Most ridiculous question from a nurse while on call

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Doctor Bob said:
Hmm... the two times I've gone into the jungle with nothing more than the stuff we could pack in, the line for our clinic was about 400 people a day (lots of people for the eight doctor group), 50 of which were mine to see. So I guess I can only claim the fifty per day.
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Absolutely great that you do this, but you had equipment…bare hands remember.

jdh71 said:
This statement makes no sense. You're a bitter NP with a chip in his shoulder contributing nothing to the conversation in here other than your own extraneous and absurd objections to the specific content.
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Nope, not an NP yet. If I was bitter and had a chip on my shoulder, I'd have left this profession long ago. However, my mother died on the 23rd in hospice so I admit I'm not my usual "chipper" self.


If you want to have a contest of "preventing, diagnosing, alleviating, or curing disease" without any tools or meds, then I'd take that challenge any day of the week. It has nothing to do with not "checking out my oppenent", and everything to do with the fact if all we have are our 5 sense and out minds, then there is NOTHING you can do I cannot.
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I really don't think you can wrap your Western hard science mindset around what I can do. :laugh:

In any case, continue your stress release and I'll depart the thread.
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zenman said:
I really don't think you can wrap your Western hard science mindset around what I can do. :laugh:

In any case, continue your stress release and I'll depart the thread.
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If you think I can't wrap my mind around alternative medicines, you would be wrong, very, very, wrong.

In fact, it wouldn't suprise me one bit, if we looked back a 100 years from now at the western bioscientific approach in practice and were like, "What the **** were we thinking?!"

There is WAY too much conflict of interest tied up in people being chronically ill in western medicine, IMHO . . . but that would take us into the world of deep politics and high strangeness, a rabbit hold most people cannot or will not appreciate.

Peace.
 
dpmd said:
there are some people in any profession that make the rest look bad. You can laugh at those without condemning the entire specialty.
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Yep.
Sure, have a go at the idiot nurses. Whatever, good nurses don't like to work with them either. Have a go at idots--they're, well, idiotic and annoying. But when you are bashing nurses for, well, nothing that's related to their abilities (ie, 3am pages to pharmacists or doctors related to orders that need clarifying or medications not available)--what are you getting out of it, really? When someone like Zenman happens to point out that the frustration in some of these vents is actually misplaced, what's the big deal? Some people vent about things others do when they, in fact, are the ones who have the problem. Why feed this? Zenman's been completely bashed here--called a troll, and told by mods that he's interfering in a thread that's not for him. Why not just listen to what he's said? There's nothing unreasonable about his comments, nor have they been rude or insulting in anyway. People are bashing him for one reason: he's a nurse. People are bashing a nurse because he's a nurse.

That's BS.

allnurses can be pretty lame at times, but the mods protect civility above and beyond, even if it means reprimanding posters that claim to be nurses. Because at the end of the day, you don't know that these people are doctors OR nurses. They're people on the internet. They can say whatever they feel like saying. What matters is that they show a modicum of respect for other posters.

If civility is not a concern on this forum, please restrict access to others that may stumble across a thread like this. 90% of it is hilarious, but when the mods ignore people that are blatantly rude and disrespectful to ANYONE, SDN becomes toxic to the completely egalitarian online community.
 
NarcolepticRN said:
When someone like Zenman happens to point out that the frustration in some of these vents is actually misplaced, what's the big deal? Some people vent about things others do when they, in fact, are the ones who have the problem. Why feed this? Zenman's been completely bashed here--called a troll, and told by mods that he's interfering in a thread that's not for him. Why not just listen to what he's said? There's nothing unreasonable about his comments, nor have they been rude or insulting in anyway. People are bashing him for one reason: he's a nurse. People are bashing a nurse because he's a nurse.
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<sigh>

Here are some of my thoughts on this, as a moderator of this forum.

- People have not been bashing zenman because he is a nurse, from what I can tell. They are bashing him for persistently pushing his way into a discussion where, for the most part, his ramblings and rants are not welcome. I don't really care to hear about his ability to practice technology-free medicine :)confused:), whether or not he'd survive in a jungle, etc. I'm guessing that other people don't, either.

