Autism and Emergencies

This is an interesting video about helping autistic people in case of emergency. 

http://todayhealth.today.msnbc.msn.com/_news/2012/03/01/10543990-autism-rescue-firefighter-teaches-how-to-help-autistic-people-in-emergencies?ocid=twitter

The man who developed the program is a fire fighter with an autistic son.  He explains how most autistic people are fixated on their routines.  An emergency is definitely out of their routine.  They get excited.  I would say agitated.

Many autistics cannot speak or communicate properly.  When they are upset, they may make funny noises, abnormal gestures like “flapping”, run around, or be absolutely still.  To calm them down, one technique is the “bear hug”.  It works on my son, Mr. Impatient. 

The video is worth watching. 

Around the Web – Making Your ER Visit Easier

Found another great article. 

This is written by an emergency room nurse.  Title is 4 ways to de-stress your ER visit.  I’ll list the short version, but strongly recommend you actually read the article.

1. Make a list of medications you take and bring it with you

2. Bring no more than two people with you.  Bring at least one in case you need a ride home.

3. Bring something to do.

4. When someone is talking to you, ignore the cell phone and pay attention.

Here’s a link:

http://www.emergiblog.com/2012/01/four-ways-to-de-stress-your-er-visit.html

For all those friends and relatives who wonder how I have time to do all that crocheting, I have the bag perpetually packed.  I just grab it when I go somewhere I think I’m going to wait.  From the local high school sports events to my kids’ medical appointments – it gives me something to do.  Of course, I got a kindle for Christmas, and it fits nicely in the bag.  So there may be less handcrafting.

Hospital Payment for Ratings

One of the latest gobment schemes to “improve” medical care is to start paying hospitals based on patient ratings.  You know those rating surveys you get after you have been in the hospital, the emergency room or had outpatient services?  Someone actually tallies those up and scores each hospital based on “patient satisfaction”. 

This has absolutely nothing to do with how good your medical care is when you are seen.  It has to do with how you think your care was. You get to rate the food, the attitude of your providers, the cleanliness of the facility, etc. 

If you don’t like the things you were told, you can give the hospital a low rating.  Unfortunately, many of those things are things you need to be told.  Things like:

1.     You don’t need to go to the emergency room for a problem you have had for months and months.

2.     A cold will get better on its own.  Antibiotics do not help.  Really.  They just increase your risk of other problems.  Like bacteria that are resistant to antibiotics or diarrhea from the medications.

3.     The pain scale only goes to ten out of ten.  You can’t have a pain of twenty or thirty out of ten.  If your pain is ten, you shouldn’t be able to sit quietly and text on your cell phone.  Tears and difficulty breathing should be involved. 

4.     Coming to the emergency room for the same problem over and over for the same problem is a waste of money and time.  That’s what doctor’s offices are for.  Unless they tell you to come back, follow up with YOUR doctor.

5.     Coming by ambulance does not get you seen sooner.  It also costs a lot of money.  If you need emergency services, call them.  If not, don’t.

6.     Yelling, screaming or being abusive to the staff doesn’t get you anywhere.  In fact, they think of ways to make you miserable.   They may not do any of them, but they think …

7.     Not all female personnel are nurses.  Not all male personnel are doctors.  This is a pet peeve of mine.  I am a female who got my M.D. in 1980.  Yup, over 30 years ago.  I still get mistaken for a nurse.  It doesn’t make me happy. 

8.     Waiting is part of the system.  Plan on it.  It doesn’t matter what you are there for.  Emergencies happen.  The person with the heart attack or gunshot is going to be seen before a fever or rash.  It’s called triage.  BRING SOMETHING TO DO.  I always have a book and my crochet bag.  I have made many scarves and worked on blankets at doctor’s and dentist’s offices, while waiting for procedures to be done, etc. 

We need to get over our “drive through”, instant gratification mentality.  Medicine doesn’t work that way.  Most times it’s a process.  There are a lot of people involved.  The doctors and nurses have to wait for your lab work, your x-rays, your records etc.  Sometimes they are waiting to see how a particular treatment worked.  Your consultant doctor may be in surgery or in a delivery or busy with someone who is “bleeding out”. 

So long as you get the best care you can when it is your turn, anticipate the wait.  Use the time wisely.   Don’t get upset.  Meditate.  Read a book or write one.  Your attitude makes a difference about the whole experience.  Then you can give them a better grade, too.

