You Guys are Even Meaner, I Love It
In Response to the prior post, with which I expected half a dozen readers to write about how disguisted they are, some of the readers actually surprised me. How you ask? Well, it seems that some of you have a mean streak I could only dream of For example, Barbados Butterfly who really would let this patient have it:
- order a 24h urine collection & QID blood sugar levels with your diabetic work-up.
- find an embarrassing illness & discuss it loudly on ward rounds (tinea, bleeding haemorrhoids, some rash that isn't scabies but by golly it could be, we really should start scabies treatment & put him in the room with that other guy with scabies. Caution: do not do this if it will mean that the patient needs a single room).
- that rash won't get better if you shower with hot water. It should be somewhere between cold & tepid.
- no smoking & no alcohol. Cigarettes are tools of the devil. Make your patient understand this. And you need to put him on an alcohol withdrawal scale chart. Particularly overnight.
- strictly enforce a sitting out of bed policy between 0700 and 2200. You don't wanna get DVT, do ya?
- get physio to crack the whip. There'll be no slackers on this ward! NB. Check first that your ward physiotherapist is not a petite, svelt, attractive blonde.
- send every medical student in the hospital to do a long case on the patient. Send the short, slow medical student with the weird laugh. Tell him that you want a full dermatological, childhood and sexual history. Ask him to get some skin scrapings from that rash. Possibly even a punch biopsy.
- order chlorvescent rather than slow K for potassium replacement. I've only met two patients who liked the taste of chlorvescent; both were demented.
- vitamin D levels are often low. Caltrate tablets are big.
- Hip protectors are really cool, dude/dudette. And they're for your own safety. Put 'em on.
- Strict bowel control. A bowel chart with faecal descriptions. There could be colorectal cancer. We want regular bowel actions & we're gonna give you all the bowel meds you require to get you there. (this does not work if your patient ENJOYS discussing his bowels).
- early morning urine collections (three) for TB. What time is early morning? You decide.
- Nasogastric tubes.
- Abdominal ultrasounds. They're indicated for many reasons, require patients to be nil by mouth & often the non-urgent ones get delayed, & delayed, & delayed. Especially if there's some confusion as to who is ordering the test.
- Nightly reviews by the night intern. "Sorry to wake you, just wanting to check how the bowels/rash are going... and did you see that storm in Texas?"
- If there's a higher than usual risk of DVT you might need to order q8h subcutaneous heparin rather than just the standard q12h. Certainly don't give daily enoxaparin.
- If the IV is just a little dodgy you can avoid causing the physical pain of the IV insertion while inflicting the pain that is an iMED beeping ALL NIGHT LONG.
- Barium or gastrograffin swallows and enemas.We know the Shem Rules and how to do as much nothing as possible. But some patients need you to go all out if you are to get them back in the community where they belong.
And the best of all from Kel since I would have never thought of it:
The patient was discharged home and refused so the bed was discontinued from his room.
Oh boy, that's evil. I'm so proud.