- Some of the zenman-bashing has been brought on by himself. At any point, he could have walked away from the conversation, but he didn't.

- Like Winged Scapula, I see no need to restrict access to this forum. There's no need to make all physicians look rosy, and there's no need to make all nurses look rosy, either. (Especially when we all agree that there are many nurses who can't do their job competently.)

- A problem that I persistently find with this forum is that it is the "general RESIDENCY" forum. With a name like that, you'd think it would be a place for current, past, and soon-to-be residents to discuss issues that pertain to them. Instead, in many cases, it is treated as a "bash residents" forum. Or as a "bash physicians/medicine" forum. And it is certainly not designed to be a "praise all nurses!" forum either.

Nurses are certainly welcome to come in and contribute to the conversation (I have learned a tremendous amount from posters like fab4fan and Farmer Jane :love::love: over the years!). But they are not welcome to come in and either a) bash physicians, or b) try and dictate where the conversation in a resident's forum is going to go. It's a forum that was designed to be driven by physicians; I'd like to keep it that way. Maybe allnurses runs their forums differently - I don't know, and I don't really care. They can run their forums as they see fit.

Finally, there was a good faith effort by a few residents and a nurse (again, fab4fan :love:) to bring the conversation back to where it was designed to go. However, once again, a few disruptive posters tried to sidetrack that effort and derail the thread again. If this happens one more time, I see no point in keeping the thread open, to be honest.

*********

Well, to try and bring the conversation back to silly pages, I think the worst page I ever got was one that I got at 8 AM (post-call morning). One of the nurses on the JCAHO committee was paging me to come down and decipher someone else's note on the chart. "I know you didn't actually sign the page, or even really take care of the patient, but your signature is the only one I can read. You have good handwriting, by the way."

<sigh> Gee, thanks.
 
smq123 said:
One of the nurses on the JCAHO committee was paging me to come down and decipher someone else's note on the chart. "I know you didn't actually sign the page, or even really take care of the patient, but your signature is the only one I can read.
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One more reason your signature should be illegible. ;)
 
NarcolepticRN said:
People are bashing a nurse because he's a nurse.
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Couldn't be further from the truth. People are bashing him because he comes in here saying he's better than doctors because he uses his hands and doesn't need all that fancy equipment. Yeah, we all wish we could be nurses and use our hands :laugh:

He was actually patting himself on the back a few months ago because his wife had RUQ pain and he correctly diagnosed cholecystitis. If only we were all that knowledgeable :rolleyes:

Sounds like another guy/girl who wants to play doctor but doesn't want to go through the rigorous training of medical school and residency.
 
Allnurses.com is boring I wanted to troll there bt I felt so sorry for them the place is like high school musical everybody is so happy and they all love each other no wonder they can't fit in here
 
SOLDIER said:
Allnurses.com is boring I wanted to troll there bt I felt so sorry for them the place is like high school musical everybody is so happy and they all love each other no wonder they can't fit in here
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They don't love everybody. Speaking as a lifetime banned member. :cool:
 
RN: pt's urine output is dropping. can we give him some lasix?
Me: is he short of breath or appear volume overloaded?
RN: No...but he's not peeing, i think he needs lasix
Me: well, poor urine output is not an indication for lasix...
 
Never publicly disagree with a moderator. Ever. Then never join an alternate MB made up of previously banned members. Then don't come back under another screen name...a couple times.

Really, it's the disagreeing with a moderator that gets you the lifetime ban, though. They are dead serious about that. You never publicly disagree with the mgmt., even when they are obviously wrong. EVen saying "I don't agree with that" will get you a warning.

Funny thing is, I'm still listed as an active member. They have tons of banned members that they list as active members; makes it look like they have all these members when their real numbers are far less. :laugh:
 
fab4fan said:
Never publicly disagree with a moderator. Ever. Then never join an alternate MB made up of previously banned members. Then don't come back under another screen name...a couple times.

Really, it's the disagreeing with a moderator that gets you the lifetime ban, though. They are dead serious about that. You never publicly disagree with the mgmt., even when they are obviously wrong. EVen saying "I don't agree with that" will get you a warning.

