Our local newspaper had a brief article today about an unfortunate man that was mauled to death by a Grizzly bear at Yellowstone National Park.
He was hiking with his wife along the Wapiti Lake trail when he surprised a female bear with her cubs.
The bear attacked and fatally wounded the man.
She was defending her cubs.
Two years ago we (my wife, son, daughter and I) were on the same trail.
I vividly remember the notices posted everywhere:
"If you see a bear and it's not aware, quietly retreat from the area. If you see a bear and it's aware, flap your arms (to make yourself look bigger), talk in a loud voice and retreat from the area. If the bear is aware and charges you stand completely still-it might be a false charge. If the bear continues to charge you, immediately drop to the ground and curl up in a ball."
At the time I remember that I had no problem with the first two sentences of instructions. The 3rd and 4th were a different story.
We saw a Grizzly while on the trip (an incredibly cool thing).
He was only about 30 yards from us.
Luckily, it was not aware.
We quietly retreated!
Thursday, July 7, 2011
Wednesday, July 6, 2011
Computer generated templates
Want to have a long impressive note that may or may not have anything to do with the reason for an office visit?
Use some of the various computer templates on the market.
It now not unusual to receive a 5 page note from a specialist from a follow-up visit.
I've seen 10-12 page primary care notes, for one visit.
Don't get me wrong. The computerized patient record has clear advantages.
The fact that it is interpretable is an advantage.
The fact that it's readable is also a disadvantage.
Many times wrong information is copied and pasted from note to note.
Patients often bring outside records in which they have made corrections to such items as their social history.
Its' also generated some lively discussions when a complete physical is recorded and the patient is sure the surgeon only did a brief exam of their umbilical hernia.
Medical legally: if it wasn't recorded it wasn't done.
The opposite is also true: if it was recorded and wasn't done, it's FRAUD.
I'm certain that malpractice attorneys love the computerized patient record.
Given technology now available, it's not a stretch to envision patients secretly taping an encounter and then having their attorney compare it to the computerized patient record.
My recommendation: don't record things that weren't done. If using templates, delete parts that were not done and are not needed.
Don't have your integrity questioned due to ignorance on how to adapt a template to the actual visit that took place.
Also, if a visit can be well documented in just a couple of lines ( for a brief follow-up visit after an I and D of a cyst, for example), free text the note (type it!)-don't use a template.
Use some of the various computer templates on the market.
It now not unusual to receive a 5 page note from a specialist from a follow-up visit.
I've seen 10-12 page primary care notes, for one visit.
Don't get me wrong. The computerized patient record has clear advantages.
The fact that it is interpretable is an advantage.
The fact that it's readable is also a disadvantage.
Many times wrong information is copied and pasted from note to note.
Patients often bring outside records in which they have made corrections to such items as their social history.
Its' also generated some lively discussions when a complete physical is recorded and the patient is sure the surgeon only did a brief exam of their umbilical hernia.
Medical legally: if it wasn't recorded it wasn't done.
The opposite is also true: if it was recorded and wasn't done, it's FRAUD.
I'm certain that malpractice attorneys love the computerized patient record.
Given technology now available, it's not a stretch to envision patients secretly taping an encounter and then having their attorney compare it to the computerized patient record.
My recommendation: don't record things that weren't done. If using templates, delete parts that were not done and are not needed.
Don't have your integrity questioned due to ignorance on how to adapt a template to the actual visit that took place.
Also, if a visit can be well documented in just a couple of lines ( for a brief follow-up visit after an I and D of a cyst, for example), free text the note (type it!)-don't use a template.
Tuesday, July 5, 2011
Depression and insomnia
A number of years ago I was depressed.
For about 2 months, prior to seeking treatment, I had severe insomnia.
An hour and a half of sleep was a good night. I got to see how incredibly long, and miserable, a night is when you can't sleep.
I found out that Wal-Mart and Denny's are never crowded at 3 AM.
Every time I would try to sleep, and would close my eyes, I would visualize different images from my past.
The images followed no particular pattern, but would be of folks I had interacted with in the past including family, friends, classmates, co-workers, enemies, etc..
I couldn't shut my mind down.
At the time it reminded me of watching a slide show.
When patients are depressed, report insomnia and the inability to stop thinking at night, I always ask them if they are experiencing a "slide show of their life."
A lot acknowledge it's exactly like that.
"How did you know?" they ask.
"Been there, done that," I reply. "I had the same problem a number of years ago when I was depressed. Let's talk about what we can do to help you get some sleep."
For about 2 months, prior to seeking treatment, I had severe insomnia.
An hour and a half of sleep was a good night. I got to see how incredibly long, and miserable, a night is when you can't sleep.
I found out that Wal-Mart and Denny's are never crowded at 3 AM.
Every time I would try to sleep, and would close my eyes, I would visualize different images from my past.
The images followed no particular pattern, but would be of folks I had interacted with in the past including family, friends, classmates, co-workers, enemies, etc..
I couldn't shut my mind down.
At the time it reminded me of watching a slide show.
When patients are depressed, report insomnia and the inability to stop thinking at night, I always ask them if they are experiencing a "slide show of their life."
A lot acknowledge it's exactly like that.
"How did you know?" they ask.
