Health Care: Psych Doc Perspective

Okay, I have been called out by ER doc. Let me state my opinions from a slightly different perspective. I am for health care reform, but admittedly don't know if this is the right legislation or not. Let me give the reasons why I think it is good:

1) Something needed to be done. Let's not have tea parties because a president is trying to help people in his own country. The tea party people are the same ones who supported a "mission accomplished" president. Some mission. Some accomplishments.

2) People need insurance. The only ones who really don't have to worry about good insurance are the extremely rich (can afford any plan) and the extremely poor (get it through county/state/Medicaid). I suspect that most people compaining about reform don't actually pay for it or worry too much. Rather, they get it as part of their company benefits and think that it's easy to get. This is another group that has nothing to worry about, yet I think comprises most of the complainers out there.

3) My parents are in none of the categories listed above. Farmer/small business owner. Unable to afford employee coverage. Hell, couldn't afford coverage for our family except plans with $5000 yearly deductibles and strict lifetime caps. Deductibles met multiple times, e.g. ruptured appendix (brother), lumbar spine (me.) Hopefully these Americans can get a reasonable deal now.

4) Don't worry too much about shortage of physicians. Unless you're in primary care. The solution will be your friend the physician assistant. They can do the same work, but the government can pay them less. How do I know? Because every govt/private insurance plan pays psychologists to do therapy and won't pay psychiatrists to do it. Specialty physicians will be okay, except for those on the extreme end, like cardiothoracic surgeons, plastic surgeons, etc.

5) Psychiatrists in general don't have to worry much. Probably >50% are employed by some government agency anyway. The name of the health plan isn't going to affect much.

6) Another poster said that this would cause the smartest Americans to choose other fields because medicine isn't worth it financially. There may be some truth to that, but this will continue a trend going on for a while. Already, physician salaries a pretty much stuck and haven't been increasing in proportion to others. Medical schools were already lowering their standards way before this bill passed. Just ask me about the felons in my med school class.

Stay healthy. Stay sane. Either way, be happy you're not living in Sudan/Iraq/etc.
I'm proud to be an American, where I am a free man.

Yeah, I know, coming from a guy who often hospitalizes patients against their will.

-Psych Doc

Dream Interpretation: Santa's A Home Wrecker!

Psych Doc,

Man did I have a messed up dream. It was Christmas time, but for some reason the weather was summer. The dream involved myself, my wife, and my kids. Out of the blue, Santa was in our house proclaiming his love for my wife. Everyone in my family was so excited because it was Santa, and was encouraging my wife to go on a date with him. I, of course, was freaking out and didn't want to allow it.

In my dream Santa was tall, macho, wearing Santa pants with a red shirt and suspenders.... looking more like a tree chopper. Him and my wife decided to go on a date in our house. They were going to paint pictures together in the kids room. My family was anxiously sitting in the living room, hoping they would come out and proclaim their love for each other. After an hour, I stormed in the room to see what was going on. They were both painting their own pictures with their backs to each other. It seemed innocent, except they were only wearing smocks, nothing else.

My dream then cut to a baseball field. We had a family baseball team and it was time for a game. The dads of the families were the coaches. But the announcer loudly proclaimed a new coach for my families team....it was freaking Santa Claus. I ran to the middle of the field and beat the shit out of Santa for being a home wrecker and sacrificing Christmas to the world to screw my wife!

Psych Doc....what the hell is the matter with me. Is my wife banging Santa?

Dear ER Doc,

In your dream, you are picturing the perfect family time. It is summer, school is out, baseball season. Nothing could be better. Except...wait for it...the ultimate in fantasy masculine figures (ok, except for maybe Conan the barbarian.)

This is a classic case of Male self-doubt. Your woman may have beaten you down to the point you feel you can do nothing right. So, in your dreams, in steps the guy who can do no wrong, good ol' Saint Frickin' Nick. The guy who takes a crap and out comes an Xbox 360 and he wipes with a complete set of 1984 Topps Baseball cards in mint condition.

You are worried that the anti-you (the guy who your wife seemingly wants) actually exists. If so, she would leave, your life would be hell, etc. But let me remind you...Santa is not real. Sorry to anybody younger than 8 reading this at home. But if it sounds too good to be true, it probably is.

I would like to know more about those pics that Santa and wife were drawing. Some more analysis could be done there.

Oh, and don't worry. Your wife has dreams that you are banging Jenna Jameson.

