I’m usually pulling about 4 or 5 hours of sleep on a typical night. Honestly, if I try to catch up and sleep more—like when I oversleep on the weekends—I actually end up feeling pretty lousy instead of rested. 🙄
Scott Allen10 said:Just to add a bit more context regarding this specific situation... the hospital could have easily spotted it, noted an opinion, and documented everything—everyone gets a discharge summary with a specific medical record number on the header. But here’s the kicker: the hospital's real headache is how to bill Medicare for an emergency visit when, logically, those costs should be routed through the Emergency Room services first. By the time they've spent the time, run the tests, prescribed meds or vaccines, and used up supplies... according to the "Blue Book," that translates to a certain amount of points... How are you supposed to explain it to a Medicare auditor when they show up? They see an expense for something that looks totally trivial, yet there's no red referral slip to back up the invoice. It feels like some bureaucratic loophole, but honestly, that's just how it works in reality. The auditor doesn't care if you were wandering around Washington, D.C. looking for help. He sees that the issue wasn't an emergency and there's no red referral slip, so that's it. Then he starts breathing down everyone's necks... the boss, the triage nurses, the admins... claiming it's an irregularity, saying it won't be paid, blah blah blah... And then some new "pest" shows up, and you're stuck wondering how to handle it... it's a total Catch-22.
Scott Allen10, buddy (hope your wife isn't giving you a hard time about this) 🙏 🙏 🙏 I feel like I've practically worn out my fingers and my keyboard trying to explain things to people, but it seems to be all in vain. 🙄 Honestly, I'd much rather be in the OR dealing with a polytrauma—think ruptured diaphragm, torn intestines, maybe even stabilizing a thorax with wire—than listening to the nonsense an auditor spews. A few months ago, my team had 10% of our revenue stripped away (our total revenue, not salaries, since we cover ourselves through procedures that don't go through Medicare) simply because we incurred The Penalty for having a higher volume of exams and services than what was set by the standard quota. 😈 And really, how am I supposed to hunt down someone whose fingers are literally hanging by a thread because they got caught in a circular saw? 😈 And where would I even go to report them—in Washington, D.C.??? 🤣
Justin Fox, sweetie, listen—I’m a surgeon, not some therapist.
And since Medicare is the one footing my bills, they set pretty strict time limits on my shifts. That means if I have a patient come in with a nasty forearm laceration, I have to clean them up, stitch them up, and get them set in a splint all within a 20-minute window. 😂
There just isn't any time to sit around chatting over coffee... or even enough time to drive them a little crazy. 🙄
Honestly, you might want to come down from your high horse and actually spend some time walking through an ER in Germany or right here in the States... or maybe just watch an episode of "ER"... that might give you a better idea of how this works. 😈
Back in the day, when I was sprinting to strip off my gloves and flying from one OR to the next, jumping from one suture to another because there were fights breaking out or car accidents coming in, I just didn't have the luxury of being super sweet and charming. And I'll admit, my mascara tends to smudge sometimes when I've been wearing a mask and goggles for hours and I accidentally rub my eyes (even though I use Diorshow). 🎉
Btw, people are judging me for no reason. You've never even seen me in action... and honestly, you haven't even heard me. 😂
Oh, and yeah... see? Even being this "mean" and uncommunicative, I still find the time to drop by and give advice via DM now and then. 😬
Justin Fox said:Jamie Clark74, look, I don't have an issue with any of those requirements, even though donating blood isn't really something on my radar.
Regarding the rule about turning away anyone who’s ever had sex with someone of the same gender—that's pretty nonsense. But if we're talking about someone who is sexually active, the statistical risk of HIV transmission goes up, and it just doesn't seem right for them to be donating blood.
Bravo!!! 🙏 🙏 🙏
We have a winner!!!
