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HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
So today's life lesson is:
Assume everyone else is an idiot.
I have a patient who keeps on dropping his hemoglobin, which means he's bleeding from somewhere. His stools are positive for blood, but his colon is normal when they scoped it, so we're going to scope his esophagus, stomach, and duodenum (early part of the small intestine) to look for sources of bleeding there.
In order to do that, the patient has to be NPO (nothing by mouth) for at least 6 hours before the procedure. It doesn't do to scope a stomach with food in it.
So I wrote an order "Please resume normal diet after EGD" (EGD is the abbreviation for the scope procedure.)
The clerk only read the first part.
And so he just got lunch.
And it's not as simple as just postponing it until tomorrow because he has clotting problems and needs to be transfused with frozen plasma, and he's going to need extra units of blood and it's going to be a mess.
Yup, folks. This is a medical error. And a pretty bad one at that.
From now on, I will have to sign out the order to resume diet to the on-call intern. Or maybe I will have to write "Please keep patient NPO now. May resume normal diet AFTER EGD." with "After" underlined and written in all capital letters, instead of the usual abbreviation, which is a "p" with a bar over it.
So today's life lesson is:
Assume everyone else is an idiot.
I have a patient who keeps on dropping his hemoglobin, which means he's bleeding from somewhere. His stools are positive for blood, but his colon is normal when they scoped it, so we're going to scope his esophagus, stomach, and duodenum (early part of the small intestine) to look for sources of bleeding there.
In order to do that, the patient has to be NPO (nothing by mouth) for at least 6 hours before the procedure. It doesn't do to scope a stomach with food in it.
So I wrote an order "Please resume normal diet after EGD" (EGD is the abbreviation for the scope procedure.)
The clerk only read the first part.
And so he just got lunch.
And it's not as simple as just postponing it until tomorrow because he has clotting problems and needs to be transfused with frozen plasma, and he's going to need extra units of blood and it's going to be a mess.
Yup, folks. This is a medical error. And a pretty bad one at that.
From now on, I will have to sign out the order to resume diet to the on-call intern. Or maybe I will have to write "Please keep patient NPO now. May resume normal diet AFTER EGD." with "After" underlined and written in all capital letters, instead of the usual abbreviation, which is a "p" with a bar over it.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
GOLD Member
Mand's Girl....and The Not So Shy One
2,723 posts
Location: Calgary, Alberta Canada
Mand's Girl....and The Not So Shy One
2,723 posts
Location: Calgary, Alberta Canada
Posted:
Oh dear.
Not good.
Sorry Lightning.
Oh dear.
Not good.
Sorry Lightning.
Solitude sometimes speaks to you, and you should listen.
SILVER Member
Pooh-Bah
2,014 posts
Location: Galveston, TX, USA
Pooh-Bah
2,014 posts
Location: Galveston, TX, USA
Posted:
That sucks!
I already learned that lesson though thanks to my idiot of a co-worker. He knows how to do essentially nothing for himself and constantly needs to be reminded of every little step. It used to not be my problem, but now I have to deal with him and it can be highly frustrating. Luckily, he will be getting the ax before the end of the summer. In the meantime though, there is nothing that one can use as a scare tactic to get him to work...
feeling your pain...
That sucks!
I already learned that lesson though thanks to my idiot of a co-worker. He knows how to do essentially nothing for himself and constantly needs to be reminded of every little step. It used to not be my problem, but now I have to deal with him and it can be highly frustrating. Luckily, he will be getting the ax before the end of the summer. In the meantime though, there is nothing that one can use as a scare tactic to get him to work...
feeling your pain...
GOLD Member
playing the days away
7,263 posts
Location: The Middle lands, United Kingdom
playing the days away
7,263 posts
Location: The Middle lands, United Kingdom
Posted:
oh dear, you have to put up with fair amounts of crap at your place Lightning! I hope they pay you lots!
oh dear, you have to put up with fair amounts of crap at your place Lightning! I hope they pay you lots!
Let's relight this forum 
GOLD Member
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
Bug, I'm paying US$24,000 of tuition a year for this privilege.
Ok, it is a privilege to practice medicine. I don't want anyone to get the idea that I hate what I do. However, I do not appreciate it when someone it up for one of my patients.
Remember, do whatever you like to me. But do not mess with my patients. I protect my patients like a mother tiger.
Bug, I'm paying US$24,000 of tuition a year for this privilege.
