Comments on: Trigger Happy? http://trismus1.wordpress.com/2007/09/26/trigger-happy/ My experiences as an ER doc Tue, 08 Dec 2009 19:37:38 +0000 http://wordpress.com/ hourly 1 By: Judy http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3716 Judy Mon, 01 Oct 2007 02:18:37 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3716 You probably managed to tick someone off. Maybe only once, probably at least a couple more times than that. What I find interesting is that you didn't blow off the allegation. You found a way to determine whether or not it was justified. As you said, Ha! I don't want the ER doc who does unjustified scans - or the doc who doesn't do justified scans. I want someone closer to the center of the curve than either of those. Sounds like you are. What I most want, though, is someone who will explain (briefly)what has been ordered and whet he/she expects to find/rule out with that test. Doesn't have to be very specific and if I come in with a headache, I don't need be told that you're ruling out a brain tumor when you do the head CT. In fact, I'd really rather NOT hear that, because I know it's on the differential. You probably managed to tick someone off. Maybe only once, probably at least a couple more times than that.

What I find interesting is that you didn’t blow off the allegation. You found a way to determine whether or not it was justified.

As you said, Ha!

I don’t want the ER doc who does unjustified scans – or the doc who doesn’t do justified scans. I want someone closer to the center of the curve than either of those. Sounds like you are.

What I most want, though, is someone who will explain (briefly)what has been ordered and whet he/she expects to find/rule out with that test. Doesn’t have to be very specific and if I come in with a headache, I don’t need be told that you’re ruling out a brain tumor when you do the head CT. In fact, I’d really rather NOT hear that, because I know it’s on the differential.

]]> By: Ten out of Ten http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3710 Ten out of Ten Sun, 30 Sep 2007 03:18:24 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3710 You know, the point of the post is that I don't order a ton of scans. But whatever. You know, the point of the post is that I don’t order a ton of scans. But whatever.

]]> By: jay willard http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3704 jay willard Sat, 29 Sep 2007 17:05:05 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3704 Nice to see that nurse K is so empathetic. As many plaintiff lawyers themselves point out, they themselves want as much testing as humanly possible because as far as they see it that is the best medicine and are we really going to fight lawyers. If you can't beat 'em, join 'em.... Nice to see that nurse K is so empathetic. As many plaintiff lawyers themselves point out, they themselves want as much testing as humanly possible because as far as they see it that is the best medicine and are we really going to fight lawyers. If you can’t beat ‘em, join ‘em….

]]> By: girlvet http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3703 girlvet Sat, 29 Sep 2007 16:53:28 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3703 It seems like some of the practice of ER medicine seems to relate to confidence. If docs are confident in their assessment skills they don't seem to order as much. Thats what it seems like to this nurse anyway. As an ER nurse I know exactly which doc will order lots of tests, which won't. I gotta tell ya we dread working with the overorderers. It seems like some of the practice of ER medicine seems to relate to confidence. If docs are confident in their assessment skills they don’t seem to order as much. Thats what it seems like to this nurse anyway. As an ER nurse I know exactly which doc will order lots of tests, which won’t. I gotta tell ya we dread working with the overorderers.

]]> By: Dr. Smak http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3694 Dr. Smak Fri, 28 Sep 2007 23:21:40 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3694 I never fault an ER doc for a scan. To me, you guys have it the hardest. You have no relationship on which to base the patient (non-complainer vs. cry-wolfer), you have no opportunity for followup, and you have immense time pressures and other patients waiting to be seen. For my patients whom I know well, sometimes it's appropriate to follow conservatively and scan if not better in 24 hours. That would be tempting fate (and a lawsuit) for you. I speak for primary care when I say that we don't fault you guys for scans. After all, what do we say when we don't know what the hell is wrong, and it's looking bad? "Go to the ER..." I never fault an ER doc for a scan. To me, you guys have it the hardest. You have no relationship on which to base the patient (non-complainer vs. cry-wolfer), you have no opportunity for followup, and you have immense time pressures and other patients waiting to be seen.

For my patients whom I know well, sometimes it’s appropriate to follow conservatively and scan if not better in 24 hours. That would be tempting fate (and a lawsuit) for you.

I speak for primary care when I say that we don’t fault you guys for scans. After all, what do we say when we don’t know what the hell is wrong, and it’s looking bad?

“Go to the ER…”

]]> By: Howard http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3684 Howard Fri, 28 Sep 2007 00:22:30 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3684 Regardless of how many scans you order, you will still be sued. Unfortunately it is simply a part of our life. You can not prevent lawsuits from being filed. But, you can help prevent yourself from losing them. If the scan is not indicated, and you have met the standard of care, you will likely win the lawsuit. Practicing in fear of your first, or next suit, is a miserable place to be. Regardless of how many scans you order, you will still be sued. Unfortunately it is simply a part of our life. You can not prevent lawsuits from being filed. But, you can help prevent yourself from losing them.

If the scan is not indicated, and you have met the standard of care, you will likely win the lawsuit. Practicing in fear of your first, or next suit, is a miserable place to be.

]]> By: William the Coroner http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3677 William the Coroner Thu, 27 Sep 2007 17:21:08 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3677 "Yeah, we don’t have the liability, but if I chart my assessment and you chart your assessment and neither one has an indication for the exam and you don’t order it, how can they sue you?" Because the bar is so low to sue, and the risks so high. Hell, if the patient/victim looks sympathetic enough, that's all you need, no science required. “Yeah, we don’t have the liability, but if I chart my assessment and you chart your assessment and neither one has an indication for the exam and you don’t order it, how can they sue you?”

Because the bar is so low to sue, and the risks so high. Hell, if the patient/victim looks sympathetic enough, that’s all you need, no science required.

]]> By: Anonymous http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3676 Anonymous Thu, 27 Sep 2007 16:04:22 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3676 Two words: Defensive medicine Two words: Defensive medicine

]]> By: Ten out of Ten http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3675 Ten out of Ten Thu, 27 Sep 2007 10:06:33 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3675 If there's no indication, I don't order it. I don't do any of that stuff. If there’s no indication, I don’t order it.

I don’t do any of that stuff.

]]> By: Nurse K http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3671 Nurse K Thu, 27 Sep 2007 03:37:19 +0000 http://trismus1.wordpress.com/2007/09/26/trigger-happy/#comment-3671 Oh, don't worry. Order away! American tax dollars are vast and never-ending. Insurance premiums have already hit a ceiling and can't go any higher! Oh wait, yeah they can. Yeah, we don't have the liability, but if I chart my assessment and you chart your assessment and neither one has an indication for the exam and you don't order it, how can they sue you? What pisses me off personally (other than the lobby back-up that is created when scan-happy doctors are on) is when a doctor won't tell the patient they're having a scan (some won't even warn the patient about the $5000 or whatever MRI scan they ordered) and I don't think there's any indication for it. It's like they want me to defend their stupid scan. Nope. Sorry. Oh, don’t worry. Order away! American tax dollars are vast and never-ending. Insurance premiums have already hit a ceiling and can’t go any higher! Oh wait, yeah they can.

Yeah, we don’t have the liability, but if I chart my assessment and you chart your assessment and neither one has an indication for the exam and you don’t order it, how can they sue you?

What pisses me off personally (other than the lobby back-up that is created when scan-happy doctors are on) is when a doctor won’t tell the patient they’re having a scan (some won’t even warn the patient about the $5000 or whatever MRI scan they ordered) and I don’t think there’s any indication for it. It’s like they want me to defend their stupid scan. Nope. Sorry.

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