Oct

12

State of Fear

October 12, 2009 | 15 Comments

Struggling for Rationality
“This patient,” I said to myself, “is going home.” 
I know.  She’s 85 with the dreaded complaint of “Altered Mental Status” described by the family as a brief period of “staring.”  No generalized seizure activity, you understand, and no syncope (fainting), slurring of speech, facial droop, drooling, weakness, confusion, sweating, fever, nausea, vomiting, or [...]

Sep

5

Yer’ Stinking Tax Dollars at Work

September 5, 2009 | 17 Comments

(More questions from real readers. -PB)
What’s the Emergency Department Really Like?
The American College of Emergency Physicians and their bogus statistics notwithstanding, the majority of cases we see are not emergencies.   As I have mentioned before, most of the cases we see probably don’t need to be seen at all by anybody in the medical profession in any [...]

Aug

30

Life or Something Sorta’ Like It

August 30, 2009 | 13 Comments

(Just a few random questions from real readers-PB)
What is your job really like?
As you know, I am an Emergency Physician working in a medium-sized community Emergency Department in a medium-sized hospital in a medium-sized city in a medium-sized state.   A “community” Emergency Department is not a major trauma center and generally sees mostly medical complaints [...]

Aug

15

Pandamorama

August 15, 2009 | 27 Comments

Quick Learner
So I had a drug seeker come in the other day with her usual back pain.  Lately I have been very stingy with narcotics and after refusing to give her a shot of anything stronger than Toradol I explained that I only give narcotics for patients with fractures or obvious acute injuries and never to patients with [...]

Jul

13

Poker and Other Things

July 13, 2009 | 16 Comments

Michael Jackson is Dead and I Don’t Care
Michael Jackson is dead and, God forgive me, I don’t care. I wasn’t a fan and I didn’t like his music. Sure, I listened to it; it would have been impossible not to but I never bought an album, stopped turning the dial at the sound [...]

Jun

14

Bread and Circuses, Water and Sewage

June 14, 2009 | 22 Comments

Customer Disservice
There are days when I explain to the family of a 98-year-old customer, in terror of the the inevitable end, that today is not that day and while the odds of their mother living another month are close to zero, she’s alert, reasonably comfortable, and they have some time to say what they want [...]

Jun

2

Anabasis

June 2, 2009 | 18 Comments

Marching Up Country
(With Apologies to Xenophon)
The campaign draws to a close and will end like many such expeditions do; in a victory of sorts for I have certainly marched into and through the Empire of Medicine with my fellow mercenaries, outwitting the enemy on many occasions, laying waste to his crops and orchards when necessary, [...]

May

22

Edumucation and Other Things

May 22, 2009 | 11 Comments

Perspective
While driving through the downtown of our small but not insignificant Midwestern city (there are corn fields five miles from the city center but we do have the state capital and a handful of miniature skyscrapers) I noticed a fat brown squirrel scampering down a tree and bounding across the street in the halting but graceful manner [...]

May

9

Panda-emic

May 9, 2009 | 8 Comments

“I got the Swine”
I’m hoarse from explaining influenza to my patients, the numbers of whom showed a small but significant increase over the last two weeks as Swine Flu hysteria grew, peaked, and then receded.  Everybody wanted a pill for “The Swine” for which, unfortunately, there is none except an essentially useless anti-viral that works [...]

Apr

23

Can’t Touch This…

April 23, 2009 | 13 Comments

Actual Patient Conversation:
“Man, that Dilaudid didn’t even touch my pain.”
“Uh, Okay.  Your CT was negative so you’re fine to go home.  I’ll ask your nurse to come discharge you.  Come back if you get light headed or start to vomit but otherwise, just take Motrin for your headache and you should be fine.”
“Can you give [...]

Apr

16

More Random Reader Questions and in Which I Give Some Real Medical Advice Without Fear of Being Sued

April 16, 2009 | 16 Comments

(Actual questions from actual readers. -PB)
I know you don’t like chiropractors but what are we supposed to do for chronic back pain?
For chronic back pain I recommend back strengthening exercises, instruction in correct lifting and posture, weight loss, physical activity, judicious use of NSAIDs, and occasionally just sucking it up.  For serious back pain which [...]

Apr

13

Don’t Forget….

April 13, 2009 | 5 Comments

A short post today, my apologies, but I want everybody who can to attend their local “Tea Party” on April 15th.  As you may recall from American history, back in 1773 American colonists irate over increasingly oppressive duties and tariffs imposed by the British disguised themselves as indians, boarded British Merchantmen in Boston Harbor, and [...]

Apr

11

47 Million Uninsured My Ass

April 11, 2009 | 9 Comments

(With apologies to Deborah Peel -PB)
So I had this uninsured patient with a chronic medical problem that was being addressed at The Big Academic Medical Center Sixty Miles Away who came to the department with worsening symptoms from her chronic medical problem, a problem that was competing, I might add, with several others that were [...]

Apr

5

Ask Yer’ Uncle Panda: More on Mid-Level Providers and other Topics

April 5, 2009 | 46 Comments

(In which I answer several random questions submitted to me by readers. -PB)
Hey, Panda, I’m not sure what specialty I would like to do and am considering going to PA school because Physician Assistants can easily move between specialties.  Your thoughts?
I often hear the ease of movement between specialties touted as a benefit of being [...]

Apr

1

1001 Ways to Die

April 1, 2009 | 6 Comments

1001 Ways to Die
There has got to be a better way to die and surely the patient at the center of our frantic activity couldn’t have wanted this one.  I arrived at his room with a code in progress although, as the patient was still alert, most of the activity involved throwing towels on the [...]

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