Open Mic Weekend


Daughters WhiteCoat are competing in two dance competitions and performing in two plays this weekend, so will be busy videotaping and taking pictures. Ergo, no posting.

However … I finally made a few tweets [?] on my Twitter account. If you are exceedingly bored, you can follow me at “WCintheED“. If I can figure out how to put a Twitter feed on the margin of the blog, I’ll try to do that next week.

The comments section is hereby open for anyone to post any questions, comments, or other medically-related esoterica. Just remember, no personal attacks.

I’ll try to answer posted questions/comments on Monday. Enjoy the weekend.



  1. I get to kickoff…woot for being up at 3 AM. Anyways, my coworker and I were arguing about building immunity (preface: my face made a painful expression when I saw him go straight from his keyboard to a jug of chocolate peanuts). He argues that you shouldn’t hand sanitize and go out of your way to avoid sickness because having a really strong immunity to everything is good for you. I was arguing that having an immune system that never has to do any heavy lifting is better. Is there a right answer?

    • I don’t know that there is a right answer.
      On one hand, virulent organisms kill you if you’re exposed.
      On the other hand, immunizations have save the lives of millions.
      Some of it has to do with timing. A large dose of infectious agent in an open wound really can’t enhance your immunity, so sterility and cleanliness is important. However, smaller doses of known antigens can prime your immune system – hence the benefits of flu shots.
      If you want to take some advice from Grandma WhiteCoat, she always used to say “everyone eats a bushel of dirt before they die.”

  2. Dr. EM Resident on

    I am an EM resident, PGY3. I moonlight at this ED close to my house, and it serves about 15,000 patients a year. Real small.

    Anyways, I was moonlighting, and everything was really quiet. So far, everything mostly was colds and sinus and a few sutures.

    But then, a male comes into the department, with an infection on his penis. Now, this is no ordinarily dressed male. He was wearing leather and a collar, chains, and some other BDSM clothing.

    I had taken the history and everything, and I leave to check on something else in the department. I ask my favorite nurse to do a basic penile exam, and I will do another exam afterwards.

    So, a few minutes later, I had completed what I needed to do, and see this nurse sitting. She starts laughing, and says “Doc, you are going to love this kid.”

    I walk into his patient room, and I begin the physical exam.

    Right when I looked at his penis, I noticed I tattoo. The tattoo was text, in an italic font.

    It said, “This penis is valued at $3,853 (After Self Appraisal) and is property of Sarah ******. If found elsewhere, please provide Testicular Torsion and call the following number.”

    There was a real phone number listed there.

    I wrote the number down on a sticky note, and after the exam I looked it up on the computer. It is a real number.

    Anything like this ever happen to you?

    • Stay in this job long enough and nothing will faze you. I’ve seen a prisoner tatoo near the anus that said “exit only”.

  3. Is there any standards as to how many beds/rooms an ER Doctor can handle (max)? Some hospitals are expanding their ER’s beds, but not the staff.
    And our hospital system has eliminated after hour/weekend ultrasound ! So if the pregnant bleeding patient shows up on Sunday or 5:15 PM, she’s sh2@# out of luck.
    Anyone else having this problem ?

    • Yup. Try it with “call in” ultrasound and CT, with the U/S tech “screening” the call-in. (Because our hospital closed OB, the hospital won’t allow any OB ultrasound for liability reasons… so P&B patients … we don’t even call).
      Then the JC mandates carpeted section to use disposable equipment… have you seen the crap that passes for suture trays (provided by the lowest bidder, of course). Don’t get me started on chest tubes…

      Fortunately I have invested in a Chakra Healing Stick. So what could possible go wrong?

      • Nothing- I mean it’s totally natural and organic, right ? No side effects whatsoever.
        I personally have started doing psychic surgery myself on a select few psych patients.

      • Wow, I was going to quote something from that Chakra stick page to point and laugh at, but nearly every sentence has me awestruck. I was not aware auras had to be sewn back together!

