8.26.2007

Just being a doctor

The other day, while working in an off-site urgent care center, there was a guy...

...this guy was a 40ish y/o man, who was working at a construction site when a 2x4 fell and hit him on his right ear. He presented to the UCC with a 2cm laceration to the external ear, involving the cartilage. At first glance it didn't seem that bad. But, then when I realized that the cartilage was involved...I was reluctant to repair the wound. Eventhough I'm able...and know all about auricular lacerations and perichondrial hematomas (thanks to emedicine and google, and of course my EM training), and am capable and qualified to repair them as an ER doctor. But, I wasn't in the ER...and the repair seemed like it would take too long in the clinic setting. Besides, I didn't want to do it wrong, and have this guy sue me because a hematoma subsequently developed and caused a cauliflower ear for his lack of follow-up (as is typical of the innercity patient population). So, I did what every clinic doc does when they don't want to deal with a particular patient....I told him to go to the ER.

He *really* didn't want to go to the ER.

I explained the complexity of his wound, the possibility of hematoma, and the close f/u that would be indicated. I told him that there may be complications...and I, basically, didn't want to take the risk. The risk that he didn't fully understand the repercussions of improperly managing this type injury. The follow-up, the wound care, and the possibly that cosmetic appearance may be suboptimal despite perfect medical treatment. (Sometimes getting patients to understand that it wasn't *you* who dropped the 2x4 on their ear causing the damage, but rather their lawsuit anger should be directed toward the perpetrator...is a difficult task if complications develop).

He listened, and expressed understanding. Then he said "doctor, I don't care how it looks when you're done...and I don't care if I have to deal with complications; as long as you do your best, I will be happy. Please try, I don't want to go to the ER...especially if you can fix it." (hmmm...can I get that in writing? Does that count as informed consent? Will that hold up in court?).

So, the doctor in me...that part who doesn't want to base every medical decision I make on what's defensible in court, but rather do what's best (and within my capacity) for people...over took me.

I repaired his ear. And it looked nice. Tiny 6-0 sutures, all neat and tight (but not too tight). No hematoma.

I told him he'd better *better* come back the very next day!! I even gave him my direct line to call me when he arrives out to triage...as to avoid waiting (to encourage him to actually return). When he arrived, he started to check in. When he realized that there were no "short-cuts" despite the fact I told him there would be...he decided to call the number I'd given him. I arrived out to triage as he was being sent to registration. I stopped him, removed the dressing, and looked at my work his ear. Still great, no hematoma. (I did document this "visit"...but, of course, I not sure if "it'll count" since the patient didn't register). But, more than anything I felt better about doing the procedure. And the patient knew I really cared about not getting sued his injury.

After my short hallway reexamination....he handed me a gift basket from him and his family saying "thank you for being a great doctor; for going beyond what's able to be documented despite our current sue happy population, and treating me with respect."

You are welcome, Sir!!

Sometimes we are allowed to just be doctors!!

17 comments:

frylime said...

yay! what a happy story!

ps...i've been reading your blog for a while and love it. i'm a current M1 student, and your stories are great for someone like me to read!

ER doctor said...

Awww....shucks!! :o)

Thanks for reading.

I am a resource to you...and all med students who find my advice helpful/applicable/relevant. Feel free to ask questions as you progress...

frylime said...

thanks! i definitely will take you up on that offer, and if it's alright, i linked you on my blog! (if you want to read about silly M1 stuff...hahaha.)

Toni Brayer MD said...

Great post and we have all been there. This is truly "how doctors think" and what our litigation happy society has rendered. Glad it was a good outcome.

scalpel said...

Very nice explanation of what it's like to work in a satellite facility.

I love it when patients say "just do it." Hope it turns out well.

rlbates said...

Good post. I love it when patients feel that way too. I always try to do my best (but sometimes those hematomas happen)

NocturnalRN said...

So nice to be thanked every now and then, huh? Good job!

thestoryofhealing said...

This is encouraging. Thank you for a wonderful post. This is my first time reading you. I will surely be back! ;-)

Lynn Price said...

I found your site via Scalpel. Cool post. What saddens me is how docs have to stop and consider what they can defend in court before they treat a patient. Something is waaay out of whack, and it sucks stale Twinkie cream.

Anonymous said...

This is a great account of how we feel as ER docs. I'm in a similar situation, recently out of residency. When I first came out I was pretty defensive. I wouldn't do anything that wasn't medicolegally defensible.

Now I'm starting to allow myself to be a real doctor. I've decided I'd rather get sued a few extra times and be able to practice real medicine than hide behind defensive medicine.

(we'll see if I still feel this way after my first lawsuit...)

said...

A片,A片,成人網站,成人漫畫,色情,情色網,情色,AV,AV女優,成人影城,成人,色情A片,日本AV,免費成人影片,成人影片,SEX,免費A片,A片下載,免費A片下載,做愛,情色A片,色情影片,H漫,A漫,18成人

a片,色情影片,情色電影,a片,色情,情色網,情色,av,av女優,成人影城,成人,色情a片,日本av,免費成人影片,成人影片,情色a片,sex,免費a片,a片下載,免費a片下載

情趣用品,情趣用品,情趣,情趣,情趣用品,情趣用品,情趣,情趣,情趣用品,情趣用品,情趣,情趣

A片,A片,A片下載,做愛,成人電影,.18成人,日本A片,情色小說,情色電影,成人影城,自拍,情色論壇,成人論壇,情色貼圖,情色,免費A片,成人,成人網站,成人圖片,AV女優,成人光碟,色情,色情影片,免費A片下載,SEX,AV,色情網站,本土自拍,性愛,成人影片,情色文學,成人文章,成人圖片區,成人貼圖

情色,AV女優,UT聊天室,聊天室,A片,視訊聊天室

清朝美女 said...