-Psych Doc

Only in the Country: Attack of the Great Squirrell

A nice middle aged female postal worker came in with a chief complaint of: Attacked by a huge squirrel

And this wasn't the first time either! It started about a week ago. She was sitting on her porch when she saw a huge squirrel sitting a few feet away (she showed me a picture she took of it...it was the biggest damn squirrel I have ever seen). She thought it would run away like squirrels do, but instead it ran towards her and attacked her! She went inside the house screaming. Her son (6'6'', 290 pounds) went outside to see what the deal was. The squirrel jumped right on the son to finish his attack. She said she never heard her big boy scream so loud.

Two days later the patient was again sitting on her porch, this time no squirrel in site. Until suddenly she saw the huge thing dart down the tree acrross the yard full force to attack her again. She ran in her house and went to the front porch...but the damn squirrel had made his way around the house and was waiting to attack her again.

Then came today. When she went to throw out her trash, the squirrel snuck out from behind the tree and attacked her leg. She came in to the ER get a tetanus shot and wound care. The nurse called the Game Warden. Being from the city...I had no clue what the hell a Game Warden was. Anyways, he suggested that she shoot the squirrel, and gave her permission to do so even though it wasn't "squirrel season."

I know this sounds crazy. I was cracking up while the patient was telling me the story. But she sure seemed normal. I guess I believe her.

-ER Doc

Only in the Country: Drugs Don't Lie

Being an ER resident in an inner city county hospital, it is a great experience to moonlight in a small rural hospital. Leaving the hustle and bustle and sounds of gunshots is worth the hour and a half drive to small town America.

Today I was called out for a "trauma" patient outside the ER. They needed help getting the patient out of his truck because the vehicle was so tall. The patient was in the passenger seat, with his girlfriend driving. The truck was huge, and attached to it was a trailer with a John Deer tractor.

The patient was a thin white male in his 30s, screaming that his leg was hanging in pieces and wanting to know if I was going to charge him since the accident wasn't his fault. The 2nd part decreased my suspicion for something serious going on.

His story was so long and drawn out I can't remember all the details. He was talking a mile a minute, obviously on drugs. He said that 2 weeks ago he got into it with a "kid" for firing a gun around his house. He had been plotting for the last 2 weeks how to get the gun from that kid (the kid was 24). Long story short, his plan didn't work. After punching out the kids car window, the kid chased him down and ran his ass over, breaking his tibia. It was a very stable fracture that didn't require admission or emergent surgery.

This guy never stopped talking, and was obsessed with what pain medicines I was going to send him home on. As I slid off his boot, a crack pipe and a stash of weed, cocaine, and meth fell out. He was so high he didn't even notice. The nurse put it in his belongings bag and we kept with our treatment.

I gave him some pain meds to take the edge off. Of course, he was "allergic" to everything but Dilaudid. And I better not dare prescribe him anything less than the 10 mg Vicodin. He swore he only does weed and only had taken 1 Vicodin in his life, but he knew that 5mg Vicodins didn't work, that he needed more codeine in the pill and less tylenol b/c the Tylenol is bad for his liver, that morphine causes a flushing and anxious reaction (releases histamine), that Demerol is pretty good but Dilaudid is great.

The patient called the police to report the accident b/c he said he wanted to "sue the shit out of that kid." Well....the nurse told the police officer about his drugs. The patient quickly sobered up and said only the pipe was his. He didn't know where the drugs came from, and threw his girlfriend under the bus. The girlfriend had a better defense. She said the drugs couldn't be hers b/c she had just snorted all of her drugs.

In the end, I splinted the patient's leg and the nurse pushed him out in his wheelchair....to the police officers car. Once he got close to the car, he purposely fell out of the wheelchair to try and delay his transfer to jail.

Oh yeah, he also offered to sell weed to our registration clerk. But the drugs weren't his remember.

-ER Doc

If you liked this post, check out the our original "Rural Medicine" post

Healthcare Reform Finale

Well it finally comes to an end. If your a follower of this blog, you know where I stand on the issue of health care reform (I am for it). That does not necessarily represent my co-writers (wish they would write more) on this blog. It's my personal opinion. I know one of them is a conservative and I can't remember how the other feels.

I'm not afraid to say I wish there was more in this bill. I wish there was a public option, or at least Co-Ops. I wish there was sweeping tort reform. I wish there were greater restrictions on the insurance companies.

Now for the sarcasm:

• Anyways, I see why so many people are upset. I mean...the stuff on this bill is soooo liberal. They had to leave out the public option b/c I guess that would be too communist. But telling insurance companies they can't deny people with pre-existing conditions is so far left. How are these companies going to make money if they have to do their jobs and COVER HEALTH CARE . How dare the Democrats put that in the bill! All the kids being born TODAY with pre-existing conditions have to be covered, not denied, now. That's got to be bad for business. And after all, health care should be a business, not a right, right?

