Sunday, February 22

Closing time at the clinic

The idea of rotating general practitioner physicians through emergency rooms and neighborhood clinics seems like a neat concept but falls flat somewhere near where the patients need appropriate care.

I am not a physician. I do not claim to be a physician. I specialize in the acute, the emergent, the unknown.
I took the same anatomy and physiology, biology and chemistry the physicians did before medical school so I like to think we have the same base education and they chose to specialize in medicine while I chose emergency care.

The old joke of a podiatrist trying to run a recuscitation without an IV is a classic example.
The sad story of a Paramedic diagnosing toe fungus is even worse.

Point being some Doctors don't belong on the front lines the same way I don't belong upstairs at the hospital.

The clinic near the local firehouse I worked at recently is notorious for calling for code 3 transfers for runny noses, broken fingers and the like. The Doctors in for the day know that no ER physician will accept a transfer of these non emergent patients, so the Docs simply call 911. When we're activated the MD knows we have to follow his treatment orders, within our protocols, regardless of our own impressions and assessments.
The most aggravating is when we get called there just after 5 PM, closing time.

This day it was for the "chest pain code 3 transfer."
This is our 3rd time there since 8 AM.

The doctor's hands are shaking as he's describing the condition of the patient. His notes are scattered as well as his verbal report, jumping from lab results to muscle tone definition and everywhere in between. He describes the patient's O2 as "TKO."
He's left out the two things I want to know: Her name and her chief complaint.

When I ask those of our MD friend his face turns to the chart and he's flipping pages, not realizing that the name will be on every page, near the top along with the records number.
While he's searching I walk around him to the patient who is sitting, smiling in the hospital exam chair.
"Is anything the matter?" She asks me.
"You tell me." I responded a little confused.

She explains she's been feeling a vague chest pressure for a few days but wanted to get her blood pressure checked here at the clinic just to be sure everything was OK.

That was just after lunchtime.

5 hours later, the pressure is the same, elevated, but here we are on a code 3 chest pain transfer.
The MD has gathered his thoughts and tells us the patient is a rule out STEMI (the new pre-hospital catchphrase) and hands me a 12-lead EKG. I'm no expert but I see no ST changes in any leads, clean R wave progression anterior, heck not even a first degree block or hint of a-fib.
The computer agreed when it wrote on the paper, in clean black ink,

***Normal EKG***.

I take a deep breath, assuming there must be something I'm missing that he learned in the extra 2 years of medical schooling he took when he let's it out:

"I'm just not sure what to do with her, I was hoping you guys could keep an eye on her on the way to the ER. All my staff is leaving."

"You don't have to go home but you can't stay here." Is what he should have said.
In the parking lot, loading the patient, I was eying the nice BMW and just hoping he would go running to the car to leave, but he waited 'till we were gone.

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