The most incredibly humane person of the week, the month, the entire yearrrrrr... Justin Fox !!!! :clapping: :clapping: :clapping:
But seriously, sweetie, tell us this: Since you're such a man of principle, would you turn down someone else's blood if you were lying there crushed after a car wreck and a transfusion was the only thing that could save your life? Huh? 😈
Mango, sorry,😲 I actually heard that straight from Vegarić's mouth (and sorry, Vegarić 😘 )
It’s true, though—you get doctors showing up at the ER or urgent care who don't even have a specialty or any specific training... they just jump right in... ugh... I'm especially sensitive to that. (Just between us, I honestly think they aren't always deservedly treated as top-tier physicians, though there are exceptions—that was just my bitter side talking back in the day. When I was a young specialist, I used to put them in their place, but now that I've got a mountain of work, I have way less time and even less patience 😛
Haig usually won't bother with an insect bite if the patient is being a total jerk about it—if there's no proof of vaccination, an Ana-tea booster dose is MANDATORY. Otherwise, Haig is a must for any contaminated wound—whether it's a human, horse, donkey, cat, dog, or snake bite, because unlike insect saliva, their mouths carry clostridia. It's also required for any wounds that have been heavily exposed to dirt (where the C. tetani spores live)....
Well, here we go again. I’m circling back to something I posted ages ago (Rachel Brooks63, you probably remember this one) — patients just don't seem to have any sense of priority or standards (and sorry, Kimberly Wright, I'm not taking a shot at you personally). They don't value expertise, which really should be the only thing that matters, they just care about accessibility.
Look, aside from the fact that everyone, regardless of what they do for a living, should be friendly and polite when dealing with people (I'm not making excuses for rude behavior), there's a difference. If someone gives you a sweet smile and some light conversation, but DOESN'T actually help you—like that grumpy, moody doctor who actually knows how to prescribe the right medication, then the smile doesn't mean much.
I run into this every single day while talking to my patients... "Oh, my doctor is just the best! She always asks about my mom, my dad, my neighbors... she's always smiling and so chatty and sweet..." "Listen, ma'am, you didn't get an X-ray of your hand after that fall two weeks ago. You have a fracture that's healing poorly, and you're going to need surgery." "But my doctor said I don't need it..." "Your doctor was wrong." "No way, she's such a lovely person!" 🙂
(I can already see everyone getting ready to jump down my throat 😈 😂 )
I’m not being paid to smile at people all day (my patients don't smile at me either, and it never crosses my mind to ask them to) or to act like a hostess or flight attendant. I'm here to treat people to the best of my ability. 🙂
That’s exactly what I deserve, honestly. Here I am thinking all my coworkers are total workaholics who follow every single rule to the letter just like I do, 😛 when really I should just be facepalming at my own stupidity: 😈 🙂
Honestly, using Dexamethasone for a puncture wound on the hand—whether it’s an insect bite or getting poked by a piece of wire—especially when there's already inflammation around it, is just totally wrong. It’s completely outdated. Even if you're dealing with an allergic reaction, a corticosteroid like this one, which is basically an older-generation fluorinated mineralocorticoid, shouldn't be the first thing you reach for! Do yourself a favor and look it up online; even a tiny 4 mg dose of Dexamethasone is enough to cause absolute chaos, messing with your glucose levels and mineral balance. Plus, when you've got a bacterial infection, it actually weakens your body's defense by suppressing leukocyte proliferation... Wait, so Tea didn't get it??? Man, that's just wild 👎
But seriously, if anything, you might actually have grounds for a lawsuit here 🙄 Because of medical malpractice.
silentmason15, what else could it be besides Tea??? 😉
It’s just standard protocol (and no, don't bother hoping it's an antihistamine 🙄 ) — either one dose if they haven't been vaccinated yet, or a booster shot
Lapu-Lapu said:That’s just how things are at the Emergency Room in Cleveland. You can say whatever you want about it.
By that logic, I could claim I was abducted by aliens🤣
I’m really not convinced that someone who is actually in pain or feeling genuinely terrible is going to take medical advice from every random person they pass on the street—whether that person happens to be a pharmacist or even the hospital director. When you aren't feeling well, you head to the Emergency Room, go through the check-in process, and explain what's going on. Sure, unless you're literally struggling to breathe or your heart is stopping, they might not see you the exact second you walk through the door, but you'll get seen eventually.
And honestly, if someone just turns around and walks out? Sorry, but that’s on them. It’s their own responsibility. Nobody is going to chase them down the street begging them to come back inside.😈
Lisa Gonzalez - look, you really need to read more carefully here. It’s exactly because of interpretations like yours that we can't get any actual treatment done "on the fly in a hallway." 😬
Also, let's not confuse the two things here—you shouldn't swap the patient's rights for how the healthcare system actually operates on the ground.