• Now insurance companies cannot place a cap on how much they can cover in a lifetime? I bet that hurts. I mean hell....if a healthy 27 year old gets devastating injuries from being hit from a drunk driver...the companies aren't going to have as much ground to drop their coverage! And how are they going to drop all the people who develop cancer? How can they do business anymore! Damn Democrats!
  

• The new bill also helps out seniors who fall into the Medicare Coverage Part D plan. It will basically help them pay for their out of pocket expenses on medications. Who do they think they are!? Shouldn't these seniors have to pay like the rest of us?! Get a job! Just because you are old, have way more illnesses b/c you are old, and already retired from working your whole life doesn't mean that the Democrats should pick up the bill, right? Leave our health care alone! Helping others....that's so Un-American.
  

• Kudos to you, Rep. Randy Neugebauer of Texas, for shouting "Baby Killer" last night. That's right. Even though the abortion clause is being taken out of the bill...I am sure the Democrats will be planning to kill babies somehow.
  

• Dow at 18 month High today, with health care stocks leading the way. I'm sure this is liberal propaganda. There is no way health reform is already helping the economy right? If so, let's not give the Democrats any credit. Keep it a secret from them. We don't want to get their heads any bigger.
  

Now in all seriousness:

• Today while moonlighting in a private hospital, I had a nice gentleman who came in with chest pain. His white blood cell count was strikingly high, over 75,000. This generally means cancer. I went to break the news to him, but he already knew. He was diagnosed with CML a year ago. He can't afford to see a Oncologist, and his health insurance dropped him. His treatment....waiting another year until he is eligible for Medicare to get treatment. He will be dead by then. But today he got admitted for the pulmonary embolisms his cancer caused. Then again, there were previous comments from older posts stating anyone can just go to a county hospital when the get cancer and get taken care of. Guess that wasn't true for this guy, or the other 50 cases I have seen just like this.

-ER Doc. "Leave our health care alone," cried the people. I say suck it

Ron Washington

Dave Chappelle as Tyrone Biggums

Ron Washington

So the manager of the Texas Rangers, Ron Washington, just admitted that he tested positive for cocaine last year during the season. The Rangers didn't fire him, and he has tested negative since.

The funny part of this story is he said the one and only time he has every done cocaine in his life was when he tested positive last year. He is 57! Come on....how many people decide to snort their first line at 57 years old. Give me a break.

I have a ton of patients that do cocaine. About 10% of my chest pain patients test positive for cocaine. A lot of them are in their 50s....but I guarantee you it's not their first time to use.

Just like the FIRST time we found out that Charlie Sheen beats his wife..... he said it was the first time it had happened. And when Tiger got caught cheating..... it was his first time....until we found out about the other 13! Or when my mom caught me wacking off as a teenager.... it was the first time I had every done it, or when my wife caught me watching porn...."I swear honey it was the first time!" Come on man. We all say it was the first time when we get busted.

So Mr. Washington, admit you have been doing drugs for awhile, and one of them happens to be coke. You didn't do cocaine for the first time at age 57 then get tested by Major League Baseball the next day.

Cynically yours,

-ER Doc

Please add your "first timer's" to the comment section

Ouch!

This guy was in his mid 40s. Pretty buff. He was bench pressing his "max" and felt a pop. The pop turned out to be his pectoralis major tendon. The image is pretty impressive b/c the bruising pretty much outlines his whole pec muscle.

Treatment is long term rest.....sometimes surgery. This guy is a brick layer, but he was more concerned about when he could work out again.




-ER Doc

Nice Dad

A tale from orthopedic surgeon colleague of mine:

He is Filipino. Last year he was operating on a trauma patient who was a 19 year old white female. When he was done with the surgery, the family had arrived so he went out to tell them what was going on.

Dr. Filipino went up to the father to say the normal "Good news, your daughter did well" stuff. He was rudely interrupted by the father. He yelled "Dammit, I told my daughter never to have a Mexican doctor and especially never to let a Mexican touch you, let alone do surgery!"

Dr. Filipino tried to calmly explain the prognosis. The dad didn't want to hear it. Doc gave up. As he was leaving, the patients boyfriend showed up. It was apparent that the family had never met the boyfriend....bc...the boyfriend was black.