        And then the ad on the side says, “Meet your Conscious Soul Mate!!” I do like the people I meet to be conscious, so I guess it’s not a total waste.

    • Hospitals can expand the number of rooms all they want. Unless they have the staff to move the patients, the expanded rooms will become glorified waiting rooms.
      AAEM has a position statement that docs should not see more than 2.5 patients per hour in a moderate acuity ED (15% admit rate). That’s single coverage for a 22,000 visit emergency department, which I think would be pretty tough.

      Hospital needs to be very careful about eliminating after hour ultrasounds. If they provide the ultrasounds during working hours but not at off hours, then they are asking for EMTALA violation. Either they provide the services all the time or they don’t provide the services at all. Tell your administrators to run that decision by their legal counsel.

      • In our case, our counsel agreed. They also checked with JC and state regulators. OB ultrasound is not available to anyone, anymore regardless of insurance. Thus, no EMTALA issues, and any hospital with OB ultrasound becomes a higher level of care.

        Interesting that JC understands that different hospitals have different capabilities, and thus the medical screening exam can be different. As it was explained to us, the screening exam (and all tests) must be the same for insured and uninsured. The content of the exam (and screening tests) is not the issue. So, as in the ‘House of God’, if you don’t have a thermometer you won’t find a fever (and the associated liability)

        So, as malpractice insurers figure out that it is safer to be able to do less, then that will be the trend. Sadly, we are already seeing this, and what could be handled locally is now transferred (dumped) to higher level of care.

        Good care — no. Medico-legally defendable care — yes.

      • I cannot help but wonder if there is a secondary gain- we now have to transfer them to the mother hospital ( by EMS) – do they get billed for 2 ER visits and an ambulance transfer ?

  4. Igloodoc: What do you do now with suspected ectopics, etc.? Immediate transfer?

    Chelsea: I’m no expert on the hygiene hypothesis, but I thought that it had more to do with early childhood immune system development than maintenance of asthma/allergies as an adult. Anyone have any answers?

    Also, asthmatics are among those who are exhorted to get the flu shot, Pneumovax, etc., because they are at higher risk of complications. Thanks to the flu on top of asthma, I can say I’ve experienced air hunger and the feeling that just breathing was making me tired. If there are sick people around, you’ll have to pry my hand sanitizer out of my trembling, cyanotic hands. 🙂

    Anon, the rest of my unscientific take is that, even with handwashing and hand sanitizers, you are not going to eliminate your exposure to germs. You ARE going to cut down on the numbers you are exposed to, which is important since higher numbers = higher probability of getting infected. Even a healthy immune system can get overwhelmed if the pathogen is present in sufficient numbers. Further, tell him he’s welcome to lick his own keyboard but that he’d better wash his hands before touching anything that the rest of you have to eat.

    • I should add that I have absolutely no qualifications to add to this thread. I am a first year vet student, which means that the two microbrains of information I know aren’t even about humans.

    • Yet the rate of asthmatics continues to skyrocket- at the same time we’ve got completely enclosed air conditioned houses, cars and schools.

    • We ship them to the nearest facility with OB that hasn’t closed yet .. $600 per transport. Good news, it’s the people’s insurance plan, for the most part.

      What is really interesting is the P&B at 38 weeks and delivery is imminent. Almost all are hi risk (druggies or no prenatal care, etc). And we have the privilege of being legally tethered to the polybabydadic offspring for 18 years… (if the don’t play first string QB for the Colts it was birth trauma, according to John Edwards’ expert ho). Nothing like watching a beautiful new life coming into the world, and the new mom playing “Who’s your daddy” for real. Makes me misty.

      Certainly no “hostile legal climate” here. My Chakra Healing stick makes it all just a bad dream.

    • I personally think it would be better to wait until you’ve got a year under your belt in residency. That way, your team knows you and you’ll have time to arrange coverage for maternity leave.
      Trying to study and care for a child in medical school would be a very challenging task.

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