If a patient shows up—and I'm going with what Kimberly Wright said about them coming in for "nonsense"—it doesn't mean they have to be admitted immediately just because they think they should be. After an initial assessment (which was already mentioned, where some doctor in the hall checked them out, gave their opinion, and said they need anesthesia, antibiotics, or whatever else), the exam can be delayed or they can be sent to the appropriate facility.
Honestly, if I were in that spot, I'd do the exact same thing. I'd take a quick look at their arm, tell them to follow up with their primary doctor or head to the Emergency Room to get what they need. I mean, sure, I’d probably also suggest they put some ice on the swelling 😬 But since I'm a specialist, I can't just write them a prescription for antibiotics 😍 We aren't allowed to do that—well, technically we can, but only for a private prescription, not one covered by Medicare 😈
Kimberly Wright said:So, I'm still waiting on an answer to my question. Or let me try asking it differently: should the Emergency Room at the new hospital have admitted us right away, even if we were just there because of some minor nonsense?
Nah, not really. It wasn't actually a case for the HOSPITAL itself, but rather for the primary care physician (George's) who handles the vaccinations and prescriptions, just like it was planned 🙄
Hey silentmason15, I’m actually pointing that out because the local reaction to an insect sting usually pops up pretty fast—we're talking pale edema and induration within an hour or two—before it eventually turns into redness and itching... Anyone who’s ever dealt with a mosquito or a wasp bite knows exactly what I'm talking about... 😬
Atlantis - honestly, that’s a great concept in theory, but in practice? It’s just not happening. 🙄
Let’s talk about phone triage for a second. 😬 Basically, that’s how almost every ER dispatch center operates—you get a nurse on the line (usually, though sometimes it’s a doctor) who gathers all the initial info. There are two major roadblocks here: 1. Patients or their families don't always give accurate information. Sometimes they do it on purpose, sometimes it's just an honest mistake. You can't really blame the ER if things go south or someone passes away because the intel provided was wrong. 😈
2. Even if they take the advice given over the phone and follow it, patients often still insist on coming in anyway, or they feel like things are getting worse. So, you haven't actually solved anything; you're still dealing with a massive influx of unnecessary visits that clog up hospital capacity and force people who truly need urgent care to wait in line.
And regarding a dedicated triage desk—man, that would be amazing. I remember being asked about this ages ago, and I was such a huge advocate for it. Take the Emergency Room at Mayo Clinic, for example. You’ve got young doctors just starting their residencies working there, but the whole system kind of falls apart when there's pressure to give every single patient a full, exhaustive workup with every specialist exam imaginable. It happens mostly because people are terrified of missing something—even though mistakes happen regardless—and they want to prevent any grounds for a lawsuit. You know the drill: "They didn't even look at me, they just sent me home and said I was fine, but then my heart gave out..."
So, no matter how you slice it, it's a mess. People are waiting, they're being bounced from department to department, or sent back to their primary care docs. I don't see a way to fix it unless we replaced those one or two doctors on a shift with like ten of them. Then everything would run like a well-oiled machine. But let's be real, there's zero chance of that happening. Medicare has these incredibly strict mandates on staffing ratios—like, exactly one surgeon per 40,000 to 60,000 people—and they don't budge on those numbers even an inch. 😈
Honestly, you guys have no idea how relieved I am that I don't have to deal with the headache of ER organization and shift scheduling anymore. 🎉
Whenever you're dealing with an infected wound, you really need to get unspecified to the patient if they haven't been fully vaccinated—meaning all three doses—within the last 8 to 10 years. Even if they have been up to date, if we're looking at a high-risk injury, like a combat wound from a gunshot or an explosion, or even something messy like a puncture from farm equipment or a cut contaminated by soil where tetanus spores might be lurking, you've got to go the extra mile. In those cases, you’d administer a booster shot along with tetanus antitoxin hyperimmune globulin (usually around 250-500 units IV), plus a triple antibiotic cocktail. Fortunately, that's not quite the situation we're facing here.