Comments for db's Medical Rants

Comment on Safety and patient care by LibraryGryffon

LibraryGryffon — Tue, 16 Mar 2010 14:53:42 +0000

We finally got my grandmother to a cardiologist after her second heart attack. She was willing to go see this doctor because she had met him once and he must be a good doctor since she had gone to school with his aunt. He looked at this frail 85yo who had no desire to try to live another 10 years, and who wouldn’t have survived the procedures necessary for that. He took her off most of the meds her GP had her on, which were doing very little except stressing her out because there were so many it was hard to for her to keep track of them. He also took her off the insanely restrictive (no salt, no fat) diet the GP had put her on after her first heart attack. His reasoning was that she probably only had 6 months or so to live, and she should be able to enjoy them. He didn’t treat her heart, he treated her.

We left the office saying, “He’s a good doctor”.

Comment on Set pieces on rounds 1 by Hildy

Hildy — Tue, 16 Mar 2010 10:20:29 +0000

What is your set piece on parathyroidectomy? I have been a surgical resident in an endocrine unit whose criteria was “if we can”.

Comment on Rate control in a fib – not too tight by Happy Hospitalist

Happy Hospitalist — Mon, 15 Mar 2010 21:13:31 +0000

I have aleTa used <100 as my goal. Always. I guess now I can use <110 and save myself some extra pages

Comment on Pain control by Hildy

Hildy — Sun, 14 Mar 2010 00:12:54 +0000

I agree with david / Dr Bob on this. Initially I attempt to estimate the pain level postoperatively, and I err on the low side, so that PRN can top it up to an adequate level. Every day, though, I look at the previous day’s total opioid use, and attempt to provide it on the next day as 2/3 regular, 1/3 PRN. This way if the patient’s pain gets a lot better, they only get their regular opioid and I can automatically wean them. If the pain is getting worse I can see this and increase the baseline.

I also have a rule of no acetaminophen, no opioids.

Comment on Safety and patient care by Michael Kirsch, M.D.

Michael Kirsch, M.D. — Sat, 13 Mar 2010 16:30:02 +0000

It was be easy to come up with a punch line ribbing gastroenterologists like me to the inquiry, “What are the indications for a colonscopy’?”

Comment on Safety and patient care by #1 Dinosaur

#1 Dinosaur — Sat, 13 Mar 2010 13:53:38 +0000

Have I told you lately that I love you?

Comment on Treating the pain of chronic pancreatitis by Arvinder Batta

Arvinder Batta — Sat, 13 Mar 2010 07:35:19 +0000

I am 21 yrs old & suffering from chronic pancreatitis from last 6 yrs. For first five yrs i didn’t come to know about it. In last year i go through MRCP test & come to know about this. Now my Dr. preciting me (Creon 10000) medicine with which i get relief from pain but during it’s use i get suffered from diabetes. My Dr. says i have to take medicine for whole life. I want some permanent cure for it. Plz. suggest me something.

Comment on Safety and patient care by bariatric surgery

bariatric surgery — Sat, 13 Mar 2010 06:42:25 +0000

In support of your contention that blade-of-grass level views of system components leads systems to fail on the larger issues, I believe that a lack of system focus does contribute to safety laspes. There are many issues which should be care regarding the Patient’s care and safety.But the situation is changes, as the big hospital have different policies to affect the patient’s policies.If everyone is focused on their tiny area, without even a clue as to what the overall risks are then safety is not a likely consideration.

Comment on Night float – a plus or a minus by Gracie

Gracie — Fri, 12 Mar 2010 20:43:01 +0000

My hospital doesn’t use night float, but you still have the handoff problem. With 5 medicine “teams” and one “team” on call every 4th night, you have tired residents who are familiar with their patients, but not the patients of the other 4 teams they’re covering for. So dealing with 4/5 ths unfamiliarity and sleepiness seems much worse than 100% unfamiliarity and alertness. I think that the psychic and physical toll of call is a detriment to patients at all hours, when call is frequent, the way it messes with sleep patterns, the exhaustion and the way it reduces morale don’t put docs in training in a good mental state… leading to not only job dissatisfaction, but depression and other problems. I think night float is a great option and I wish we had it. A month of hellishness would be okay with me….

Comment on Safety and patient care by AnnR

AnnR — Fri, 12 Mar 2010 18:32:32 +0000

I live in the DC Metro area where the local subway system seems bent on destroying as much equipment as possible while also taking out employees and passengers.

Needless to say they’ve had an “audit.” The lead paragraph about the audit results was that the agency didn’t even have a “top 10 safety issues” list.

In support of your contention that blade-of-grass level views of system components leads systems to fail on the larger issues, I believe that a lack of system focus does contribute to safety laspes.

If everyone is focused on their tiny area, without even a clue as to what the overall risks are then safety is not a likely consideration.

How many health sector employees can rattle off the top ten safety issues in their workplace?