May 25th, 2007
Dear Paw Paw:
The CEO of our hospital recently adopted a policy that all of the ED Doctors and Nurses had to abide by a Dress Code. He wants the Nurses to all wear the same colored uniforms and the Physicians to wear dress clothes and a white coat. I and the rest of the girls think this is a violation of our Civil Rights and we should have the freedom to express ourselves. Do you know a good lawyer who can sue and get us a lot of money?
Frustrated Fashion Freedom Nurse in Frisco
Dear Frustrated:
Babycakes, I think all Nurses should get their uniforms at Hooters and I could give a dead goat’s tail about what them snooty doctors wear. Frankly I don’t know why the nurses should look any different than Housekeeping, Lab, Xray, Doctors or the Registration Clerks. Yep I think they should all look like clones of that Brittney Spears chick. Let’s keep everyone guessing.
So what if patients find your nose ring, bling, tattoos and see through T-shirt from Lizard Larry’s Lounge less than professional. If you want to look like an incompetent Bozo, that is your God given right. Besides if they can’t understand you when you are doing your assessment just because you like to chew bubble gum, talk on your cell phone and play with your tongue piercing simultaneously, then that is their problem. Maybe they need to talk to Oprah or Dr. Phil and just get over it.
Of course most so called experts on customer service disagree, but what the goat dung do they know! They’ll tell you that everyone needs to look clean, well groomed, and professional. That each department should have a unique uniform that easily differentiates them from others. They have the gall to suggest that physicians should wear professional dress and a white coat. They will lead you to believe that patients actually have certain preconceived notions of what the doctor and nurse should look like. And that if you fail to meet their expectations they may feel you are less than professional in your care of them as well.
Yep your CEO is definitely an old fart with an idea that is not politically correct. You should send him off to Prison for “re-education” and collect a huge settlement from the hospital. I can’t get over the nerve of some people. I suppose he thinks you are there to satisfy patients. What a cretin. Call Sleazy Slim’s Legal and Waste Management Services at 800-555-2727 and tell Slim I sent you. Now, how about a lap dance Sweetie and can I get 10% of the cash you get from your lawsuit?
Paw Paw
Friday, May 25, 2007
Tuesday, May 8, 2007
Clueless In Colorado
May 9th, 2007
Dear Paw Paw:
The other night I saw a diabetic dialysis patient who had drunk a lot of hooch and popped some kind of pills to try to get high. My professional diagnosis was that he was Really Sick. I called the Hospitalist who asked me for his anion gap. I didn’t know what he was talking about and he got frustrated with me. He said something to me about mudpiles, but I don’t know how playing in the dirt has anything to do with taking care of patients. Should I complain about him?
Dr. Clueless in Coloarado
Dear Dr. Clueless:
Oh this goes way off the scale on my Stupid O Meter. He should complain about you! Anion Gap is not where the pioneers crossed over the Appalachian Mts. on their journey to the West. It is a way to characterize patients with metabolic acidosis and help identify the causes. Metabolic acidosis can be associated with low, normal or elevated Anion Gap. Mudpiles is a mnemonic for the causes of elevated anion gap acidosis:
M Methanol
U Uremia
D DKA, AKA or starvation ketosis
P Paraldehyde, Phenformin (Metformin)
I Iron, INH
L Lactic Acidosis
E Ethylene glycol
S Salicylates
The anion gap can be calculated by the formula: Na – (Cl + CO2). Normally, it is less than or equal to 12. If it is more than 12 it is elevated. Low anion gap acidosis is really weird and we won’t go into that now. Normal Anion Gap acidosis has the mnemonic “HARD UP” which you obviously are. Hard Up stands for:
H Hypoaldosteronism
A Acetazolamide
R Renal Tubular Acidosis
D Diarrhea
U Uretero-sigmoidostomy
P Pancreatic fistula
Now go and read about Acid – Base Disorders and try to be a real doctor.
Paw Paw
Dear Paw Paw:
The other night I saw a diabetic dialysis patient who had drunk a lot of hooch and popped some kind of pills to try to get high. My professional diagnosis was that he was Really Sick. I called the Hospitalist who asked me for his anion gap. I didn’t know what he was talking about and he got frustrated with me. He said something to me about mudpiles, but I don’t know how playing in the dirt has anything to do with taking care of patients. Should I complain about him?
Dr. Clueless in Coloarado
Dear Dr. Clueless:
Oh this goes way off the scale on my Stupid O Meter. He should complain about you! Anion Gap is not where the pioneers crossed over the Appalachian Mts. on their journey to the West. It is a way to characterize patients with metabolic acidosis and help identify the causes. Metabolic acidosis can be associated with low, normal or elevated Anion Gap. Mudpiles is a mnemonic for the causes of elevated anion gap acidosis:
M Methanol
U Uremia
D DKA, AKA or starvation ketosis
P Paraldehyde, Phenformin (Metformin)
I Iron, INH
L Lactic Acidosis
E Ethylene glycol
S Salicylates
The anion gap can be calculated by the formula: Na – (Cl + CO2). Normally, it is less than or equal to 12. If it is more than 12 it is elevated. Low anion gap acidosis is really weird and we won’t go into that now. Normal Anion Gap acidosis has the mnemonic “HARD UP” which you obviously are. Hard Up stands for:
H Hypoaldosteronism
A Acetazolamide
R Renal Tubular Acidosis
D Diarrhea
U Uretero-sigmoidostomy
P Pancreatic fistula
Now go and read about Acid – Base Disorders and try to be a real doctor.