Ok, it is a privilege to practice medicine. I don't want anyone to get the idea that I hate what I do. However, I do not appreciate it when someone
it up for one of my patients.Remember, do whatever you like to me. But do not mess with my patients. I protect my patients like a mother tiger.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
GOLD Member
Mand's Girl....and The Not So Shy One
2,723 posts
Location: Calgary, Alberta Canada
Mand's Girl....and The Not So Shy One
2,723 posts
Location: Calgary, Alberta Canada
Posted:
Lightning, I wish my Aunt would have had someone like you to watch over her when she, my uncle and cousins got into the car wreck back in November. My uncle died...losing consciousness at the scene and never regaining it. He took the brunt of the impact, sadly.
She had some nasty injuries to her face and eye, and was in serious condition.
She was put on a morphine drip...after that, the doctors escorted all of her family out of her hospital room, and talked to her "privately" about signing a living will. The woman had *just* lost her husband *and* was on a Morphine drip. I think, at the very least, her daughter or someone with power of attorney should have been in the room with her...but that's just my 2 cents...
Mind you...I'm not educated in the ways of medicine...
Lightning, I wish my Aunt would have had someone like you to watch over her when she, my uncle and cousins got into the car wreck back in November. My uncle died...losing consciousness at the scene and never regaining it. He took the brunt of the impact, sadly.
She had some nasty injuries to her face and eye, and was in serious condition.
She was put on a morphine drip...after that, the doctors escorted all of her family out of her hospital room, and talked to her "privately" about signing a living will. The woman had *just* lost her husband *and* was on a Morphine drip. I think, at the very least, her daughter or someone with power of attorney should have been in the room with her...but that's just my 2 cents...
Mind you...I'm not educated in the ways of medicine...
Solitude sometimes speaks to you, and you should listen.
GOLD Member
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
That sounds pretty inappropriate of them, but on the other hand, it would have been worth it to have had a family meeting at that time.
That sounds pretty inappropriate of them, but on the other hand, it would have been worth it to have had a family meeting at that time.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
GOLD Member
Mand's Girl....and The Not So Shy One
2,723 posts
Location: Calgary, Alberta Canada
Mand's Girl....and The Not So Shy One
2,723 posts
Location: Calgary, Alberta Canada
Posted:
The thing is, she, and her kids would rather their organs be donated than not. It's just how they handled the situation that bugged the family.
In fact, I think she, and my uncle had donated all of their organs...unfortunately the damage to my uncle was too extensive for them to retreive any of his organs.
My medical cousin and I chatted about the hospital, and he said they handled some things poorly, the living will being the worst example, but overall, they did well. The hospital is understaffed, badly, and it's the primary receiving hospital for the area....
The thing is, she, and her kids would rather their organs be donated than not. It's just how they handled the situation that bugged the family.
In fact, I think she, and my uncle had donated all of their organs...unfortunately the damage to my uncle was too extensive for them to retreive any of his organs.
My medical cousin and I chatted about the hospital, and he said they handled some things poorly, the living will being the worst example, but overall, they did well. The hospital is understaffed, badly, and it's the primary receiving hospital for the area....
Solitude sometimes speaks to you, and you should listen.
GOLD Member
playing the days away
7,263 posts
Location: The Middle lands, United Kingdom
playing the days away
7,263 posts
Location: The Middle lands, United Kingdom
Posted:
OMG!
YOU PAY to be there?! Wow, props for finding that kind of cash every year, I didn't realise it worked like that in America. No wonder the US health care is so mucked up, it really does push towards elitism if I understand it the right way. There can't be many people who can afford, or be willing/able to make the sacrifice, to become a doctor there
You're such a darlin!
Written by: L i g h t n i n g
Bug, I'm paying US$24,000 of tuition a year for this privilege.
OMG!
YOU PAY to be there?! Wow, props for finding that kind of cash every year, I didn't realise it worked like that in America. No wonder the US health care is so mucked up, it really does push towards elitism if I understand it the right way. There can't be many people who can afford, or be willing/able to make the sacrifice, to become a doctor there
You're such a darlin! Let's relight this forum
GOLD Member
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
Well, most people take out massive loans, get federal grants, etc. There's no way that the majority of people could actually pay for this education. But doctors are paid so well, in part, because we have loans to pay off.