Oops! What is a Mom / Doctor To Do?

Three Speed takes a spill!

The reason there haven’t been any posts for the last couple of days is that there has been some excitement in the Lasermed house.  Three Speed fell and injured himself at school in the middle of the school day.  He injured both of his ankles, one more than the other.  When I got home, he was on the couch with an ice pack, pillows and a courageous look. 

We had to make a decision about whether or not to take him to the Emergency Department.  [This is the current terminology, since it isn’t a “room” anymore.]  His ankle was “non-displaced” to my semi-professional eye.  That means it looked swollen, but not bent at a funny angle.  Mr. Lasermed, who was a paramedic in his former life, agreed with this. 

Just to be sure, I called and spoke with the ED doctor.  They don’t have an orthopedist in our hospital all the time.  So we would get an X-ray, a bill from the radiologist, the ED doc, and a fee for using the ED.  OR... We could wait until the AM, and go to the orthopedics office, where they have their own X-ray machine, and we get to see the doctor we need to see.

We decided to wait.  We iced it, elevated it, waited until the next day and went to the orthopedics office. Nothing broken (thank goodness), but he can’t march in band for 6 weeks. He saw the "old man" in the practice.  He doesn’t do surgery any more, but has more experience than any of the other doctors there. The gentleman doesn't like gel packs for icing – he prefers frozen veggies!  I think it’s a waste of veggies, but he says they conform better to the injured part. 

Three Speed is on the couch even as I write this.  He’s feeling better.  Now it’s almost hard to keep him down.  His foot is purpling nicely.  It is still quite swollen.

And we saved well over $1000 in medical charges. 

Around the Web

In Case of Emergency (ICE)

This was from someone else’s blog.  The blogger was a paramedic.  I think it’s a good idea.  Those of you who have cell phones should pay attention to this.  If you don’t have a cell phone, why not? 

The EMS people are trying to find a way to rapidly identify your emergency contacts.  They are asking us to enter a contact for emergency and call it “ICE” for In Case of Emergency.  If you are unable to tell them who needs to be called, they can use this number.  You surely don’t want them calling your dentist or gynecologist.  You want them to call your spouse or parent or child or best friend.  So label that person or persons in your phone. 

1.     If “ICE” (In Case of Emergency) was a national icon close family or a friend could be notified immediately.

2.     ICE is a great idea that can make a difference. Everyone reading this is on their computer, tablet or mobile phone. Go to your phone directory, get a number you want contacted in case of emergency and enter it as ICE. Then forward this to your email list.

3.     It you have more than one contact name file the names in the telephone directory as ICE1, ICE2 and ICE3.

I think this is a wonderful idea.  I’m going to do it after I post this. 

Pain Scale – Who made it up?

Ten is supposed to be the worst pain ever!

Sometime in the last few years, there appeared a new “vital sign”.  It’s called the pain scale.  We can’t measure this one with a thermometer or a sphygmomanometer.  This one is much more subjective.  In other words, we ask you to grade it yourself.  You will get asked “on a scale of 1 to 10, with 1 being no pain and 10 being the worst pain you can imagine, how much pain are you having now?”  At least that’s the plan.

I love to have people sitting quietly across my desk saying “8” or “9”.  Remember “10” is supposed to be the worst pain ever.  Like if you just got run over a truck, or stabbed 50 times, or….  You get the idea.  My doctor friends who have had kidney stones give them an “8”.

If you are fully conscious and well aware of your environment, it’s not a ten.  If you’re not crying or screaming, it’s not a nine.  If you can still breathe calmly, answer questions and remember your birthday and social security number, it’s not even an 8. 

Remember that the top number is 10.  Anyone that has a number greater than ten has obviously not listened to the question.  We hear “11” or “12” fairly frequently.  We also hear “20” and “30”, and occasionally “100”.  You don’t get any more credit for numbers over ten.  Really.  Except that the medical people taking care of you think you are stupid. 

You won’t get seen faster in the emergency room or the doctor’s office.  You won’t get any more pain medication.  In fact, you will probably get less pain medication, or none at all.  Those of us that do this for a living think that you are looking for pain medication, not really in pain if you say your pain is a “15”, but you can’t stop texting or talking on your phone.  Really.

