Comments on: Walk in My Shoes http://symtym.net/2004/10/walk_in_my_shoes/ meandering healthcare, law, technology... Sat, 13 Feb 2010 14:46:08 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: symtym http://symtym.net/2004/10/walk_in_my_shoes/comment-page-1/#comment-32 symtym Sat, 30 Apr 2005 06:54:00 +0000 http://symtym.com/?p=183#comment-32 Your comments reflect the real world dilemma many ER physicians face, we would like to be completely straightforward about the diagnosis and what should be done based upon our clincial evaluation. But, by time the patient arrives the advice nurse or primary care provider may have been called or even the triage nurse has given an opinion about what should happen that our hands are tied in terms of patient (or parent) expectations. There are two levels of expectations, those of the patient (and parent) and those of the referring agents (physician, mid-level, advice nurse, etc.). In a sense, we must be mindful that a "successful" encounter must address both sets of expectations. The irony here from the third party advice nurses is that we may get a letter about our quality of care if we don't get a CT based upon their telephonic interview. Your comments reflect the real world dilemma many ER physicians face, we would like to be completely straightforward about the diagnosis and what should be done based upon our clincial evaluation. But, by time the patient arrives the advice nurse or primary care provider may have been called or even the triage nurse has given an opinion about what should happen that our hands are tied in terms of patient (or parent) expectations.

There are two levels of expectations, those of the patient (and parent) and those of the referring agents (physician, mid-level, advice nurse, etc.). In a sense, we must be mindful that a “successful” encounter must address both sets of expectations. The irony here from the third party advice nurses is that we may get a letter about our quality of care if we don’t get a CT based upon their telephonic interview.

]]> By: symtym http://symtym.net/2004/10/walk_in_my_shoes/comment-page-1/#comment-33 symtym Sat, 30 Apr 2005 04:54:00 +0000 http://symtym.com/?p=183#comment-33 Your comments reflect the real world dilemma many ER physicians face, we would like to be completely straightforward about the diagnosis and what should be done based upon our clincial evaluation. But, by time the patient arrives the advice nurse or primary care provider may have been called or even the triage nurse has given an opinion about what should happen that our hands are tied in terms of patient (or parent) expectations.<br><br>There are two levels of expectations, those of the patient (and parent) and those of the referring agents (physician, mid-level, advice nurse, etc.). In a sense, we must be mindful that a "successful" encounter must address both sets of expectations. The irony here from the third party advice nurses is that we may get a letter about our quality of care if we don't get a CT based upon their telephonic interview. Your comments reflect the real world dilemma many ER physicians face, we would like to be completely straightforward about the diagnosis and what should be done based upon our clincial evaluation. But, by time the patient arrives the advice nurse or primary care provider may have been called or even the triage nurse has given an opinion about what should happen that our hands are tied in terms of patient (or parent) expectations.

There are two levels of expectations, those of the patient (and parent) and those of the referring agents (physician, mid-level, advice nurse, etc.). In a sense, we must be mindful that a “successful” encounter must address both sets of expectations. The irony here from the third party advice nurses is that we may get a letter about our quality of care if we don't get a CT based upon their telephonic interview.

]]> By: Pk http://symtym.net/2004/10/walk_in_my_shoes/comment-page-1/#comment-31 Pk Sat, 30 Apr 2005 02:38:00 +0000 http://symtym.com/?p=183#comment-31 I have extremely active and adventurous children who've had more than their fair share of accidents. Most, typical kid stuff, some absolutely absurd and one, stupidity of the supervising adult. My 2 sons, have been to the ER for head injuries a total of 5 times. Each time we were told by the on call doctor to take them to the ER to SEE IF they needed a CT scan. With the exception of the stupid supervising adult event, we didn't call the doctor, we went straight to ER. When we got to the ER, the first time, the doctor was going to order the CT scan but I could just tell something was up, and I asked him why he seemed hesitant. He explained that not all head injuries really NEED a CT scan, but to be on the safe side ... and I realized he was doing a CYA proceedure reluctantly. I told this doc ... hey, if youd on't think he needs one, give me the instructions to watch for. I don't want to put my kids through unnecessary testing! I can't even imagine demanding putting my kids through a CT scan if the doctor wasn't sure he needed one! From then on, when we'd take them in, I made sure the ER doctor made sure he knew that we understood that we were there for an evaluation to SEE IF he needed a CT scan, not to have a CT scan. (and get stitches when necessary ;) ..) The last event, when we didn't call, no one even questioned it, they took him striaght from triage to CT and asked us why we hadn't called an ambulance ...because ...we didn't have a cellphone was our answer. He was going to the pool with another family, the MOTHER let him ride on the TRUNK OF THE CAR!!!!! He slid off and landed on his head!! ARGH!!!!!! She never followed us to the ER, she just took her kids to the pool. Took her 2 weeks to even come check on my son!! No, my kids don't play over there anymore. I have extremely active and adventurous children who’ve had more than their fair share of accidents. Most, typical kid stuff, some absolutely absurd and one, stupidity of the supervising adult.