Well, most people take out massive loans, get federal grants, etc. There's no way that the majority of people could actually pay for this education. But doctors are paid so well, in part, because we have loans to pay off.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
GOLD Member
Mand's Girl....and The Not So Shy One
2,723 posts
Location: Calgary, Alberta Canada
Mand's Girl....and The Not So Shy One
2,723 posts
Location: Calgary, Alberta Canada
Posted:
Don't forget malpractice insurance.
Don't forget malpractice insurance.
Solitude sometimes speaks to you, and you should listen.
GOLD Member
Self-Flagellation Expert
3,414 posts
Location: Bogged at CG, Australia
Self-Flagellation Expert
3,414 posts
Location: Bogged at CG, Australia
Posted:
heh, you should try going for a pilot. Not only do you face the threat of being attacked, hijacked, bombed, getting sick in some weird and/or wonderful place, you have to pay, up front, approximately 60,000 AUD for the privelage. and thats just to get the licence. then there is all the other things you need to buy, like the flight manuals, for each region of the planet, of which there is 8, i think, and at 500 AUD a pop, thats a pretty significant cost, for a set of books. then theres all the medicals, the other manuals you need, the headsets and other flight gear, the other, other manuals...
After all that, you get to rake up 500 hours in the command seat of a multi-enjine jet aircraft. that sounds pretty hard, and its a lot harder than it sounds. Especially when you consider a lear jet, or similar small business jet, hires out for, from memory, about 4000 AUD an hour. thats a whole lot of money before you can go get a job flying jets. oh, sure, you can fly a piddly little cessna for eastwest bumplug airlines in the middle of the desert, for about 30 years, to save up enough money to hire a jet for enough time to get the necessary experience.
fun fun fun, and at the end of it all, you get to spend weeks, sometimes months away from your family, being the person responsible, wholly and solely, for 300 people at a time, having the possibility of hijacking etc hanging over you, downright messed up sleeping habits, and 150,000 odd AUD a year in your pocket. Oh, and that pay only comes when you are a top level captain, about 15-20 years into the business, normally by which time you are ready to retire.
BUT, and this is a biiig but:
you get to fly. and that makes it allll worth it
heh, you should try going for a pilot. Not only do you face the threat of being attacked, hijacked, bombed, getting sick in some weird and/or wonderful place, you have to pay, up front, approximately 60,000 AUD for the privelage. and thats just to get the licence. then there is all the other things you need to buy, like the flight manuals, for each region of the planet, of which there is 8, i think, and at 500 AUD a pop, thats a pretty significant cost, for a set of books. then theres all the medicals, the other manuals you need, the headsets and other flight gear, the other, other manuals...
After all that, you get to rake up 500 hours in the command seat of a multi-enjine jet aircraft. that sounds pretty hard, and its a lot harder than it sounds. Especially when you consider a lear jet, or similar small business jet, hires out for, from memory, about 4000 AUD an hour. thats a whole lot of money before you can go get a job flying jets. oh, sure, you can fly a piddly little cessna for eastwest bumplug airlines in the middle of the desert, for about 30 years, to save up enough money to hire a jet for enough time to get the necessary experience.
fun fun fun, and at the end of it all, you get to spend weeks, sometimes months away from your family, being the person responsible, wholly and solely, for 300 people at a time, having the possibility of hijacking etc hanging over you, downright messed up sleeping habits, and 150,000 odd AUD a year in your pocket. Oh, and that pay only comes when you are a top level captain, about 15-20 years into the business, normally by which time you are ready to retire.
BUT, and this is a biiig but:
you get to fly. and that makes it allll worth it
"beg beg grovel beg grovel"
"master"
--FSA
"There was an arse there, i couldn't help myself"
--Rougie
BRONZE Member
Mistress of Pink...Multicoloured
6,140 posts
Location: Over There, United Kingdom
Mistress of Pink...Multicoloured
6,140 posts
Location: Over There, United Kingdom
Posted:
Sorry to hear about that Lightning.
I remember it happened to my Grandad, just before his triple heart bypass he was given some food or something he wasn;t meant to have and they have to delay the op by a day.
Sorry to hear about that Lightning.
I remember it happened to my Grandad, just before his triple heart bypass he was given some food or something he wasn;t meant to have and they have to delay the op by a day.
Never pick up a duck in a dungeon...
