ED Physicians with overkill

ERRNTraveler, RN · Aug 31, 2007

I worked in an ER as a traveler where the doctors actually got paid a percentage of any tests they did- it was basically like they were working on commission- they were HORRIBLE about ordering "million dollar work-ups" on everyone- full labs, CT's, MRI's, Ultrasound, Nuc Med scans..... on just about EVERYONE!!! It was pretty ridiculous. Then, even if everything was still normal, they would still admit. There were so many times where the ER doc would have the pt. up for admission within 5 minutes of them arriving in the ER...... drove me crazy!

ZippyGBR, BSN, RN · Aug 31, 2007

obviously the US has no equivalent to IR(ME)R a piece of Uk legislation the ionising radiation (medicla exposures) regulations which places an onerous responsibility o nthe referrer to be able to justify his /her requiest for any imaging modality which uses ionising radiation ...

is the a US equivalent to the 'purple book' which the royal college orf radiologists publish in the UK with suggested imaging modalities for different presentations ... and stepping outside those guidelines without discussing it consultant to consultant rarely if ever happens ...

in the Uk we have a hard enough time convicing radiographers to do indicated imaging at times - especially as some of them seem to think that an 'negative' result from an investigation is a 'wasted' investigation ...

aberrn · Sep 1, 2007

All ER's have at least one Doc like that. It's called C.Y.A...

boztc · Sep 1, 2007

I still remember, fondly, one of my favorite Docs. Under the H&P he once wrote "no findings." For a diagnosis, "Malingerer."

God, I loved him!

alkaleidi · Sep 3, 2007

I can empathize with the frustration with this kind of ED doc. We've got one that does that, and at the same time, has underkill when it comes to other things. For example?

Had an infant with an abscess on her vulva. Obviously not kept as clean as she should have, and however that happened, his plans were to do an I&D. Two little squirts of lidocaine (that run out of the opening in the abscess, by the way) and about 5 minutes later he's cutting into the abscess. The baby screamed and I know his intentions were not to inflict pain, but how can you miss the fact that the medication was not only not absorbed locally, but didn't even go INTO the tissue? And why not test the skin to see if there was localized numbness? Hrm. I felt really bad and what do you do/say at a time like that? Not much you can, I guess. Just doesn't make sense to do unnecessarily (sp?) TOO much for some, and the bare minimal not enough for others!

rjflyn, ASN, RN · Sep 3, 2007

Unfortunately ED medicine has turned in to CYA medicine. We see pt's everyday who we don't know any history about, others sadly who we are their primary care provider. We have to look at every possibility of what's causing a persons particular problem. Also pt's have become very adept at knowing what to tell, how to act in front of the triage nurse to get seen quicker, unfortunately often times this involves a complaint one cannot just write off simply with an exam and prescription. Hence the big work ups. So please don't come in complaining of vague belly pain, your going to get the million dollar 4 hour work up, and thats going to delay the care of everyone coming in behind you. And please don't complain when our survey company calls after you are discharged, its your own fault it took so long.

RJ

Zookeeper3 · Sep 4, 2007

Well I worked an inner city ER and our MD's ROCKED!!!!! We had a family that brought in mom, no insurance for headaches. We found she had "new diagnosed HTN", who knows how long.... they only sought tx in the ER as needed.

We gave them pamphlets in spanish on HTN, the new meds, picked the cheapest one and thought we were done. NOOOOO, they DEMANDED a head CT. Doctor was adamant that once she was given meds and bp came down, HA went away... no need for CT. Family refused to leave without the CT. MD refused as it was not medically needed.

The ER doc told them, point blank, if they want an elective CT, done stat in the ER against medical advice they would have to prove address for billing, with picture ID, same as which is done out patient. Family disappeared AMA with patient.

Now this is not the slippery slope, get out of doing what you need, so don't go there people, please.... this was a non needed procedure.

Our docs also say to those looking for tylenol, motrin and other OTC scripts that if they didn't buy cigarettes, get rid of the cell phone and not get their nails done, there would be plenty of $$ left over to pay for their childs tylenol that was needed to treat a fever of 100 for a cold and he wouldn't write a script.

bigsyis · Sep 5, 2007

We have one who CTs everything. He has been sued 4 times - won all 4 cases, but it did bad things to his mind. Can't say that I blame him.

It has been my experience that if they've been sued, they order to CTA-the patient's AND theirs. I think if they've been burned (even if they won) it makes them more vigilant and aware of the kinds of things malpractice attorneys will try to use against them.

The result of our litigious society. :uhoh3:

catlynLPN · Sep 5, 2007

I have a story about the ED and NOT getting any tests done.

I went to the ED one night with severe abdominal pain, and the ER doctor diagnosed me with reflux. Then couple of months later same thing.....same doctor, same diagnosis. Only this time I went to my regular PCP who suspected gallbladder disease. Had to have surgery.

If the ER doctor had CT'd me or done SOMEthing besides just giving me a Demerol inj for reflux pain......{?????}......and sending me home.......maybe I could have had the laproscopic instead of the full abdominal surgery.

This same ER is notorious for sending people with chest pain home, also. If I ever get sick again, I hope I'm in a good enough frame of mind to keep going on to the next town before stopping at an ED.

teeituptom, BSN, RN · Sep 5, 2007

Okay....this is the first time I have been in an ED that I have seen this. We have an ED physician that orders EVERYTHING on EVERYONE. For example every abdominal pain gets every lab, every xray and ALWAYS ends up in a CT scan no matter the age. Had a 5 year old that the plan film showed him so full of poop that he could have been renamed "turd", and they STILL did a CT that read "Constipation".
It is very frustrating because every patient is in the ED for 3 to 4 hours unless they are cut and dry....lac, ear ache, sore throat. Fever, Abd pain, Chest pain (no matter the age) all get the big workup. Even if the labs are normal, they end up in CT one way or another... Chest pain...normal labs...Chest CT.... Abd pain....normal labs..... Abd CT..... Fever.....normal labs......They find a reason for a CT.
They do not understand that they are busy all night long because the ED is full and I have no place to put new patients..."bring them back so I can see them".... My question is WHERE do you want me to put them. It is not fair to the nurses nor the patients.
Just curious if anyone else has a physician that is like this....
Thanks for letting me vent.

We have one who orders so many cts we call him Dr CT.

bigsyis · Sep 5, 2007

If the ER doctor had CT'd me or done SOMEthing besides just giving me a Demerol inj for reflux pain......{?????}......and sending me home.......maybe I could have had the laproscopic instead of the full abdominal surgery.

Sorry to hear about your experience, and worse yet, that you have a local ER MD that gives Demerol for reflux! :eek: :nono: If that ever gets out, the poor staff at that ER will be dealing (no pun intended) with every drug-seeker for miles around!

teeituptom, BSN, RN · Sep 5, 2007

Sorry to hear about your experience, and worse yet, that you have a local ER MD that gives Demerol for reflux! If that ever gets out, the poor staff at that ER will be dealing (no pun intended) with every drug-seeker for miles around!

Drug seekers in the ER, Imagine that. I just can't believe it. Never would happen in a million years