The Medical Thread

[HotDamnImAPhiMu]

Originally Posted by kstar

My dog was limping so I gave him a Tylenol, and now he's vomiting, what should I do?

I might be dumb enough to do this. I already give my dog two baby asprin when she's limping badly, so I can (almost) picture feeling SO BAD for the dog and just wanting the dog to feel better and you're out of baby asprin but the chewable tylenol is right there, and...

[AOII Angel]

Originally Posted by cheerfulgreek

Has anyone read the article in "NewScientist" magazine about xeno organs? It was just saying that in the near future, a person in need of a heart transplant could be offered a pigs organ. I guess there was a group of people who met in China to talk about certain global guidelines in regards to the first clinical trials of xenotransplants. Is there a short supply of human organs or something, because I can't see how this would be possible. It just seems like they would have to make a lot of genetic changes to prevent the organs from being attacked/rejected as foreign by the immune system. I thought it was a great article though.

This isn't an out-there concept. You know that we already implant pig valves into people who need new heart valves. When you get a new valve, there are three options, cadaveric, pig or mechanical. Patients do not go on anti-rejection drugs with pig valves because our immune system accepts pig parts fairly well.

[cheerfulgreek]

Originally Posted by kstar

My two favorites are still:

My dog was limping so I gave him a Tylenol, and now he's vomiting, what should I do?

And

My male dog was humping my female and now they're stuck together butt to butt, how do I pull them apart?

lol! kstar, I totally forgot about these. Yes, we've gotten these calls too. Have you gotten any chocolate calls? or what about the Advil ones. "Uhm, I gave my dog some chocolate and now he won't stop vomiting. What should I do?"

Originally Posted by HotDamnImAPhiMu

I might be dumb enough to do this. I already give my dog two baby asprin when she's limping badly, so I can (almost) picture feeling SO BAD for the dog and just wanting the dog to feel better and you're out of baby asprin but the chewable tylenol is right there, and...

Cats are more susceptible to asprin toxicity than dogs. Ibuprofin is like the worst for both.

[cheerfulgreek]

Originally Posted by AOII Angel

This isn't an out-there concept. You know that we already implant pig valves into people who need new heart valves. When you get a new valve, there are three options, cadaveric, pig or mechanical. Patients do not go on anti-rejection drugs with pig valves because our immune system accepts pig parts fairly well.

Thanks for that AOP Angel. This was all new to me until I read the article.

[tld221]

I have a question about. Emergency rooms.

I've spent many of nights (and days) in ER's for illnesses that, in the grande sceme of things, aren't emergencies, but do require immediate care (it can take weeks to get an appt). The doctor who staffs the ER patients-what are they doing? Patients wait hours to be seen by a doctor who only spends 10 mins with them. There are people who've say they've been here from 430pm and still haven't been seen.

I went to an ER where I was literally the only patient waiting to be seen. It still took a half hour to triage and another 2 hours to be seen. What gives?

I would think that the hospital would want to get patients out asap. Why do we wait hours on end? Are ER's a big joke to doctors/nurses? Are yall just lmao-ing behind that registration plexiglass?

[KSigkid]

Originally Posted by tld221

I have a question about. Emergency rooms.

I've spent many of nights (and days) in ER's for illnesses that, in the grande sceme of things, aren't emergencies, but do require immediate care (it can take weeks to get an appt). The doctor who staffs the ER patients-what are they doing? Patients wait hours to be seen by a doctor who only spends 10 mins with them. There are people who've say they've been here from 430pm and still haven't been seen.

I went to an ER where I was literally the only patient waiting to be seen. It still took a half hour to triage and another 2 hours to be seen. What gives?

I would think that the hospital would want to get patients out asap. Why do we wait hours on end? Are ER's a big joke to doctors/nurses? Are yall just lmao-ing behind that registration plexiglass?

I didn't see a problem...until a few years ago, when I was still working for a hospital. I was brought down to the ER with a fairly serious problem, and was virtually ignored (and this was at one of the top 5-10 hospitals in the country, probably the world) until I mentioned I worked for the hospital.

I was brought into a room within 5 minutes.

[BigRedBeta]

Most academic medical centers I'm aware of are completing huge expansions of their ER's, but despite this growth, the ER's are still swamped.

The most important thing is that it takes time to give medical care. Lab tests have to be run, CT scans and X-rays have to be taken and so on.

If people are sick enough to be admitted to the hospital then the ER docs have to wait for the physicians from the team that's going to be the primary care givers to come down from whatever they're doing to complete the admission. Meanwhile a bed has to be found, there's a ton of paperwork to be done, and so even those patients who have had decisions made on their care sit in an ER room for a long time. There have been plenty of times when I've been on the wards and my team has been told we're getting an admission and it's 3+ hours before they actually make it to the floor and into a room.

