DrLilith

They havin' a special on wacky arm-wavin' inflatable tube men at that hospital? Just sayin'.

Yes, I remember this topic was discussed at a break-out session at a local fam. med. CME conference...one of the local hosp/clinic entities was trying such a program, their first group of patients was about 30-40 people. There were some growing pains and glitches at first, of course. Their most confounding/difficult case was a young adult who'd present in frank DKA, would still be conscious for a while and not allow any other treatment until she got her "D" medicine...at least every other week. But even with these frequent fliers still *sometimes* getting what they wanted, that program had already saved the group MILLIONS of dollars in unnecssary tests/treatments/admissions in less than one year...on fewer than 40 patients. That made me sit up and pay attention.

"Hangnail, yeast infection, cold sx for 2 hours...seriously???" Reminds me though of a case from my early primary-care days: 40's-something woman with cc of recurrent yeast infections. Due to the "recurrent" part I ordered a somewhat wider workup, incl blood for HIV Ab, TSH...the lab thought the blood sample was funny, too liquidy, so they ran a CBC: Hgb was 3.5. Checked a new sample: Hgb 3.4. Sent her straight for direct admit. Got transfused several units obviously. Final dx: 7+ cm colon cancer, miraculously not metastatic. That yeast infection (and the clinic lab workers' intuition) almost certainly saved her life. (Oddly, the only symptom which was bugging her enough to present to the PCP for the first time in several yrs was the lady partsl itch, not the 40+ lb unintentional weight loss, the change in stool caliber, nor the increased fatigue...) So, you never know for sure based on the CC. (Well, maybe the hangnail.) That said , y'all sure do describe some humdingers on this forum. Keep 'em coming!

---- This doctor sayeth to many inquiring patients (many times): save your money. Those overhyped drinks are overpriced, and oversweetened.

"status dramaticus event" --- LOVE IT! I am SO stealing this descriptor!! (Thanks for all the awesome stories, I am an Urgent Care doc so I don't often see the acuity or frank ridiculousness that y'all do, but there certainly is some overlap at times. And thank you, and many apologies, for having to deal with the narcotic/antibiotic/MRI seekers after I tell them NO, Urgent Care is not going to prescribe them what they are demanding because their friend/parent/internet said they must have said treatment/test...Thank the deity I don't have to kowtow to EMTALA for the really absurd requests. And thank you for being there for the folks who really do need you!)

"ED nurses that wear t-shirts instead of scrub tops." What's wrong with the scrub tops? Love'em. It's the scrub bottoms that never fit right on big-bottomed gals like me (and then the pager falls into the toilet on your 30-sec pee break)! ---- Love nurses! They're awesome...and underpaid.

"Last shift we were getting ready to incubate a bad COPDer..." I just got the weirdest visual of trying to fit an elderly pink-puffer into a neonatal incubator...lol!