Funny thing is, I'm still listed as an active member. They have tons of banned members that they list as active members; makes it look like they have all these members when their real numbers are far less. :laugh:
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maybe they should get laid ?:laugh:
 
SOLDIER said:
Allnurses.com is boring I wanted to troll there bt I felt so sorry for them the place is like high school musical everybody is so happy and they all love each other
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No, they don't.

They really, really don't.
 
Winged Scapula said:
I only read the first few posts but the best one (so far) was "nurses stay up all night while doctors get a call room to sleep in".

Uhmmm...that doctor on call most likely has not come in at 11 pm for a "shift" and will not leave at 0700 to go home and sleep.:rolleyes:

I do dearly hope someone clarified that somewhere later in the thread.
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I've been surprised at how many people who've been working at the hospital where I am this year don't realize the length of our "shifts." I thought it was common knowledge after the work hour restrictions started. I remember seeing that on the news.

When they (RNs, HUCs, CNAs) started asking when I got to leave, and they'd say "oh, that's not too bad." I'd respond with, "well, I got here at 6AM yesterday." Some still don't comprehend that we do that q4.
 
fab4fan said:
Never publicly disagree with a moderator. Ever. Then never join an alternate MB made up of previously banned members. Then don't come back under another screen name...a couple times.

Really, it's the disagreeing with a moderator that gets you the lifetime ban, though. They are dead serious about that. You never publicly disagree with the mgmt., even when they are obviously wrong. EVen saying "I don't agree with that" will get you a warning.

Funny thing is, I'm still listed as an active member. They have tons of banned members that they list as active members; makes it look like they have all these members when their real numbers are far less. :laugh:
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I remember you fab4fan from allnurses.com I was a very regular member there under the same name that I am here (and everywhere for that matter) and I was banned for pointing out that a member who was using the term "nurse" when referring to herself wasn't a nurse. She would say "I am a nurse in everyway that counts". I PM'd her and told her to knock it off and sent her paragraph from her own BON that said you cannot legally use the term "nurse" . They know she's not a nurse yet they banned me for a lifetime because I argued with a mod.

Brian Short is short on brains, only interested in the money that his site earns for him so he can sit on his duff. He "pays" to have press releases written and published about how many members they have. I too am still listed as an active member and that's been 2 years ago! Out of all the members they supposedly have less than 0.1% have ever posted. Allnurses.com is such a farce. They want sweetness and holiness blown up every ones arse, especially the mods. I have my own nursing forum now, we all still use the same user names that we did on allnurses.com
It really bugs the crap out of Brian. He told me not to start my own forum because no one ever succeeds. Just save your money. I told him I will succeed, and I have and I told him I don't get even, I win and his crappy site is falling apart. It's all people looking for free advise and wanting to be a nurse. We lovingly refer to them as allnazi's!
 
Winged Scapula said:
I only read the first few posts but the best one (so far) was "nurses stay up all night while doctors get a call room to sleep in".

Uhmmm...that doctor on call most likely has not come in at 11 pm for a "shift" and will not leave at 0700 to go home and sleep.:rolleyes:

I do dearly hope someone clarified that somewhere later in the thread.
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:laugh:

I love when they come in for their night shift at 8PM and complain about how tired they are by 10pm.

It's also amusing that they talk all this smack about how doctors don't listen to their advice on how to manage a patient. Of course when the **** hits the fan, it's the doctors' who get named in the lawsuit. It's gotta be nice playing monday morning quarterback.

The other entertaining post was the nurse who was complaining how busy she was because she had 5 patients and didn't have time to do the busywork ordered by the physician.
 
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I watch nurses switch swifts 3times a day
I agree they work hard I mean we all do
There will always be those doctors disrespect nurses and nurses disrespect doctors
But as I was reading that post even the site mods was attacking doctors
I really think those nurses should look up the history of nursing
In south africa a nurse will never question us I really don't know what is happening in america
 
I would not believe anything I read on allnurses.com. That site is such a "farce" mostly made up of wannabee nurses, medical assistants that "think" they are nurses, and mods who "don't" work as nurses and are all on a power trip, sitting anxiously with their fingers on the ban button. With that said.....

I've been a nurse for 34 years and I've seen a huge difference in the relationship between doctors and nurses. When I first began, whenever a doctor would enter the nurses station if one of us was sitting there charting you best get your butt up and offer your chair to the doctor.