"Been there, done that," I reply. "I had the same problem a number of years ago when I was depressed. Let's talk about what we can do to help you get some sleep."
Monday, July 4, 2011
Happy 4th!
Let every nation know, whether it wishes us well or ill, we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe, to assure the survival and success of liberty-John Fitzgerald Kennedy
Where liberty dwells, there is my country-Benjamin Franklin
Liberty is the breath of life to nations-Goerge Bernard Shaw
There is nothing wrong with America that cannot be cured by what is right with America-William J. Clinton
Where liberty dwells, there is my country-Benjamin Franklin
Liberty is the breath of life to nations-Goerge Bernard Shaw
There is nothing wrong with America that cannot be cured by what is right with America-William J. Clinton
Sunday, July 3, 2011
A simple request
We have a staff bathroom, like most medical facilities. It's not large and the sink is very close to the toilet.
Without fail, every time you wash your hands, water splashes on to the toilet seat. When the seat is wet and you've just arrived to make a deposit, you don't know if it's water, urine or some other body fluid.
It also has a trash can that's usually over flowing by the end of the day (and unfortunately, often has used feminine products visible).
My only request is the following: WHENEVER YOU OPEN THE DOOR TO LEAVE THE BATHROOM, ALWAYS ASSUME THAT SOMEONE IS WAITING TO ENTER.
Before exiting the bathroom, push the trash down in the can, wipe any water off the toilet seat, pick up any pieces of paper towels from the floor, and use the air freshener if needed.
It doesn't take long to clean up and it sure enhances the "experience" for anyone that follows!
Without fail, every time you wash your hands, water splashes on to the toilet seat. When the seat is wet and you've just arrived to make a deposit, you don't know if it's water, urine or some other body fluid.
It also has a trash can that's usually over flowing by the end of the day (and unfortunately, often has used feminine products visible).
My only request is the following: WHENEVER YOU OPEN THE DOOR TO LEAVE THE BATHROOM, ALWAYS ASSUME THAT SOMEONE IS WAITING TO ENTER.
Before exiting the bathroom, push the trash down in the can, wipe any water off the toilet seat, pick up any pieces of paper towels from the floor, and use the air freshener if needed.
It doesn't take long to clean up and it sure enhances the "experience" for anyone that follows!
Saturday, July 2, 2011
Gotta laugh!
A 63 y/o male has advanced Parkinson's Plus Syndrome.
He has significant rigidity, immobility, falls frequently and has not responded to most medications.
His daughter (his caregiver) came with him to the appointment.
It was a fairly sad encounter as they were recalling the most recent visit to a well known neurologist, an expert in neurodegenerative diseases, including Parkinson's.
I hadn't received the consult note back yet.
The patient was teary eyed when he let me know the neurologist said there was "nutin more he could do."
After a brief pause, I responded (I couldn't stop myself), "he really said that?"
"Yes."
"He said nutin...n-u-t-i-n?"
Thankfully, all of us were then able to enjoy a good laugh.
Laughter is still the best medicine for patients, caregivers and the doctor!
He has significant rigidity, immobility, falls frequently and has not responded to most medications.
His daughter (his caregiver) came with him to the appointment.
It was a fairly sad encounter as they were recalling the most recent visit to a well known neurologist, an expert in neurodegenerative diseases, including Parkinson's.
I hadn't received the consult note back yet.
The patient was teary eyed when he let me know the neurologist said there was "nutin more he could do."
After a brief pause, I responded (I couldn't stop myself), "he really said that?"
"Yes."
"He said nutin...n-u-t-i-n?"
Thankfully, all of us were then able to enjoy a good laugh.
Laughter is still the best medicine for patients, caregivers and the doctor!
Friday, July 1, 2011
The most expensive care anywhere
A 32 y/o male had been to the Emergency Room (ER) for lower abdominal discomfort.
Labs (blood and urine), as well as an abdominal and pelvic CT scan were normal.
I could not interpret the hand written medical record.
It didn't appear to include a physical exam.
The patient confirmed this observation.
No diagnosis or treatment was given.
He was told to see his primary care provider (me) the next day.
I did not know the ER doc.
On my exam, palpation of the epididymus of one testicle reproduced all his pain.
He was involved in a long term monogomous relationship.
He was told to use supporting underwear and given a prescription for an antibiotic (filled at a local grocery store for free).
A week later, on re-check, he was fine (cured!).
He had already received one bill from the ER for approximately $2200.00.
I decided not to let him know that additional bills (from the radiologist, etc.) would be arriving in the future.
Alrighty then...
Labs (blood and urine), as well as an abdominal and pelvic CT scan were normal.
I could not interpret the hand written medical record.
It didn't appear to include a physical exam.
The patient confirmed this observation.
No diagnosis or treatment was given.
He was told to see his primary care provider (me) the next day.
I did not know the ER doc.
On my exam, palpation of the epididymus of one testicle reproduced all his pain.
He was involved in a long term monogomous relationship.
He was told to use supporting underwear and given a prescription for an antibiotic (filled at a local grocery store for free).
A week later, on re-check, he was fine (cured!).
He had already received one bill from the ER for approximately $2200.00.
I decided not to let him know that additional bills (from the radiologist, etc.) would be arriving in the future.
Alrighty then...
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