Paw Paw
Friday, May 4, 2007
From Nervous in Nebraska
May 5, 2007
Dear Paw Paw:
Last week a 28 year old woman who is G8, P7 at 39 6/7 weeks gestation presented to our ED saying she was in labor. Her water broke at home and she was having contractions every 4 minutes. Dr. Dorch examined her and told her, “You are only 6 cm dilated. I don’t do Obstetrics and you need to go somewhere else.” He discharged her from our ED and told her to go to one of the large hospitals about 45 minutes away. She was quite dismayed, but got into her Gremlin with her husband and 7 children and drove away. I and the rest of the nurses thought this might be an EMTALA violation. What should we have done?
Nervous in Nebraska
Dear Nervous:
Next time Dr. Dork tries to pull a stunt like this take a metal bedpan and whack him over the head until his toes bleed. Of course this is an EMTALA violation. What does he think EMTALA is? Something you get at Taco Bell? He ain’t Prissy from GWTW and he needs to know ‘somethin bout birthin babies’ if he is going to work in the ED!
EMTALA is a law and violations are crimes. This means he could face the following penalties:
1. Termination from Medicare and Medicaid
2. Fines of up to $50,000 per violation
3. Criminal prosecution or lawsuit under the Civil Rights Act if a patient says that the EMTALA
violation was based on discrimination
4. Suspension of Medical Staff privileges
5. He could be reported to the State Medical Board and NPDB
6. Investigated by State PRO or Licensure Board for questions about his quality of care
In short, his career, livelihood, and finances would be toast. No his liability insurance will not pay or provide him with legal assistance. The hospital can be fined and lose ability to see Medicare patients too. If that were to happen the hospital is essentially out of business. The hospital could seek to collect damages from him as a result of his violations.
For patients in labor, EMATLA requires that he perform a screening exam, provide treatment and meet all transfer requirements. Usually the patient(s) needs to be stabilized which means delivery of the infant. CMS has decided that all emergency departments are capable of delivering full term uncomplicated deliveries, whether the hospital provides obstetric services or not. If the hospital does not offer obstetric services transfer may be an option, but only if it can be done safely and properly. A Gremlin is not a proper mode of transport for anyone, a Porsche maybe, but a Gremlin never. This woman deserves a medal for being able to fit herself, hubby and 7 kids into one.
The transfer form must state why the patient needs more advanced services. Transfer of women in labor may be acceptable only if she requests the transfer or if the physician certifies that the benefits outweigh the risks. What you describe is one of the more common EMTALA violations. It often results in citations. You can not discharge a patient (any patient) and tell them to go to another hospital for care.
Next time refuse to discharge the lady, and call someone with at least ½ an ounce of sense to come and take care of the woman. If necessary call your ED Nurse Manager, DON, ED Medical Director or the largest employee in the hospital to come and sit on Dr. Dork while you and the rest of your team do his job for him.
Paw Paw
Dear Paw Paw:
Last week a 28 year old woman who is G8, P7 at 39 6/7 weeks gestation presented to our ED saying she was in labor. Her water broke at home and she was having contractions every 4 minutes. Dr. Dorch examined her and told her, “You are only 6 cm dilated. I don’t do Obstetrics and you need to go somewhere else.” He discharged her from our ED and told her to go to one of the large hospitals about 45 minutes away. She was quite dismayed, but got into her Gremlin with her husband and 7 children and drove away. I and the rest of the nurses thought this might be an EMTALA violation. What should we have done?
Nervous in Nebraska
Dear Nervous:
Next time Dr. Dork tries to pull a stunt like this take a metal bedpan and whack him over the head until his toes bleed. Of course this is an EMTALA violation. What does he think EMTALA is? Something you get at Taco Bell? He ain’t Prissy from GWTW and he needs to know ‘somethin bout birthin babies’ if he is going to work in the ED!
EMTALA is a law and violations are crimes. This means he could face the following penalties:
1. Termination from Medicare and Medicaid
2. Fines of up to $50,000 per violation
3. Criminal prosecution or lawsuit under the Civil Rights Act if a patient says that the EMTALA
violation was based on discrimination
4. Suspension of Medical Staff privileges
5. He could be reported to the State Medical Board and NPDB
6. Investigated by State PRO or Licensure Board for questions about his quality of care
In short, his career, livelihood, and finances would be toast. No his liability insurance will not pay or provide him with legal assistance. The hospital can be fined and lose ability to see Medicare patients too. If that were to happen the hospital is essentially out of business. The hospital could seek to collect damages from him as a result of his violations.
For patients in labor, EMATLA requires that he perform a screening exam, provide treatment and meet all transfer requirements. Usually the patient(s) needs to be stabilized which means delivery of the infant. CMS has decided that all emergency departments are capable of delivering full term uncomplicated deliveries, whether the hospital provides obstetric services or not. If the hospital does not offer obstetric services transfer may be an option, but only if it can be done safely and properly. A Gremlin is not a proper mode of transport for anyone, a Porsche maybe, but a Gremlin never. This woman deserves a medal for being able to fit herself, hubby and 7 kids into one.
The transfer form must state why the patient needs more advanced services. Transfer of women in labor may be acceptable only if she requests the transfer or if the physician certifies that the benefits outweigh the risks. What you describe is one of the more common EMTALA violations. It often results in citations. You can not discharge a patient (any patient) and tell them to go to another hospital for care.
Next time refuse to discharge the lady, and call someone with at least ½ an ounce of sense to come and take care of the woman. If necessary call your ED Nurse Manager, DON, ED Medical Director or the largest employee in the hospital to come and sit on Dr. Dork while you and the rest of your team do his job for him.
Paw Paw
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