The ER doc speaks

[George K]

I've been following this guy on X for a long time. He's the one that does the educational posts - see the "pneumothorax" thread.

Anyway, he comments:

'When an ER patient says “I would’ve come in sooner but I didn’t wanna bother you guys”, something is really fucking wrong until proven otherwise. Trust me on this one.'

"I’ve said it before and I’ll say it again, when a critical patient develops a sudden and strong urge to move their bowels, they are about to code until proven otherwise."

"Just a reminder that when a patient says “I feel like I’m gonna die”, they are about to code until proven otherwise. Trust me on this one."

"When an experienced nurse says “I have a bad feeling about this patient”, they are about to crash until proven otherwise. Trust me on this one.

"I’ve said it before and I’ll say it again, when a critical patient suddenly develops an intense and desperate thirst for water, they are about to code until proven otherwise."

"An ER patient who says “I just don’t feel right” is having a medical emergency until proven otherwise"

"Trauma Surgeon: What was the indication for an automatic trauma activation on this patient?

Me: He’s a farmer."

"Doctors, If a patient asks you for a cup of water, don't ask someone else. Get it yourself. It means more than you might realize.

"“I feel fine but my wife made me come in” has a positive predictive value for serious pathology that approaches 100%"

[Jolly]

He's right, you know.

[George K]

This one deserves a comment.

"Doctors, If a patient asks you for a cup of water, don't ask someone else. Get it yourself. It means more than you might realize.

A while ago, I read a book on "How Doctors Think."

I don't remember much, but there were a couple of interesting takeaways. One of them was that bad doctors don't get sued more often than good doctors. ARROGANT doctors get sued more than other doctors. If you can humanize yourself, look at the patient, not the computer/chart, if you can sit down and be at eye level with the patient, if you touch the patient, in a caring way, you're going to establish a relationship that is based on trust and sympathy. Going to the OR can be a really scary thing for many people, and if you can make that easier with a little empathy - well that goes a long way.

[Mik]

Love that. It's true. All my doctors are very personable like that. Otherwise they wouldn't be my doctor. If you see me as only one more widget patient you are unlikely to provide the best care.

[George K]

My routine when I saw a patient.

1. Walk into room, address patient as "Mr." or "Ms."
2. Pull up a chair next to bed and sit down after shaking hands.
3. Take history
4. Explain the anesthesia part - answer questions
5. Get personal - ask who's here with patient, where do they live, stuff like that.
6. Say, "We're going to take real good care of you today," while putting hand on shoulder/thigh/hand - whatever's closest.
7. Shake hands again and leave.

[Doctor Phibes]

These are all great.

Growing up, one of our family GP's was a man named 'Doctor Friend', and he was very well named. People in the area still talk about him with real affection 50 years later, he really cared about his patients.

I sprained my neck quite badly when I was about 6, and my poor mother (who was a nurse) thought I might have broken it. I still remember him coming to the house and quietly calming us both down before arranging for x-rays.

[Jolly]

The eye doc my wife worked for prayed with every patient before surgery.

I think he was sued once in thirty years.

[George K]

https://www.medscape.com/viewarticle/seated-doctors-satisfy-patients-2024a1000ftl

---

A recent US study evaluated the impact of the practitioner's seated position next to the patient on the quality of the doctor-patient interaction in an internal medicine department. This research involved a sample of 51 doctors (average age, 35 years; 51% men) and analyzed 125 clinical interviews (n = 125 patients; average age, 53 years; 55% men). Participants were not informed of the real objective of the study. The patient's perception of medical care was also solicited.

The experimental protocol involved two distinct configurations. Either the chair was positioned near the bed (within 90 cm) before the doctor arrived or it remained visible in its usual place. Each meeting with a patient was randomized according to the chair location (intervention group: n = 60; control group: n = 65).

The primary criterion was the doctor's binary decision to sit or not at a given moment during a meeting with a patient. Secondary criteria included patient satisfaction, time spent in the room, and the perception of time spent in the room by doctors and patients.

The chair's location had no effect on the average duration of the interview, whether actual or estimated. When a chair was placed near the bed, the doctor sat in more than six out of 10 cases (63%), compared with fewer than one case out of 10 (8%) when the chair was less easily accessible (odds ratio, 20.7; 95% CI, 7.2-59.4; P < .001).

The chair arrangement did not lead to a significant difference in the average duration of presence in the room (10.6 min for both groups). Likewise, no notable difference was observed regarding the subjective estimation of this duration from the practitioners' point of view (9.4 min vs 9.8 min) or from the patients' point of view (13.1 min vs 13.5 min).

In the group in which the doctor sat to converse, patient satisfaction was significantly higher, with an overall difference of 3.9% (P = .02). Patients felt that the information provided was better (72% vs 52%; P =.03), and their confidence in the proposed care was also higher (58% vs 35%; P = .01). On the other hand, no significant difference appeared between the two groups regarding the information retained by the patient (doctor's name and reason for hospitalization) or the doctor's behavior.

[George K]

@George-K said in The ER doc speaks:

"Trauma Surgeon: What was the indication for an automatic trauma activation on this patient?

Me: He’s a farmer."

[taiwan_girl]

[jon-nyc]

That’s his wedding ring. The finger next to it has a bad fracture.

I’m not a radiologist, but I play one on TNCR.

[taiwan_girl]

what is the black thing on the middle finger?