-ER Doc

Delusional Parasitosis

A 38 year old very nervous female arrived to the ED with a large bandage covering her left check. Prior to evaluating the patient, I reviewed her chart and saw that she had a pathology report from a recent biopsy that said "normal tissue consistent with excoriation, no malignant cells identified."

With that information, I went to see the patient. She was very anxious and scratching her whole body. I immediately thought scabies or drug addictions that can make people scratch.

I asked her, "How can I help you today?"

She immediately started telling me the story..."I've got little worms all over my skin and I'm really scared b/c the wound on my cheek keeps getting bigger, and I've already seen the doctor and no one can help me! The worms keep jumping out!"

I asked her, "Do you have an psych conditions, or do you do any drugs?" She denied both.

I then took off the bandage. I was absolutely stunned b/c her entire left cheek was missing until the inside of her mouth. The only tissue left was the very inside of her cheek!

She said, "Can you get the worms out?"

I told her that we could help and then called our Face Surgeon who came to evaluate her. He said that she need immediate psych help (duh), and that once she was mentally stable she would require plastic surgery to repair the large defect. I sent her to psych and hope that she will get better soon!

-Doc Sensitive

Post from WhiteCoat's Call Room Need “Entirely Free Health Care?” Go to the ER!

Here is a copy/paste of a post from WhiteCoat's call room on emergency medicine. Shocking this man is considered a frontrunner as a future presidential candidate. Sorry I haven't posted much lately....I have been too busy offering "free care" and hugging trees.

--ER Doc

Need “Entirely Free Health Care?” Go to the ER!

March 5th, 2010

After hearing Mitt Romney’s views of emergency medical care during a recent interview, I’ve concluded that he is a dope.

He was recently interviewed on MSNBC’s “Morning Joe” about some book he’s peddling and his response to one of the questions just shows that he has no clue about the economics of health care.

Question: Do you believe in “universal coverage”?
Answer: “Oh, sure. Look, it doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way.”

Can’t embed the video here, so you’ll have to go to MSNBC and start the video at about 5:35 to cut to the chase.

Hospital emergency departments provide medical care to patients just for the heck of it with no expectation of payment? Businesses just give you services and you don’t have to pay them for it? Great business model! Why didn’t I think of that?

In fact, I like that business model so much that I’ve decided to go to Massachusetts to take out a loan at a bank. Then I can get some “entirely free money for which I have no responsibility.”
On the way, I’ll stop at a car dealership where I can get an “entirely free car for which I have no responsibility.”
And I’m going to enroll my kids in some Massachusetts colleges where they can get an “entirely free education for which they have no responsibility.”

Oops. Better watch what I say before I get thrown in the Gulag.

Don’t laugh, using Mitt Romney’s logic, the “emergency room” docs in Massachusetts are already there.

Classic Conversation

As I came on to my shift last night, I inherited a patient from a colleague who was awaiting the results of a cat scan of his back. He was in a car accident last month and had continued pain. Once the scan was read as normal, I went to introduce myself and give him the good news. The following is pretty much a word for word conversation between myself, him, and his ex wife. Oh...and this conversation did not take place in a private room. The ER was packed and I was seeing patients in a row of chairs. There were other patients sitting next to them who could hear everything (I don't want any HIPPA comments. This is real county hospital life).

Me: "Hello, sir. I'm ER Doc. I took over for Dr. XYZ. You cat scan came back normal, so we will be sending you home with some pain meds and instructions on how to take care of your back pain."

Patient: "What medicine are you sending me wit?"

Me: "A few Vicodin and Naprosyn. "

Patient: "That don't work on me. I need something stronger."

Ex Wife: "He needs Demerol. Give him that."

Me: (Busted out laughing b/c I was taken back by surprise). "No ma'am. I'm not writing for anything stronger."

Ex Wife: "LOOK, we used to be married, now we just have sex. Well, we used to have sex. But his back be bothering him too much and I don't get anything anymore. So hit him up with Demerol so I can get mine."

Me: (laughing again, now with around 8 other patients watching and laughing). "Have you tried getting on top?"

Ex Wife: "That don't matter none. His back hurt too much and I need mine. So fix him up with the Demerol. If you fix the back, I'll take care of his front."

Me: "Ma'am, if I gave him Demerol for his back, his front would be gone too. You can see a primary doctor for your sexual issues. I have to go now, good luck."

-About 5 minutes later the patient walked up to the doctor's station to see what was taking soooo long for him to be discharged. He proceeded to hit on all the nurses....pretty graphically. I jumped in and said, "Sir, you are going to have to go sit back down. After all, you can't get it up anyways."

-ER Doc