Open Mic Weekend


Away for the weekend and into Monday (actually posting this from my phone).
Take over the comments section with any medically-related questions or comments you have.
Just remember — no personal attacks.
Will try to answer any questions on Monday.
Have a great weekend!


  1. We have a couple of “big work-up” docs in our ER, but one is just so ridiculous, so over the line- I often wonder if it’s as much to do with being paid more, than for ‘CYA’ purposes. He just makes me absolutely batty, he slows down the whole ER and the doctor in the other section has to see twice as many patients.
    Case in point. Over the weekend, we saw a young college student who had way too much ETOH and admitted to being at a party where lots of people were smoking THC. This person was really dramatic, anxious, crying (probably a negative reaction to the pot, but who knows), and apparently on the scene, was found wandering, not knowing who they were/ where they lived. He ordered a CT head- which I could sort of understand- fine, expose her to radiation in the absence of evidence of injury, but whatever.
    BUT, the two orders that got me were a PT/PTT and ammonia level. WHAT?!? An effing ammonia level? THEN, when it was actually elevated, he said to ignore it, he wasn’t going to do anything with it. WHY DID YOU ORDER IT THEN? And really, a PT/PTT? What information does that give us. How do either of these tests change our plan of care?
    You know what? We didn’t do the UDS he ordered before we discharged this person either. He was gone, the doc he signed out to didn’t care. BECAUSE, WHO CARES? They sobered up, were ambulatory, A&Ox4 and able to call someone for a ride home. Why does it matter if there was something other than the ETOH on board?
    Rant over.

  2. Actually, the doctor generally makes nothing off the tests and radiologic studies ordered. In the ER this is almost universally true. And patients that sit and take up space waiting on studies are patients that are not generating new bills. It is far more lucrative to see 3 level 3 ER visits than to order unnecessary tests and take the extra time to get to level 4 on 2 visits in the same amount of time.
    Big Workup docs probably make less in other words. It’s not money. It’s usually fear or incompetence or both. Or they misunderstand how doctors make money as much as most laypeople/nurses/techs/etc do.


  3. I know it has been talked about before on this website but the law in Florida that forbids doctors from asking about whether their patients have guns at home. For violating this law, providers can be subject to license suspension and/or revocation and at 10K fine. There are a few loopholes where safety may be at risk but it says that you can’t record it in the medical record unless its “relevant to medical care”. What the heck does that mean? Fortunately, various medical societies in Florida have already filed suit to overturn this misguided law.

    We have government intrusion into many aspects of medicine- we don’t need the government sticking their noses in the doctor-patient relationship. ER doctors and psychiatrists need to assess whether their psychiatric patients have firearms at home that could put them at risk for completed suicide. Pediatricians and family doctors need to give guidance to parents to keep their firearms locked up and out of reach of children.

    We aren’t out to take away anyone’s guns- we are doing our part for public safety and health and these questions are a part of any comprehensive medical screen. If people don’t like the fact that their pediatrician asks about guns in the home- find another pediatrician. If you don’t like the ER doctor asking about it- lie and say that you don’t have guns at home. Don’t punish me because I am taking a good history and doing my job. Do something useful like fix medicaid- don’t stick your noses in my patient interactions.

    JAMA has an excellent article written from the POV of healthcare providers as to why this law is a bad idea. Its available for free at

    • I’m with you.
      As medical records become more digitalized (why do you think that feds are offering a $44,000 incentive to change to EMR?), and as more patients obtain government medical insurance, there will be more government intrusion into medicine.

  4. Do any of you doctors, RNs, PAs, medical staff ever get paged on an airplane for a medical emergency? If so, tell us some stories. (Change the facts of course.)


    • About 12 years ago I was on a plane en route to the annual ACEP conference and they asked for a doctor. 40 people popped up and started running toward the front of the plane. It was pretty funny. I just sat back down cause I figured the other 39 ER doctors on the plane could handle it.

    • I was warned by an older doctor to think hard before answering. In the good old days, the airline would give you a free ride or something nice in thanks. Now, they want you to sign all kinds of paperwork accepting responsibility for everything and excusing the airline from any fault.

  5. I’m still trying to figure out why so many of the patients I see in the ER state they “just moved here” . Why is it the first thing you do when you move to a new town is to check out thelocal ER ?

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