My 2 sons, have been to the ER for head injuries a total of 5 times. Each time we were told by the on call doctor to take them to the ER to SEE IF they needed a CT scan.
With the exception of the stupid supervising adult event, we didn’t call the doctor, we went straight to ER.

When we got to the ER, the first time, the doctor was going to order the CT scan but I could just tell something was up, and I asked him why he seemed hesitant. He explained that not all head injuries really NEED a CT scan, but to be on the safe side … and I realized he was doing a CYA proceedure reluctantly.

I told this doc … hey, if youd on’t think he needs one, give me the instructions to watch for. I don’t want to put my kids through unnecessary testing! I can’t even imagine demanding putting my kids through a CT scan if the doctor wasn’t sure he needed one!

From then on, when we’d take them in, I made sure the ER doctor made sure he knew that we understood that we were there for an evaluation to SEE IF he needed a CT scan, not to have a CT scan. (and get stitches when necessary ;) ..)

The last event, when we didn’t call, no one even questioned it, they took him striaght from triage to CT and asked us why we hadn’t called an ambulance …because …we didn’t have a cellphone was our answer.
He was going to the pool with another family, the MOTHER let him ride on the TRUNK OF THE CAR!!!!! He slid off and landed on his head!! ARGH!!!!!!

She never followed us to the ER, she just took her kids to the pool. Took her 2 weeks to even come check on my son!! No, my kids don’t play over there anymore.

]]> By: Pk http://symtym.net/2004/10/walk_in_my_shoes/comment-page-1/#comment-34 Pk Sat, 30 Apr 2005 00:38:00 +0000 http://symtym.com/?p=183#comment-34 I have extremely active and adventurous children who've had more than their fair share of accidents. Most, typical kid stuff, some absolutely absurd and one, stupidity of the supervising adult.<br><br>My 2 sons, have been to the ER for head injuries a total of 5 times. Each time we were told by the on call doctor to take them to the ER to SEE IF they needed a CT scan.<br>With the exception of the stupid supervising adult event, we didn't call the doctor, we went straight to ER.<br><br>When we got to the ER, the first time, the doctor was going to order the CT scan but I could just tell something was up, and I asked him why he seemed hesitant. He explained that not all head injuries really NEED a CT scan, but to be on the safe side ... and I realized he was doing a CYA proceedure reluctantly.<br><br>I told this doc ... hey, if youd on't think he needs one, give me the instructions to watch for. I don't want to put my kids through unnecessary testing! I can't even imagine demanding putting my kids through a CT scan if the doctor wasn't sure he needed one!<br><br>From then on, when we'd take them in, I made sure the ER doctor made sure he knew that we understood that we were there for an evaluation to SEE IF he needed a CT scan, not to have a CT scan. (and get stitches when necessary ;) ..)<br><br>The last event, when we didn't call, no one even questioned it, they took him striaght from triage to CT and asked us why we hadn't called an ambulance ...because ...we didn't have a cellphone was our answer.<br>He was going to the pool with another family, the MOTHER let him ride on the TRUNK OF THE CAR!!!!! He slid off and landed on his head!! ARGH!!!!!!<br><br>She never followed us to the ER, she just took her kids to the pool. Took her 2 weeks to even come check on my son!! No, my kids don't play over there anymore. I have extremely active and adventurous children who've had more than their fair share of accidents. Most, typical kid stuff, some absolutely absurd and one, stupidity of the supervising adult.

My 2 sons, have been to the ER for head injuries a total of 5 times. Each time we were told by the on call doctor to take them to the ER to SEE IF they needed a CT scan.
With the exception of the stupid supervising adult event, we didn't call the doctor, we went straight to ER.

When we got to the ER, the first time, the doctor was going to order the CT scan but I could just tell something was up, and I asked him why he seemed hesitant. He explained that not all head injuries really NEED a CT scan, but to be on the safe side … and I realized he was doing a CYA proceedure reluctantly.

I told this doc … hey, if youd on't think he needs one, give me the instructions to watch for. I don't want to put my kids through unnecessary testing! I can't even imagine demanding putting my kids through a CT scan if the doctor wasn't sure he needed one!

From then on, when we'd take them in, I made sure the ER doctor made sure he knew that we understood that we were there for an evaluation to SEE IF he needed a CT scan, not to have a CT scan. (and get stitches when necessary ;) ..)

The last event, when we didn't call, no one even questioned it, they took him striaght from triage to CT and asked us why we hadn't called an ambulance …because …we didn't have a cellphone was our answer.
He was going to the pool with another family, the MOTHER let him ride on the TRUNK OF THE CAR!!!!! He slid off and landed on his head!! ARGH!!!!!!

She never followed us to the ER, she just took her kids to the pool. Took her 2 weeks to even come check on my son!! No, my kids don't play over there anymore.

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