Open Mic Weekend


It’s been about a month since the last open-mic weekend.

What’s on your mind?

All weekend everyone is welcome to post any medically-related comments, questions, observations in the comments section. Will try to answer any questions through the weekend.

Only rules are that there are no personal attacks and that the comments/questions are medically-related.

Have a safe and enjoyable weekend.


  1. Dr. Septic Work-Ups 4 All is on this weekend and if I draw another two sets of blood cultures and a lactate on a normotensive, afebrile patient again, I’m going to freakin’ go off. Seriously, I’ve done like 12 order sets like this the last 24 hrs and none of these people were febrile nor hypotensive.

    Is there some paper floating around out there that says that everyone with mild cellulitis (eg. erythema on the top of the foot) or abdominal pain (even abdominal pain related to constipation) should get a lactate drawn or is Dr. Septic Work-Ups 4 All just ordering this stuff to torture us?

    Also, please, please, please, stop ordering type and crossmatches for 17-year-olds with normal hgb and appendicitis or 40-year-olds with gallbladders! I have to re-draw the patient for a blood bank tube and not a single surgeon in America wants a healthy 17-year-old kid getting type and screened before surgery, especially a surgery where the average blood loss is something like 30-50cc.

    Thank you all.

    • retired because of BS like this on

      Like most of the stupid, wasteful, unnecessary things we do; he is doing it because an emergency physician has been successfully sued for NOT doing it.

    • Haven’t you read about the new JIM DWYER criteria for diagnosing sepsis? After all, any signs of infection plus pulse greater than 90 plus other vague criteria could mean that a patient has SEPSIS. Doesn’t have to be a fever or hypotension.

      Replace clinical judgment with cookbook medicine and this is what you get. God forbid you miss a case and then have some irresponsible journalist inappropriately publishing your name in a national newspaper. Then the lawsuits come crashing down. Some docs have more risk tolerance than others, but the effects of guidelines and lawsuits are defensive medicine and more expensive care.
      Now the feds are trying to create more checklists to reduce the amount of testing.
      Why have docs?

      I don’t have an answer for the whole T&C deal. I’m assuming you have discussed with the doc. Maybe ask the surgeon if he/she wants a T&C and if not, tell the doc that the surgeon said not to order it. Do that a few times and the doc will hopefully get the hint.

  2. Not a new topic: What are docs doing about those patients who enjoy their E.D. narcotics a bit too much, but then write lengthy complaints to administration complaining about their “medical care” when they don’t receive their mega-dose narcotics for chronic issues? Administrative types here are wanting to know why we are having complaints and how it can effect the all knowing Press-Ganey stats. Best I can tell, these are decent compassionate physicians trying to do the right thing for patients in general. They don’t want the come to Jesus talk after the fact on how they as professionals knowingly enabled the patient’s narcotic addiction by providing these mega-doses of pain meds.

    I have heard Greg Henry’s platitudes about not fixing a drug habit in one E.D. visit and agree with it conceptually, but it provides no practical ways for dealing with an increasing problem.

    Orginal and creative thoughts and comments on this topic are always appreciated.

    • Wouldn’t it be great if every time that a discretionary prescription for narcotics was written under the threat of job loss, there was a chart entry saying something along the lines that “Neither this visit nor a prescription for narcotics appear to meet medical necessity guidelines, however according to a directive from Jim Dwyer, hospital CEO, emergency physicians are to consider proper medical care as being secondary to patient satisfaction.”

      If you know of a doctor or NP/PA who has been either fired, who has had a decrease in pay, or who has had any other adverse action taken against them because of patient satisfaction issues, please contact me by e-mail. The sooner the better. I need to put you/them in touch with someone.

  3. Need some help to settle an argument. What do ED people really think of people who rock up to the emergency department to have self inflicted cuts stitched up?


    • Like most ER nurses, I’m friendly and pleasant to all my patients. In my head, it depends. People who seem desperately sad, and at a loss to do anything else about their pain make sad and make me want to work as hard as I can to help them find resources.
      Then there are those that are dramatic, demanding attention, acting foolish. Of course, my nurse brain knows that everyone acts differently under stress and when in pain (physical and emotional), and I treat them as compassionately as the first group.
      But in my head, I’m only human, ya know? The 2nd group is a lot harder to deal with emotionally. It takes a lot more work to feel compassionate. I like to think I’m good at it though. I genuinely like people and want to help them.

    • I agree with ERNurse
      In most cases, what the staff thinks of you and how they treat you really depends on how you treat them and how you act.
      Act like a drama queen/king and be a jerk, you’re more likely to get eye rolls and a condescending attitude.
      Treat us like humans and most of the time we’ll go out of our way to help you.
      Can’t say that everyone working in an ED feels the same way, but from the places I’ve worked, this is by far the majority opinion.

  4. Saw the cover of Reader’s Digest for this month: “50 Secrets Surgeons Won’t Tell You” and was reminded of your blog, ha.

    Ever consider making a list of “Secrets ER physicians won’t tell you?”

    • I think Reader’s Digest did the same thing with emergency departments a few years ago. I seem to remember that Grunt Doc took a little heat for some secrets he suggested.
      I’ll bet that we could probably make a better list regarding the ED if you all were interested. Don’t know that we could come up with 50 secrets, but we could probably come up with quite a few.

  5. For the next open mic weekend, I’m gonna need an entire medical breakdown of Abby and Brittany Hensel, those 22-year-old conjoined twins that are basically like a two-headed body (and have their own organs until you get to their intestines when everything is shared). I especially want to know about all things related to sex, and all things related to critical illness, especially if one is critically ill but the other is not. Questions to get you started: What happens if one is brain dead and the other isn’t? How would you do compressions (they have 2 hearts)? How would you defibrillate?

    This has been the talk of our unit ever since their show came on TLC. It’s pretty mindblowing to think about!

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