SILVER Member
All the neurotic makings of America's lesser known sweetheart
9,831 posts
Location: body in Las Vegas, heart all around the world, USA
All the neurotic makings of America's lesser known sweetheart
9,831 posts
Location: body in Las Vegas, heart all around the world, USA
Posted:
ya psychologists are in the same boat as doctors. i pay around $30,000 a year for school, that includes tuition, cost of living, books, etc. and i started my field work (practicum) the second semester. each practicum is between 3-6 credits (mine were 6 each). so multiply 6 credits times 5 semesters, at $610 per credit = $18,300 to work for free. and that doesn't include my internship. yup, i pay for that too.
*sigh*
ya psychologists are in the same boat as doctors. i pay around $30,000 a year for school, that includes tuition, cost of living, books, etc. and i started my field work (practicum) the second semester. each practicum is between 3-6 credits (mine were 6 each). so multiply 6 credits times 5 semesters, at $610 per credit = $18,300 to work for free. and that doesn't include my internship. yup, i pay for that too.
*sigh*
I was always scared with my mother's obsession with the good scissors. It made me wonder if there were evil scissors lurking in the house somewhere.
Do not meddle in the affairs of dragons for you are crunchy and good with ketchup.
**giggles**
GOLD Member
Self-Flagellation Expert
3,414 posts
Location: Bogged at CG, Australia
Self-Flagellation Expert
3,414 posts
Location: Bogged at CG, Australia
Posted:
you really should move to australia. a medical degree comes under band 3 HECS, which means that you start paying back about 7k AUD for each year of study once you earn over a certain amount. pretty much nothing is up front, except books and finding somewhere to live.
you really should move to australia. a medical degree comes under band 3 HECS, which means that you start paying back about 7k AUD for each year of study once you earn over a certain amount. pretty much nothing is up front, except books and finding somewhere to live.
"beg beg grovel beg grovel"
"master"
--FSA
"There was an arse there, i couldn't help myself"
--Rougie
BRONZE Member
Insert Champagne Here
13,215 posts
Location: without class distinction, Australia
Insert Champagne Here
13,215 posts
Location: without class distinction, Australia
Posted:
really MiG! i didnt know that!
mike, have a hug
really MiG! i didnt know that!
mike, have a hug
i would have changed ***** to phallus, and claire to petey Petey
Rougie: but that's what I'm doing here
Arnwyn: what letting me adjust myself in your room?..don't you dare quote that on HoP...
BRONZE Member
veteran
1,453 posts
Location: Lancs England
veteran
1,453 posts
Location: Lancs England
Posted:
we have a "adv" jar in the office if anyone uses abriviations or short hand we get fined £1 which sucks
we have a "adv" jar in the office if anyone uses abriviations or short hand we get fined £1 which sucks
before i met those lot i thought they'd be a bunch of dreadlocked hippies that smoked, set things on fire ,and drank a lot of tea but then when i met them....oh wait (PyroWill)
GOLD Member
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
It gets worse. Much worse.
Ok, background: the clotting factors in the blood are made by the liver. In patients with liver disease, which this gentleman has, they can't make enough of these factors and they can bleed, which is why they need to be tanked up with Fresh Frozen Plasma, which will replete their coagulation factors.
This gentleman has had horrible coagulation times (we measure the activity of these factors by how long it takes his blood to clot when stimulated by certain chemical signals).
So because we want him to have these two procedures today, we ordered 5 units of FFP to be hung last night at 3AM. The nurse LOST the order. So he never got it.
He's getting it right now, but we wanted him to go to EGD at 0745 so he could go to his second procedure by noon so we could be sure he got everything done and then maybe we can get him out of the hospital by the end of the week. He'll go to EGD in maybe an hour and we'll see if he can get his second procedure today.
We're documenting these errors, because they blame it on the doctors when patients spend too much time in the hospital.
It gets worse. Much worse.
Ok, background: the clotting factors in the blood are made by the liver. In patients with liver disease, which this gentleman has, they can't make enough of these factors and they can bleed, which is why they need to be tanked up with Fresh Frozen Plasma, which will replete their coagulation factors.
This gentleman has had horrible coagulation times (we measure the activity of these factors by how long it takes his blood to clot when stimulated by certain chemical signals).
So because we want him to have these two procedures today, we ordered 5 units of FFP to be hung last night at 3AM. The nurse LOST the order. So he never got it.
He's getting it right now, but we wanted him to go to EGD at 0745 so he could go to his second procedure by noon so we could be sure he got everything done and then maybe we can get him out of the hospital by the end of the week. He'll go to EGD in maybe an hour and we'll see if he can get his second procedure today.
We're documenting these errors, because they blame it on the doctors when patients spend too much time in the hospital.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
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