The doctor would announce when he was ready to see his patients and the charge nurse, then known as the head nurse, would walk behind the doctor down the hall carrying his charts. Don't remember any female docs back then. We were literally scared of the doctors.

In recent years, we chat as friends, we discuss patients, we ask for advice and they likewise ask us for advice about patients.

In the first 15 years of my practice we charted everything by hand, we had very few meds to pass, very few IV's, we had time to actually talk to the patient and give good bedside care.

Between 1999 and 2005 I worked days on a med/surg floor. I would have 4-5 patients. Of course with discharges and admissions it could be as many as 10 patients once the shift was over. I could end up with 5 totally different patients as I had started out with. But 5 at a time was the max. IMHO 5 is too much. 12 hours and it was all I could do to get everything done. I am very well organized and was always the one chosen to precept because of my organizing skills. I was rarely late clocking out when other nurses were always an hour or so late charting. I never got more than 10 minutes for lunch because my pager was always going off. I never got a 15 minute break. The patients over the years have, as a vast majority, become unthankful and look at the nurse as their personal servant. The family members have become increasinly demanding and agressive. The family members are the one who made me give it up after 30 yrs of working on the floors. I have no issues with doctors. There are a few who think they are so great and so wonderful but I just kinda listen to them, say Thank You, and go along my way.

It's wonderful to be able to be able to comfortably speak with the doctors. I wouldn't go back to the way it was for anything.

I now mainly deal with Interventional Radiologists and barr one I like them all and we are respectful of each others jobs.
 
J. The other entertaining post was the nurse who was complaining how busy she was because she had 5 patients and didn't have time to do the busywork ordered by the physician.[/QUOTE said:
You do realize that their 5 patients is a lot different than if we had 5 patients. They're with the patient a heck of a time more than we are. It's possible she was very busy.
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doctorhouse said:
You do realize that their 5 patients is a lot different than if we had 5 patients. They're with the patient a heck of a time more than we are. It's possible she was very busy.
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That's great. Second year residents carry 20 patients, and some attendings are responsible for 40+ possibly spread across different hospitals. When something goes wrong with one of those forty patients, the doctor gets sued, not the nurse. Sorry, I don't have any sympathy. We're all busy.
 
J1515 said:
That's great. Second year residents carry 20 patients, and some attendings are responsible for 40+ possibly spread across different hospitals. When something goes wrong with one of those forty patients, the doctor gets sued, not the nurse. Sorry, I don't have any sympathy. We're all busy.
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Thats what I'm thinking. As an intern, you're on for 30 hours and have to know EVERYTHING about 10-12 patients who can be on 12 different floors, and possibly be required to know something about every other patient on the entire service.

Being "with" the patient doesn't mean much. A critical care nurse is with their one patient all the time. Theyre busy for the whole shift, but its one patient.

We're all busy, and you'll never "get it" unless you're in the other persons shoes.
 
DutchgirlRN said:
It's wonderful to be able to be able to comfortably speak with the doctors. I wouldn't go back to the way it was for anything.
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+1.

Most of the people who long for the "good ol' days" weren't even around back then.
 
Blue Dog said:
+1.

Most of the people who long for the "good ol' days" weren't even around back then.
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I still have my starched cap, thankyouverymuch. :cool:

I don't want to go back to the days of being Stepin Fetchit. But I'm not really fond of the direction things are going in lately, particularly with doctors who aren't really doctors and the over-emphasis on "customer satisfaction" instead of quality of care. We spend too much time playing concierge when we could be taking care of patients.
 
fab4fan said:
I'm not really fond of the direction things are going in lately, particularly with doctors who aren't really doctors and the over-emphasis on "customer satisfaction" instead of quality of care. We spend too much time playing concierge when we could be taking care of patients.
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Agreed.

Patients aren't "customers."

People who are in the business of serving customers give them what they want.

Healthcare is about giving people what they need.
 
fab4fan said:
We spend too much time playing concierge when we could be taking care of patients.
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I could not agree more.