Stumbled upon blog

Edwinleap.com

I stumbled upon this man’s blog through a physician’s web site called Sermo.  More about that another time.  This is from a post called: “ER: Theses for an Emergency (Medicine) Reformation”

 I’m certainly no Martin Luther, though I think he was a very cool guy. And in medicine, there’s now place to nail my theses, as Luther did in Wittenberg, and so spark a reformation. But if there were, here are a few of the things I’d say.

Physicians and nurses are weary of being the victims of assault and abuse at work, all the while perceiving that their hospitals and employers are more concerned with the rights and safety of the assailants. Shame on you, if you allowed your staff to be abused while you worried about the criminal who attacked them!

Thesis: Medical providers are under attack and need protection more than their attackers.

In all likelihood, physicians practicing full time emergency medicine don’t need to be recertified by board exams or anything else. And they may not even need documented CME. Actually practicing is its own education, day in, day out and year after year. They actually look things up and learn on the job.

Thesis: We practice medicine on real patients, and learn as we go. No more tests, no more hoops.

The pain scale, and the entire pain management culture, is (to quote my children) an ‘Epic Fail.’ It has led to addiction, abuse, dysfunction, disability, staggering cost in confabulated complaints and worst of all, unnecessary deaths from prescription medications. Regulatory panels and advisory groups need to stop wringing their hands and listen to the reality of people like us, who are asked, on every shift, ‘can I have more pain pills?’

Thesis: Narcotic abuse and addiction can start in the ED. The pain scale is worthless. The age of the ‘candy man’ must end.

The rest of medicine cannot abdicate its responsibilities, expecting emergency medicine to stand in the gap like Atlas, holding it up, so that they can avoid call, avoid poor patients, avoid drunks and have a comfortable life. Remember when they thought our speciality was inferior? Odd that we can now do anything.

Thesis: We cannot be all specialties to all people, and we cannot carry medicine for the convenience and economic prosperity of others.

EMTALA must be reformed. It has cost lives, jobs and entire facilities. And it has, like all entitlements, bred dependency, irresponsibility and abuse. Whatever benefits it accrued have been washed away by a tidal wave of reckless, uncaring misuse of the great gift the government gave the public…the gift of our productivity.

Thesis: EMTALA results in theft and abuse. It has to be reformed, or medicine as we know it will be finished in America.

Customer service has a place, but must be re-defined. A person who steals from you, abuses you and/or assaults you, knowingly, must cease to be a customer. Their satisfaction surveys should be stapled to them as they are escorted to the door.

To read the rest, go here:

http://edwinleap.com/blog/?p=1892

Calling Your Doctor After-Hours 1

Think Before You Dial

Every doctor makes arrangements for you to call him or her after hours.  If they are not available, there is always someone who is available.  These numbers are supposed to be used for Urgent matters ONLY.  Most of us have a disclaimer that, if you are having an Emergency, you should hang up and call 911.  That means things like: crushing chest pain, cutting your arm off, shot with an arrow… you get the idea.  Do not call your doctor’s office.  Get to the Emergency Department.  They know what to do for that stuff. 

OK, it’s not an Emergency.  Now, is it Urgent?  Or is it something that you should be dealing with during the regular office day? 

 “Poor planning on your part does not constitute an emergency on my part.”  This means that you need to check your medications BEFORE the weekend.  If your bottle of blood pressure pills only has a couple of pills left in it and has no refills on the front, you better call the office DURING THE DAY.  If you call on the weekend, you will generally get a grumpy doctor.  He or she will call you in enough medication to get through until Monday, when you will have to call your regular doctor.  You will have to pay your co-pay twice, too. 

Your doctor is NOT connected to the appointment book.  S/he cannot discuss your bill.  Generally speaking, your lab results are not available to the doctor.  Your doctor cannot give you advice about a problem that you have not been seen for in the office.  Your doctor will not be able to treat a family member that they have not ever seen.  Most doctors cannot deal with anything wrong with your teeth.  You need to call your dentist.  Honest.  We don’t go to medical school for that. 

When should you call?  If you have had surgery and the doctor has instructed you to call if something happens (like a fever, bleeding, etc.).  Your pediatrician will give you warning signs with newborns and kids.  Listen to them. 

Oh, by the way, more and more doctors are charging for after-hours calls.  So take that charge into your calculations before you call.  The charge can vary from a few dollars to over $100 depending on the length and complexity of the call, the kind of physician you call, and your geographic location.