep your stomach as empty as possible until we know what’s going on, alright?” “You got it, doc,” he answers. I move on to room 4.  “Oh.  Oh!  Heeeeeelp!   I need a laxative.  Please, something for the pain,” screams an obese 42 year-old Caucasian woman. “That should be no problem.  Just tell me a bit more about what’s going on, ma’am,” I ask as she paces the room, obviously very uncomfortable and anxious out of proportion to a case of constipation. “It’s been about a week since I had a bowel movement.  I feel  r e a l l y  bloated,” she says.  “Whoa.  Whoa!  Whoa!”  she moans, then takes a few slow, deep breaths.  “It feels like I’ve got an 8 pound ROCK stuck down there binding me up.  Please!  Give me a laxative, an enema or something.  Stick your hand up there and take it out, I don’t care what you’ve go to do.  Just do something for the pain.  I’m begging you, please!” “Where is your pain?” I ask her. “Right here,” she says pointing to her lower mid abdomen. “When was your last menstrual period?” I ask. “Oh, geez.  Oh geez!” she says, as she stops pacing and lies down on the stretcher.  She lies on her side and gets into a fetal position.  “Just give me an enema.  I’ve been disimpacted before.  Just do it.  Do it!” “Okay, I’ll have to do a rectal exam.  If there is an impaction, I’ll try to remove as much as possible and then we will give you an enema.  It will be very uncomfortable, but you’ll get tremendous relief.  Okay?”  Veronica hands me some gloves and some lubricant.  I lean over to do the rectal exam and she lets out her loudest scream yet. “I think it’s coming out!  Arrrrrrrrrrrrrrrrrrgggggghhhh!” she screams.  I lean over again ...

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A Physician Tries to Make Sense of Sandy Hook

By Birdstrike M.D.   Since the massacre of innocent school children and those that gave their lives educating and trying to protect them this past Friday at Newtown Connecticut’s Sandy Hook Elementary School, I’ve struggled to make sense of this calamity as much as much as anyone.  As a Physician who has worked to save the lives of sick and injured children, and as a father of children the same age as those massacred in cold blood, I have searched for answers to the questions, “Why?”   “How do we make sure this never happens again?” and “How do I know this won’t happen to my family?”  along with everyone else.  As I’ve read, seen and listened to various explanations and solutions, some better than others, most have rung very hollow.  The arguments and blame fly back and forth, “We need to ban guns,” “We need more guns,” “We need more outpatient mental health treatment,” “We need to re-institutionalize the mentally ill,” and so on.  The more I listen, the less I am convinced that anyone I’ve heard, from the checkout clerk at my local grocery store, to the President of the United States has any real solution to prevent this from happening again, or even make such happenings less frequent. As I dropped my daughter off at school today, and let her get out of the car and walk away from me and out of my sight, I realized that to a certain extent, this was and always has been an act of faith of sorts.  As I’ve thought more and more about this horrible incident, the questions keep coming, but without answers.  I have no good answers to the above questions.  In a nearly post-spiritual world where technology can do practically everything but find answers to the truly important questions in life, I realize there is a word that does perfectly describe this incident, and consolidates all the pain, hurt, chaos, insanity, confusion, murder, blood and tears.  All religion, preaching, atheism, agnosticism and separation of church-and-state arguments aside, the only word I can find that offers any sort of explanation, summary or satisfying consolidation of what we saw last Friday is…..evil. Pure evil. If anyone doubts the existence of true evil, you’ve seen it.  That is the most disturbing and frightening thing about the incident at Newtown’s Sandy Hook Elementary School.  Despite all the good in this world and all the good we may try to achieve with varying levels of success as physicians trying to heal sick and injured children, or trying to protect our own children, we share this world with a certain element of pure unadulterated evil.  Despite all of our necessary efforts to prevent, protect against and deter it, when someone chooses to truly commit an act of pure evil, they can.  When one does so, there is very little any of us can do about it but hurt, mourn the lost, support the living and move forward with acts of good hoping time will offer at the very least, some solace and clarity.  My deepest condolences go out to the victims of this incident, their families and all of those touched in any way.

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Accepting Our New Normal and Finding New Opportunities

by Birdstrike M.D. It Is Here To Stay The 2012 Presidential election is over. Obamacare is the law of the land and is certain to remain so.  There was tremendous uncertainty not knowing whether the law would be repealed, revised or remain.  Many of us opposed the bill, and there certainly are negatives.  Like it or not, it is time to “get over it,” and not a second later than now.  The new-found certainty offers an opportunity to reassess and adapt to the coming changes. In addition to Obamacare, other pillars of our “new normal” include patient satisfaction surveys, threats of reimbursement cuts, increasing pressure from administrators obsessing over “metrics,” more time drained by cumbersome electronic health records, resentment from patients who blame us for the failings of the healthcare system, as well as a steady stream of frivolous lawsuits with no end in sight.  It’s time to adapt to our “new normal.” Comparing and Contrasting With Other Industries In this modern age of Medicine, these factors have been piled on top of the traditional responsibilities of physicians such as life and death, health and wellness, and paradoxically have seemed to rise above them in importance like unstoppable flood waters drowning the ghosts of Hippocrates, Osler and Marcus Welby M.D.  This contributes to poor morale among physicians and understandably so.  Other industries have had to deal with the same concepts for decades, however.  The service industries are bound by “patient satisfaction” measures and always have been.  Businessmen also have to guard against lawsuits. They expect them and manage the risk and accept it as a norm. I doubt they perceive a lawsuit where they did nothing wrong, as life altering like so many physicians do.  Companies often times have decreases in sales just as our reimbursements may drop and constantly have to adapt.  Just about everyone else in the “real world” has to deal with a “boss” of some variety and a necessary part of their job is to keep that person or entity happy, regardless of whether they like them personally or not.  So why do we find it so difficult to deal with such factors? Are we special? Are we different? In a word, “No.”  Not anymore.  It’s time to accept that fact and move on.  We are now cogs, replaceable de facto employees of a massive business-medico-legal-political machine; nothing more.  All indications are that it will remain this way.  Much can be learned from such other industries that have had to adapt to the stark realities ahead of us.  I think for the profession of Medicine to reinvigorate itself, and for us to truly value what we do have again, we must properly manage expectations. What Government Will (or Will Not) Do Though we might each individually be very replaceable, the reality is that we still have extremely high paying jobs in a profession that is relatively recession proof with greatly increasing demand for our services. There are some other positives and ironic realities that I think many physicians are glaringly overlooking.  One is that Obamacare proposes to commit about 1 trillion more dollars towards healthcare over the next 10 years, with tens of millions newly insured.  Necessarily, demand for our services will go up, way up.  And the best (or worst) news is that despite all the talk about “severe rationing” and “draconian reimbursement cuts” there’s good reason to believe that talk is a big load of….nonsense.  That’s right; they’re not going to cut a damn thing.  How can I be so sure? There has been essentially no real political will, whatsoever, by either political party to make any significant cuts from the federal budget, ...

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