Ok, I know I've talked about New Doc before, but she seems to be getting worse. Honestly, I think she just needs to get her confidence up and learn to trust her clinical skills. She knows her shit. She does. But she doesn't trust that she does.
I promise you, New Doc, you don't need a full cardiac work up on every single patient with pleurisy. Stop asking, "do you have chest pain?" to every single patient. Given the patient populous that we see, you will have people claiming "chest pain," not actual chest pain, every single time you ask. Try questions like, "does it hurt when you cough?" Perhaps the answer to that question is less scary than an affirmative chest pain question.
We all know what happens when you get a positive on the chest pain question. Nurses, techs, etc are suddenly flung into a whirlwind of activity in order to meet our Joint Commission time guidelines. So, stop it. You stop that now!
Patients who could easily leave within a couple of hours end up staying five or six to get repeat EKGs and cardiac enzymes. These people just want to go home. And we want them to go home too!
Every now and then, a patient ends up worse off because he or she needs to go to the bathroom and trips on a molecule of thin air in our bathroom. When that happens, do you know who gets screwed? We do!!! It's a measure of how good of medical providers we are, you know? Sometimes that person who trips ends up with a broken arm and a broken hip, regardless of age.
I have three words for you, New Doc: DISPO, DISPO, DISPO!!!
Oh, and if someone comes in with no cardiac history, no family history, one risk factor, and COMPLETELY NEGATIVE chest x-ray, labs, cardiac enzymes, and EKG, please prepare yourself mentally, to meet up to the challenge and actually discharge a person home!
People don't need to be admitted just to see if they have an elevated Troponin later.
Ok, I think I'm done. . .
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