Throw in the occasional serious event (trauma, patient with chest pain who's crashing) that causes everyone to drop what they're doing, and the flow of things get even more disrupted.

Lastly, if you're in the ER towards the end of a shift change, it's going to be even longer as there has to be handoff of patients that are currently in the process of getting care. Check out takes time and is a well documented point in which medical errors occur, so there is an emphasis, particularly in the ER about getting it right.

Certainly, nothing I've said makes it any less frustrating when you're waiting for hours, but it's important to state that the ER is not a joke to doctors and nurses.

If you have to go to the ER for care, it's best to go as early in the morning as you can. Most places I've been have a pretty typical "schedule" where there are very few patients in the morning and things just get busier and busier as the day goes on.

[AKA_Monet]

Originally Posted by tld221

I have a question about. Emergency rooms.

I've spent many of nights (and days) in ER's for illnesses that, in the grande sceme of things, aren't emergencies, but do require immediate care (it can take weeks to get an appt). The doctor who staffs the ER patients-what are they doing? Patients wait hours to be seen by a doctor who only spends 10 mins with them. There are people who've say they've been here from 430pm and still haven't been seen.

I went to an ER where I was literally the only patient waiting to be seen. It still took a half hour to triage and another 2 hours to be seen. What gives?

I would think that the hospital would want to get patients out asap. Why do we wait hours on end? Are ER's a big joke to doctors/nurses? Are yall just lmao-ing behind that registration plexiglass?

I am not a medical doctor... But let me tell you ER health care personnel are like the hardest working PCP's in the healthcare business... You really do have to be dedicated to work in the ER. There is SOOOO much paperwork to fill out, follow up on what they have to do, triage at some level, making sure you have enough beds--i.e. areas to put people, and the required emergency drugs--like pain killers, drips, etc. to give them--making sure who you are is what your DNA says you are... And that is just for the major accidents if you are at a trauma 1 level hospital. Then, if you are combined teaching, you have to residents and fellows doing their time on the wards. And if you are at a specialized ER, etc. you are cranking out the high risk patients... Another reason why I am NOT a physician!!!

8 PM+ is NOT the time to go to the ER, generally for "relative wait times"... And dare I say up until 5 AMish is a decent time to go to the ER--relative wait times are "lower", maybe...

Some hospital's ER's fill up around 5 PM+. I know a few physicians that do ER work, and wow, they work their azzes off... Surgery to stabilize the patient. I know the Chief of ER at Cedars-Sinai, LA, and she said bluntly ER care is NOT healthcare... It is true military style triage care... That's why all medical military personnel is awesome at ER care...

So, if you are flu sick, and you are puking blood, goto the ER... If you have a 100 F temp with headache, drink Gatorade, take a Tylenol and CALL to your providers... If you break a bone, go to the ER... If you can walk on your leg, while painful, try to see your GP... If you have a gunshot wound, yeah, go to the ER, but they will report it to the police...

More hospitals are providing 24 hour nurse lines... The nurses can let you know how "emergency" your issues are when you call them. For now, they do not cost money... But at least you do not have to wait and come up out of pocket...

The example is if you break a bone, they have to get the space to do the X-ray and or run you through the CATscan. Then there have to be techs to find the space. There are some SOP's in place here...

The other issue is get your providers in the loop by noting ANY and possibly every health symptom you think you may have... I have started emailing my providers when I have EVERY health alteration overall...

Remember, YOU ARE YOUR OWN BEST HEALTH ADVOCATE!!!

As for Salmonella lunacy that is going on... Save the puke and give it to the lab... I mean seriously... Make them deal with it... I told my OB-GYN that I was going to give her some "stuff" in 10% formalin if I did not get a response and was going to get some chem and path on it... She, laughed and said, no, we are not there yet... And save a small jar full of bloody poop... That might piss them off, but let me tell you, human samples for the CDC is priceless these days...

[Zephyrus]

Is this true? I haven't read it anywhere, but I heard that in Russia, their medical doctors use the same needles over and over again. They just sterilize them. Is that true? And how do other countries medical standards compared to ours?

[Zephyrus]

Originally Posted by cheerfulgreek

The most hilarious one though was this lady and her cat. She called and said that her cat is in heat, and wanted to know how to stop the whining. I asked her about getting her cat fixed, but she didn't want to do that. She just wanted to know if we had some kind of meds that would stop the whining. I started explaining to her the most effective way to stop the crying. I got half way though and she cut me off and said forget it, I'll just get her fixed. I didn't think it was that big of a deal, but I guess she did. She said "Absolutely not. I'll just get her fixed!"

LOL! Please explain this. How would you stop the loud heat meows?

[BigRedBeta]

Originally Posted by Zephyrus

Is this true? I haven't read it anywhere, but I heard that in Russia, their medical doctors use the same needles over and over again. They just sterilize them. Is that true? And how do other countries medical standards compared to ours?

