A gigantic, curious spectacle with clowns, freaks, and flaming hoops to jump through. The clowns and the freaks, I think we already know about. It’s the damn hoops that make me want to pull my hair out. What hoops you ask? The gasoline soaked circles of hell and damnation that we call “Trailblazer”. WTF? Yeah, WTF. Trailblazer is some idiotic administrator’s idea of documentation standards for emergency doctors. We have to jump through these impossibly stupid hoops if we ever want to see a dime from Medicare, even if it means riding a ridiculously tiny bicycle through that ring of fire. Here’s just a couple examples:
1. “Review of Systems”. Clearly the brainchild of some non-practicing internist who in their former life only had the ability to evaluate one patient every few hours, and whose H&P (history and physical) resembled the unedited version of War and Peace. Why do I need to ask about burning with urination when someone has an open leg fracture? Because the bastards tell me I have to in order to get paid for my services. The “Complete” Review of System has degenerated into the same incomprehensible mumbling of garbage that we all go through before we get to the meat of the dictation.
2. Differential Diagnosis. Another ill-conceived exercise in mental masturbation. Medicare requires that we document at least four different things that the stated problem could be. I’m not saying that thinking about some of the other possibilities is a bad idea. But to mandate that we do this on every and all patients, regardless of the complaint is ludicrous. Had a fella that couldn’t get a piece of steak to go all the way down his esophagus. Diagnosis: impacted esophageal foreign body. Differential Diagnosis: Rib eye, New York Strip, Filet, Chicken. Had a fella that jammed a vibrator in his poo-hole and couldn’t get it out. Diagnosis: rectal foreign body. Differential diagnosis: Ribbed, Scented, Flavored, Magnum.
Barnum and Bailey may be dead, but the circus is alive and well. If you join, you’ll have to share a bunk with the horse riding monkey.
Vivienne reprimanded me for not actually writing about priapism in the last post. Yes, I left it in the title. No, I didn’t have the energy to write about it last night. Alas, this wasn’t actually my patient, but one of the other doc’s. Fella came in with an erection that just wouldn’t quit. Most guys reading this might be saying,”Where can I can I get some of that?”. But there is good wood, and then there is not so good wood. It can be painful if you leave the light on for too long. His Jimmy had been standing tall for hours, and he was in a world of hurt. The doc injected phenylephrine into the side of his donger, and he wilted like a cut flower. Probably the first time the guy was so relieved he couldn’t keep it up for a woman, and the first time the woman was so proud she could turn off a guy so effectively.
Claire is going to be working a table for Bike to Work day on June 24th. She’ll be at Community Cycles off the Goose Creek path. Look for the Alchemist banner, grab a bagel, and talk real loud about how cool our shirts are.