tag:blogger.com,1999:blog-4968787219619380438.post7776643906257324986..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Unprofessional behavior by medical hospitalistsSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-4968787219619380438.post-1500239820294322162012-07-09T13:22:31.209-04:002012-07-09T13:22:31.209-04:00Bob, good to hear another point of view. I hate Co...Bob, good to hear another point of view. I hate Coumadin too.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-86712281144467023292012-07-09T12:53:08.589-04:002012-07-09T12:53:08.589-04:00Running the test is only a small part of the Turn ...Running the test is only a small part of the Turn Around Time (TAT).<br />Add in the amount of time it takes for the secretary to put in the order, the phleb then waits for Xray to get their fourth film. The nurse then tells the phleb that she will draw the blood they need when she starts the IV, right after she does something quick with another patient.... 10 min later.<br />Turns out that the patient is on Coumadin, and it takes 15 for the blood to clot. Finally spun, and run thru the 15 parameter analyzer, and the Coumadin rich plasma (that was thought to be serum) decides to clot in the analysis path, requiring a 15 minute tear down, and re-riming the clot.<br />If the er system is not down, the result is then picked up by the nurse, who was on another of her 10 minute jobs, and brought to you.<br />While every source of pre and post analytic frustration is not present on every specimen, there's usually at least one on most of them.<br />BTW.. We also make fun of you because you gripe about it taking an hour for lab results when it takes you four hours to discharge the patient..... ;-PBobhttps://www.blogger.com/profile/13887370527502545883noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-79033543698148836202012-06-22T09:47:24.675-04:002012-06-22T09:47:24.675-04:00Suzanne, I have a theory that the lab does whateve...Suzanne, I have a theory that the lab does whatever it wants regardless of how you mark the specimens. The fact is, the new auto-analyzers most labs have can run any test in 5 to 10 minutes, yet it still takes an hour to get a stat lab result back.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-4927582024163984712012-06-21T23:41:00.034-04:002012-06-21T23:41:00.034-04:00I have docs in the ER that mark labs as urgent...u...I have docs in the ER that mark labs as urgent...um really we are in an ER...ya think?Anonymoushttps://www.blogger.com/profile/00239549305651230543noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-2644666037071929312012-06-21T14:46:54.380-04:002012-06-21T14:46:54.380-04:00Ampace, I'm afraid at times the mistrust is re...Ampace, I'm afraid at times the mistrust is real.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-86434136255921454862012-06-21T09:20:27.494-04:002012-06-21T09:20:27.494-04:00not just tough cases, they're the ones we reme...not just tough cases, they're the ones we remember! no one remembers the slam-dunk appy...mdawarehttps://www.blogger.com/profile/11511273712090189564noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-52681995459425185812012-06-21T09:11:47.678-04:002012-06-21T09:11:47.678-04:00MD Aware, Thanks for admitting that it goes both w...MD Aware, Thanks for admitting that it goes both ways. I agree with you that there is no real incentive for residents to admit, especially if it's not an interesting patient. But paying them to admit is likely to lead to a lot of unnecessary and unjustifiable admissions.<br /><br />I also agree that the borderline cases, like right lower quadrant abd pain with an equivocal CT scan, are the tough ones.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48649232547938957462012-06-21T08:45:08.020-04:002012-06-21T08:45:08.020-04:00As an incoming M1, I find the bickering between sp...As an incoming M1, I find the bickering between specialists a little disheartening. Does this lead to some sort of passive aggressive mistrust between specialists or is it reserved for happy hour and blogs?ampacehttps://www.blogger.com/profile/04529647952155035859noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-6196149022238751342012-06-21T08:38:22.137-04:002012-06-21T08:38:22.137-04:00I don't want my tone to be misconstrued -- thi...I don't want my tone to be misconstrued -- this is all in good fun! but don't worry, we in the ED know that the upstairs folk make fun of us, and I admit that we disparage other specialties as well. my favorite are the layered disparagements, e.g: "the ER is silly for never giving lasix to CHF patients!" vs. "those hospitalists always make fun of us for never giving diuresing APE pts when we know that doesnt help and usually hurts!"<br /><br />in all seriousness, I think a lot of the rancor, particularly in academics, is that the admitting residents don't get any "incentive" to admit; it's just one more patient from the ED (i.e. they don't get paid more for another patient). further, esp with surgical (of all stripes) patients, it's a needle vs haystack problem. the surgical resident never sees the patient with the normal RUQ US because the patient went home. the patient with clear cholecystitis is quick & easy. but the ones that rankle everyone are the patient with a small stone, maybe a thick wall, no pericholecystic fluid, tenderness but not too bad... it takes all day to figure out which way the patient goes and it's really just an unclear patient.mdawarehttps://www.blogger.com/profile/11511273712090189564noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-58182293806037742532012-06-21T07:15:56.470-04:002012-06-21T07:15:56.470-04:00Anonymous, thanks and I understand why you chose t...Anonymous, thanks and I understand why you chose to be anonymous. You raise some interesting points.<br /><br />Jennifer, no question is silly if you don't know the answer. There are probably others who don't know what a hospitalist is but were too timid to ask. Paste this link, http://en.wikipedia.org/wiki/Hospital_medicine, into your browser.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-2664956771719092462012-06-21T05:36:13.880-04:002012-06-21T05:36:13.880-04:00silly question, as am not from the states. what...silly question, as am not from the states. what's a hospitalist?jennifer downshttps://www.blogger.com/profile/12958241288136689274noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-91629939277146905842012-06-20T21:47:18.901-04:002012-06-20T21:47:18.901-04:00I would like to do a study like this in the ER. I ...I would like to do a study like this in the ER. I think it would show that<br /><br />100% of ER docs admitted to<br /><br />- ordering expensive studies without ever seeing a patient<br />- calling a consult without an actual diagnosis just hoping the consultant would admit a patient<br />- not being able to find the OR or ICU in their own hospital<br />- not being able to locate the spleen on an abdominal ct scanAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48251256681697566352012-06-20T14:48:59.312-04:002012-06-20T14:48:59.312-04:00Anonymous, thanks. They're too busy discussing...Anonymous, thanks. They're too busy discussing personal matters at work to risk missing a day.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-58120468402895256702012-06-20T13:04:18.700-04:002012-06-20T13:04:18.700-04:00Going to work when sick. What were they thinking? ...Going to work when sick. What were they thinking? I'm sure finding someone to fill in would not present a problem. Don't they get 20 or 30 sick days?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-86185933636398140992012-06-20T10:18:24.583-04:002012-06-20T10:18:24.583-04:00Roger and Leo, thanks for commenting.
Roger, the...Roger and Leo, thanks for commenting. <br /><br />Roger, the research was funded by the ABIM {American Board of Internal Medicine] Foundation and the Pritzker Summer Research Program, but I can see how you might have assumed it was by companies that make listening devices.<br /><br />Although I agree with the essence of Leo's comment, I'm not sure the Journal of Hospital Medicine [Impact Factor 1.95] is a well-known journal.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-6707128117091607142012-06-20T10:03:03.162-04:002012-06-20T10:03:03.162-04:00Ugh, I find it sad that reputable schools with rep...Ugh, I find it sad that reputable schools with reputable researchers get grants for ridiculous research projects which eventually get published in well known journals. On the other hand you have struggling researchers who are good, with great research ideas at so so schools who cannot find the funding or get their published in well known journalsLeonoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-75674630711886793442012-06-20T09:59:53.513-04:002012-06-20T09:59:53.513-04:00Were the grants from companies that develop listen...Were the grants from companies that develop listening devices?Rogernoreply@blogger.com