Comments on: Defensive medicine in the ER

By: grey,md

grey,md — Thu, 28 Jun 2007 23:10:00 +0000

“Please spare us with the Doctor knows best and if your not a MD you cant comment on the care.”

But why? So you can continue your ignorant critique of the docs who are licensed, ultimately responsible professionals for patient disposition and ASSESSMENT with liabilities to prove it…
ER[M]URSE go to med school, residency and BE TRULY RESPONSIBLE if you dare not to be professional at being a nuissance.
TAKE RESPONSIBILITY – you have discussed this in your blog intentionally or not, at one time or another. Look at yourself in the mirror, maybe you could see the ER “clients” you critiqued in your previous blog entries. TAKE RESPONSIBILITY AND STOP YOUR CONDESCENSION!!!

By: yours truly

yours truly — Thu, 28 Jun 2007 23:01:00 +0000

Nurse K and other pretentious fellas:
1. did you miss class when they taught what crackers and clear liquid diets are? or has your license changed this designation already?
2. were u also absent when ‘incidental findings’ was discussed? did your teacher really know what they are, or just pretended to, like you do now? well, my dear, its not too late…you can still educate yourself on this topic and others you like to pretend that you are knowledgeable or licensed for; your profile says you are age 27, and have lots of time to finish medical school, residency, get licensed…and finally [drumroll please] practice what you are itching-to-do-but-have-no-clue -about-to-question-at-this-point-
without-sounding-ignorant
3. or, you can go to law school and contribute your ‘expertise’ half-baked as such, to the licensed professionals who are truly the drivers of rising healthcare costs…

By: ERMurse

ERMurse — Thu, 28 Jun 2007 22:47:00 +0000

Please spare us with the Doctor knows best and if your not a MD you cant comment on the care. The tests described for the patient is out of line and shows a lack of confidence and or assessment ability. It does not take a medical degree to figure that out.

By: POed 2

POed 2 — Thu, 28 Jun 2007 22:21:00 +0000

AND NURSE K AND YOUR ILK –
have you thought of spending your efforts and time on quality nursing, instead of 2nd guessing your docs in every turn? Wonder how much more efficient you could be getting the responsible steps done? And how many more patients your ER can provide primary care to…

NO, the doctors don’t make any more money for doing more tests; they actually get economically de-credentialed. [If you have no clue what this is, Elliot et al., go research it; it should keep you better informed than in your ignorant commentary]

By: P O'ed

P O'ed — Thu, 28 Jun 2007 22:11:00 +0000

Bottom line: Nurse K and her/his ilk should quit spending long days in the ER and go to medical school.
That way, you can start practicing what you advocate with your own livelihood, professional liability, and liberty on the line. If you want to play, you gotta pay. PUT YOUR MONEY WHERE YOU KEEP PUTTING YOUR MOUTH IN, WITH YOUR IGNORANT CRITICISMS, COMMENTS AND BLOGGING!!!

By: Anonymous

Anonymous — Thu, 28 Jun 2007 21:09:00 +0000

agree with headline comment. although i doubt the kid was rapidly progressing. why not admit the kid and observe? if the kid isnt changing his loc why bother with an immediate CT. although we dont know the time frame and the actual experience.
yes its an expensive workup. but this was one case. im sure there are hundreds of kids sent home without a CT.

By: Anonymous

Anonymous — Thu, 28 Jun 2007 20:46:00 +0000

Headline:

Eighteen year old patient dies of kidney failure from rhabdomyolysis. ER doctor implicated.

How many of you would be commenting with 20/20 hindsight that the idiot should've done more workup before letting the patient go home with some advil and a note?

By: Anonymous

Anonymous — Thu, 28 Jun 2007 20:28:00 +0000

“My feeling on the hematuria was that since the patient was stable, she could get a repeat UA at her clinic when she followed up there for the back pain. If you don’t have a clinic, we give you a card for a clinic that offers low-cost primary care services”

I am sorry nurse K but everything you are telling me shows that you have not had to make primary medical decisions. I have seen FIRSTHAND docs go to court because their ER staff gave a “go to a low cost provider” card with address to a patient with an abnormality. Guess what, the person did not follow up and one year plus later showed up with metastatic cancer. Guess who went to court for that one. It wasn’t the ER staff, it was the ER doc. Your other analogy is stupid. PT visits are not emergent issues to be addressed in the ER (though important). I suspect if you bothered to ask the ER doc he would have given you a reasonable explanation (or maybe not). But the fact is hematuria needs to be followed/evaluated and not dismised because of what it COULD mean (remember that differential diagnosis of hematuria I was talking about). In the end it’s not you making the call and it’s not your butt on the line. If you feel you are right and the doc is an idiot there is an easy solution…go to med school.

By: Nurse K, Generic ER Nurse

Nurse K, Generic ER Nurse — Thu, 28 Jun 2007 20:13:00 +0000

If the test was never ordered in the first place, no one gets a "cash payment." We are in a free market, and if defensive medicine was decreased, the cost of doing business for insurance companies would decrease, and, through competition, prices for insurance would decrease (or, at the very least, increase less). If she was a Medicaid patient, yours and my taxes would be reduced. As a chain reaction, more uninsured people who were previously priced out of the market would be able to afford insurance.

You appear to be a troll, but the goal of medicine isn't to shatter the healthcare system as we know it by ordering so many tests that price of insurance makes it unattainable for most, if not all, people. Doctors' goal isn't to "stick it to The Man."

What if she requested it be done?

So what? If there's no indication, there's no indication.

By: Anonymous

Anonymous — Thu, 28 Jun 2007 19:51:00 +0000

What if she requested it be done? Still defensive medicine?

And again, who gets the benefits of all these savings? Do the 45 VPs at Kaiser all get a new Lexus?