(法新社倫敦四日電) 英國情色大亨芮孟a片的公司昨天說,芮孟av日前成人影片av女優世,享壽八十二歲;這位身價上億的房地產日本av開發商,部落格a片經在倫成人av推出第一場脫衣舞表演。

成人網站
芮孟的財產估計av女優達六億五千萬英鎊成人影片(台a片av女優情色近四成人百億),由於他名下事業大多分布在倫敦夜生色情a片色情區蘇活區sex,因此擁有「蘇成人網站情色之王」的稱號。
部落格

他的公司「保羅芮成人影片孟集團」旗下發a片行多種情色雜誌,包括「Raavdvdzzle」、情色電影「男性世界」以及「Mayfair」。色情影片


芮孟本名傑福瑞.安東尼.奎恩,父親色情為搬運承包商。芮孟av成人光碟五歲離開學校,矢言要在表演事業留名,起先表演讀av心術,後來成為巡迴歌舞雜耍表演的製作人。


許多評a片下載論家認為,他把情色情色電影表演帶進主流社會成人電影,一九五九年主成人網站持破情色視訊天荒的脫衣舞表演,後來更靠著在蘇活部落格區與倫敦色情西區開發房地產賺得大筆財富。

a片下載
有人形成人電影容芮孟是英國的海夫納,地位AV片等同美國的「花花公子」創辦人海夫納。

元美女 said...

(法新社a倫敦二B十WE四日電) 「情色二零零七」情趣產品大產自二十三日起在色情影片倫敦的肯辛頓成人電影奧林匹亞展覽館成人影片舉行,倫敦人擺脫對性A片下載的保守態度踴躍參觀,許成人網站多穿皮衣與塑膠緊身衣的好色之徒擠進這項世界規模最大的成人生活展,估計三天展期可吸引八萬多好奇民眾參觀。

活動計畫負責色情人米里根承諾:「要搞浪漫A片、誘惑人、玩虐待,你渴望的我們都有。」

他說:「時髦的設計與華麗女裝,從吊色情飾到av女優束腹到真人大小的雕塑,是我們由今年展出的數千件產品精情色電影選出的一部分,參展產品還包括時尚服飾、貼情色電影身女用內在美、鞋子、珠寶、玩具、影片、藝術、圖書及遊戲,更不要說性愛輔具av及馬術裝備。」

參觀民眾遊覽兩百五十多個攤位AVAV女優有性感服裝、玩具及情色食品,迎合各種品味。
a片
大舞情色台上表演的是美國野蠻搖滾歌手瑪莉蓮曼森的前妻─全世界頭牌脫衣舞孃黛塔范提思成人影片,這是成人電影她今年a片下載在英國唯一一場表演。

以一九四零年代風格演出的a片黛塔范提思成人網站表演性感的天堂鳥、旋轉木馬及羽扇等舞蹈。

參展攤情色位有的推廣情趣用品,有的公開展示人體藝術和人體雕塑,也有情色藝術家工會成員提供建議。

eda said...

101煙火,煙火批發,煙火工廠,製造浪漫煙火小舖,煙火小舖,衣蝶,衣蝶,情趣用品,情趣商品,情趣,情趣,衣蝶情趣精品百貨,衣蝶情趣精品百貨,,煙火批發,情趣禮品,成人用品,情趣內衣,情趣精品,情趣商品,情趣用品,情趣,情趣,真愛密碼情趣用品,真愛密碼,真愛密碼,真愛密碼情趣用品,貓裝,自慰器,性感內褲,角色扮演,丁字褲,,跳蛋,AV,丁字褲,煙火,情趣用品,情趣用品

酒店上班請找艾葳 said...

艾葳酒店經紀提供專業的酒店經紀,酒店上班,酒店打工、兼職、酒店相關知識等酒店相關產業服務,想加入這行業的水水們請找專業又有保障的艾葳酒店經紀公司!
艾葳酒店經紀是合法的公司、我們是不會跟水水簽任何的合約 ( 請放心 ),我們是不會強押水水辛苦工作的薪水,我們絕對不會對任何人公開水水的資料、工作環境高雅時尚,無業績壓力,無脫秀無喝酒壓力,高層次會員制客源,工作輕鬆。
一般的酒店經紀只會在水水們第一次上班和領薪水時出現而已,對水水們的上班安全一點保障都沒有!艾葳酒店經紀公司的水水們上班時全程媽咪作陪,不需擔心!只提供最優質的酒店上班環境、上班條件給水水們。

angelina diaz said...

Hey grate story.very encouraging post.Thank You so much for this post.

regards,
buy viagra online without prescription

Hacker said...

Thanks for reading. istanbul ismek spor yemek güzellik bilgisayar el sanatları kursları Yemek Kursu İsmek ibb eğitimleri