Alcholics do not perceive danger appropriately, says a German scientist
Really? I would never have guessed...
Wednesday, August 29, 2007
Sunday, August 12, 2007
The Pain Scale
(the following post inspired by this post...thanks ERnursey, scalpel, monkey)
The 10 point pain scale is a load of CRAP and here are several reasons why:
1. "On a scale of 0-10, what would you rate your pain?" "it's a 12"
Right there. See that? Clearly directed, 0-10. Answer was a 12. If you can answer with any damn number you please, then it's not a 0-10 scale, and therefore meaningless. "yeah, well, mine's a...a...14 bajillion"
2. "What happened today?" "I bumped my toe." "On a scale of 0-10, 10 being the worst pain you can imagine, how bad is your pain?" "Oh, doc, it's a 10!" Really? Seriously??? God, you live a pampered life, if you can't imagine any worse pain than that. What about getting shot? What about getting stabbed? What about having your fingernails ripped off one by one, slowly???
3. "On a scale of 0-10, 10 being the worst pain you've ever felt..." What? Worst you've ever felt? What happened to "worst you can imagine?" Consistency is needed.
4. My personal favorite, after the 12 on a 10 point scale (still can't get over that one...)...If you tell me your pain is a 10 on a 10 point scale (ie, there's no worse pain possible), then you are not allowed to jump and scream when the IV gets started!!! I suppose that makes the IV a 12.
5. and finally...If I enter the room, say hello, repeat myself, and then wake your a$$ up, your pain is not a 10.
The 10 point pain scale is a load of CRAP and here are several reasons why:
1. "On a scale of 0-10, what would you rate your pain?" "it's a 12"
Right there. See that? Clearly directed, 0-10. Answer was a 12. If you can answer with any damn number you please, then it's not a 0-10 scale, and therefore meaningless. "yeah, well, mine's a...a...14 bajillion"
2. "What happened today?" "I bumped my toe." "On a scale of 0-10, 10 being the worst pain you can imagine, how bad is your pain?" "Oh, doc, it's a 10!" Really? Seriously??? God, you live a pampered life, if you can't imagine any worse pain than that. What about getting shot? What about getting stabbed? What about having your fingernails ripped off one by one, slowly???
3. "On a scale of 0-10, 10 being the worst pain you've ever felt..." What? Worst you've ever felt? What happened to "worst you can imagine?" Consistency is needed.
4. My personal favorite, after the 12 on a 10 point scale (still can't get over that one...)...If you tell me your pain is a 10 on a 10 point scale (ie, there's no worse pain possible), then you are not allowed to jump and scream when the IV gets started!!! I suppose that makes the IV a 12.
5. and finally...If I enter the room, say hello, repeat myself, and then wake your a$$ up, your pain is not a 10.
Uh oh...
...I seem to making it onto a few people's blog lists!
I guess that means I need to come up with some witty, or intelligent, or at least profound, things to say, in case even MORE start to read this!
oh, the pressure!
I guess that means I need to come up with some witty, or intelligent, or at least profound, things to say, in case even MORE start to read this!
oh, the pressure!
Thursday, August 9, 2007
No soup for you!
We got our regular admonishing from our medical director today about food in patient care areas. You see, according to JCAHO, no food or drink can be consumed in patient care areas. This includes any area that can be seen from a patient bed. Unfortunately, in the design of the ER I work in, that includes all of the physician workstations.
So...we're not allowed to drink water, coffee, or eat at our workstations. I'm thinking about revolting, at least until some demands are met.
1. The patients can't eat where I can see them.
2. You pay for my Urology visit when my urine gets so concentrated that I form a kidney stone.
3. I get a break to eat during my 8 hour shift that spans either lunch, dinner, or breakfast. (The nurses do..."sorry, I'm on break." Hourly wage earners do...15 min every 4 hours, by law. The doctors? Nah. Maybe I should go back to waiting tables).
4. You start focusing on the IMPORTANT THINGS THAT MIGHT ACTUALLY AFFECT PATIENT CARE.
So...we're not allowed to drink water, coffee, or eat at our workstations. I'm thinking about revolting, at least until some demands are met.
1. The patients can't eat where I can see them.
2. You pay for my Urology visit when my urine gets so concentrated that I form a kidney stone.
3. I get a break to eat during my 8 hour shift that spans either lunch, dinner, or breakfast. (The nurses do..."sorry, I'm on break." Hourly wage earners do...15 min every 4 hours, by law. The doctors? Nah. Maybe I should go back to waiting tables).
4. You start focusing on the IMPORTANT THINGS THAT MIGHT ACTUALLY AFFECT PATIENT CARE.
M.D.O.D.: Medgeekonomics
M.D.O.D.: Medgeekonomics
Excellent post by Etotheipi on physician salaries (and the discussion's pretty interesting, as well!)
Excellent post by Etotheipi on physician salaries (and the discussion's pretty interesting, as well!)
Where everybody knows your name...
We spend a lot of time in the ED griping about "frequent fliers" as well as those who come in for, apparently, nothing in particular. One of the favorites in our ED is a gentleman (haha) who has really lived a rough life. 'Nam did something to him, and he's never quite recovered
This man is a raging alcoholic, and when he comes in drunk, is really quite a piece of work. He's violent, demanding, verbally abusive, and quite often ends up leaving AMA, after being told 18 times that he can't wander the halls of the ED.
The first time he was a patient of mine, I was quite naive, and had to sternal rub him to get him to wake up and talk to me. Oh, what a mistake. I spent the next 15 minutes in some variation of arguing, negotiating, restraining him. And he left AMA.
Well, last night it was hot as $hit here. Sarge, let's call him, shows up in the ED. Awesome. Just what we needed. One of the poor off-service interns goes to see him (I'm a mean upper level). He's not drunk this time, which is good.
I'm really not sure what his chief complaint was. All I know is this...he lives alone, in a metal trailer, and his AC went out. It was 122 degrees in there. He wanted us to find some reason to admit him to the hospital.
Now, I'm not advocating being an alcoholic, especially not an abusive one, or for admitting someone to the hospital for no reason.
But does it strike anyone else as horribly sad that this man, whatever he may have to himself or others, when in trouble, doesn't go next door, doesn't call a friend, but comes to the hospital? We are all that suffices for a family for him.
And we said "sorry...no reason to admit you."
*not that we should have done any differently...but it's a little heartbreaking all the same
This man is a raging alcoholic, and when he comes in drunk, is really quite a piece of work. He's violent, demanding, verbally abusive, and quite often ends up leaving AMA, after being told 18 times that he can't wander the halls of the ED.
The first time he was a patient of mine, I was quite naive, and had to sternal rub him to get him to wake up and talk to me. Oh, what a mistake. I spent the next 15 minutes in some variation of arguing, negotiating, restraining him. And he left AMA.
Well, last night it was hot as $hit here. Sarge, let's call him, shows up in the ED. Awesome. Just what we needed. One of the poor off-service interns goes to see him (I'm a mean upper level). He's not drunk this time, which is good.
I'm really not sure what his chief complaint was. All I know is this...he lives alone, in a metal trailer, and his AC went out. It was 122 degrees in there. He wanted us to find some reason to admit him to the hospital.
Now, I'm not advocating being an alcoholic, especially not an abusive one, or for admitting someone to the hospital for no reason.
But does it strike anyone else as horribly sad that this man, whatever he may have to himself or others, when in trouble, doesn't go next door, doesn't call a friend, but comes to the hospital? We are all that suffices for a family for him.
And we said "sorry...no reason to admit you."
*not that we should have done any differently...but it's a little heartbreaking all the same
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