It's certainly possible. I won't take any sort of stance on the question one way or the other as it pertains to Russia specifically. There are certainly situations where I can believe that it happens.

I'm actually in Australia right now and hanging out with some British medical students so I can answer the question in regards to those countries.

From what I've seen/heard, overall medicine is medicine. The premium on data that has come about because of the movement toward evidence based medicine has made some treatments very standardized (which is actually really beneficial to me because it means that I know the answers to the questions when asked). So that means that in most first world countries things are going to be similar (though not the same). I'd even venture that in the affluent, developed portions of developing nations are going be close as well.

Where I notice the difference most, because it's what impacts me or sticks out the most to me, is the differences in the education and training setups that exist. In the rest of the world students enter medical school directly from HS, and it takes 6 years instead of the 4 years of college and the 4 years of medical school in the States. The post-graduate training systems are also different. Whereas in the states, recent grads go directly into their specialty of choice (or at a minimum a year of something similar to their ultimate goals), in these other countries, the recent grads spend two years in a general training program which will include patients of all ages and several different fields of medicine (including surgical specialties). So needless to say all the other students are very shocked when I (the future pediatrician) am able to say that I have less than 15 days of treating adult patients left in my career.

The other thing that's very noticeable is the working hours for those in training/residency programs. In the US, residents are capped at working 80 hours a week averaged over 4 weeks and get a set salary...in Australia, they're contracted to work 38 hours a week, and get overtime pay when they work more than that. In the UK it's 48 hours, salaried. Everyone thinks we work too hard. I just have to laugh at the concept of only working 38 hours a week since the typical call shift in most US residency programs is 30 consecutive hours. Much of the overseas concern for duty hours comes from studies showing increased errors by those burdened with fatigue, but one of the residents said he had seen the USMLE questions that make up our board certifying process and he thought they were incredibly difficult. I also think that in the US there tends to be more oversight of what inexperienced doctors do by the older residents and the attending physicians but at the same time the interns are given responsibility in patient care. In Australia, my intern is getting good at paperwork but not really making decisions on treatment.

In more general terms of health care quality, the US lags behind other systems, due in large part to the issue of the uninsured. At least in other countries patients don't use the ER as their primary source of care. It's an issue of access to care more than anything else. If you can pay for care in the US, you're golden, but obviously there are wide swaths of our population which don't fit that description.

Certainly, compared to developing countries, we have a lot more "stuff" in our arsenal of care. It's not really a fair comparison. But I think most people would be shocked about how well physicians in these countries care for their patients with the limited resources.

[cheerfulgreek]

Originally Posted by Zephyrus

LOL! Please explain this. How would you stop the loud heat meows?

The lady freaked, and I'm sure GC members would too.

I don't think that would be a good idea.

[kstar]

Originally Posted by cheerfulgreek

The lady freaked, and I'm sure GC members would too.

I don't think that would be a good idea.

Does it have to do with... manipulating something?

[cheerfulgreek]

Originally Posted by kstar

Does it have to do with... manipulating something?

lol

I guess you could say that. I always recommend Qtips.

[XOMichelle]

Originally Posted by tld221

I have a question about. Emergency rooms.

I've spent many of nights (and days) in ER's for illnesses that, in the grande sceme of things, aren't emergencies, but do require immediate care (it can take weeks to get an appt). The doctor who staffs the ER patients-what are they doing? Patients wait hours to be seen by a doctor who only spends 10 mins with them. There are people who've say they've been here from 430pm and still haven't been seen.

I went to an ER where I was literally the only patient waiting to be seen. It still took a half hour to triage and another 2 hours to be seen. What gives?

I would think that the hospital would want to get patients out asap. Why do we wait hours on end? Are ER's a big joke to doctors/nurses? Are yall just lmao-ing behind that registration plexiglass?

I'm not really sure where you went, but I did a rotation at the CHLA ED for a month, and people waited a long time because there were just a lot of people to be seen, and the medical staff were going as quickly as they could through the list. Most of the patients, like you, didn't have true emergencies, and they waited longer than people who had more serious illnesses. The nurses would color-code the patients (red, yellow, blue, green) based on urgency and the docs would take whomever was next on the list based on color/urgency and time of arrival. Wait times were variable once they got into a room - could be 30 min, could be 4 hours.

A clinic or an after-hours urgent care center will probably be faster and easier for you. I recommend establishing relationship with a regular primary care doctor as well, perhaps there is someone with a more flexible schedule near you? Many GP's/internists can fit you in same-day or next-day if you are ill, and may be able to telephone in Rx's for you without an appointment (although I believe this depends on individual state laws). It will likely be cheaper for you too to find a clinic -- ED visits are expensive.

ETA: Residency update: Done with interviews! Rank lists are due Feb 25th and Match Day is March 19th.