And I definitely think it's easy for us docs to think that wow they only have three patients, I wish I only had three patients... except it takes us 5 minutes to figure out and write the order for IV medications, except it takes 20 minutes for the nurse to get it from the pharmacy, verify it, prime it into the pump, and start it running, and then do it q4,q6,q-whatever... I agree completely with the person that said you need to walk in the person's shoes to completely understand the type of busy that each different job goes through...
 
fab4fan said:
I still have my starched cap, thankyouverymuch. :cool:

I don't want to go back to the days of being Stepin Fetchit. But I'm not really fond of the direction things are going in lately, particularly with doctors who aren't really doctors and the over-emphasis on "customer satisfaction" instead of quality of care. We spend too much time playing concierge when we could be taking care of patients.
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Speaking of customer satisfaction, I read some nursing notes from new RN grads, and they refer to patients as clients. My mom did a nursing refresher course, and said that's what the people are supposed to be called, but she didn't agree with it.
 
Ashers said:
Speaking of customer satisfaction, I read some nursing notes from new RN grads, and they refer to patients as clients. My mom did a nursing refresher course, and said that's what the people are supposed to be called, but she didn't agree with it.
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*****s. The young can be so easily led. Tell your Mom to fight the good fight.

The only people with clients are hookers and attorneys. Since I fall into neither category, I take care of patients. If someone gets that overwrought about being called a "patient," in my book that person really isn't all that sick and probably doesn't need to be in the hospital, then.
 
J1515 said:
Couldn't be further from the truth. People are bashing him because he comes in here saying he's better than doctors because he uses his hands and doesn't need all that fancy equipment. Yeah, we all wish we could be nurses and use our hands :laugh:

He was actually patting himself on the back a few months ago because his wife had RUQ pain and he correctly diagnosed cholecystitis. If only we were all that knowledgeable :rolleyes:

Sounds like another guy/girl who wants to play doctor but doesn't want to go through the rigorous training of medical school and residency.
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Now, now, let's keep it honest. Remember I diagnosed my wife AFTER the ER doc said she had Viral Gastroenteritis. I knew better and got her in to see an IM doc who happened to be smarter. There was no need for me to pat myself on the back as this was too easy...I learn from my experiences. I once helped a cardiologist very early one morning wheel a patient up to the cath lab. Turned out his vessels were clean as a whistle and he was having a GB attack. I can understand the cardiologist as this was his focus, but what was the ER doc thinking? I understand s**t happens, but I try to learn from it.

You're correct... "If only we were all that knowledgeable."
 
zenman said:
Now, now, let's keep it honest. Remember I diagnosed my wife AFTER the ER doc said she had Viral Gastroenteritis.
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With all due respect, that makes the ER doctor a *****, not you a doctor.


zenman said:
I once helped a cardiologist very early one morning wheel a patient up to the cath lab. Turned out his vessels were clean as a whistle and he was having a GB attack. I can understand the cardiologist as this was his focus, but what was the ER doc thinking? I understand s**t happens, but I try to learn from it.
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The ER doc was most likely doing the right thing and this is exactly why nurses and NPs are not physicians. Maybe the pt had nonspecific changes on EKG? maybe the pt had elevated cardiac enzymes? Personal or family hx of heart disease? Risk factors for heart disease? Or maybe in the past the ER doc made the exact mistake you would have and missed an atypical MI in a patient with RUQ pain. Patients can present with atypical symptoms of an MI, especially the very old, very female, and very diabetic. If only you knew how many are misdiagnosed as having biliary colic, indigestion, gastroenteritis, pancreatitis, GERD. Thank god most doctors (especially the EM guys) are experienced enough to know this and catch it.
 
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zenman said:
Now, now, let's keep it honest. Remember I diagnosed my wife AFTER the ER doc said she had Viral Gastroenteritis. I knew better and got her in to see an IM doc who happened to be smarter. There was no need for me to pat myself on the back as this was too easy...I learn from my experiences. I once helped a cardiologist very early one morning wheel a patient up to the cath lab. Turned out his vessels were clean as a whistle and he was having a GB attack. I can understand the cardiologist as this was his focus, but what was the ER doc thinking? I understand s**t happens, but I try to learn from it.

You're correct... "If only we were all that knowledgeable."
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Where did u get that experience to make that diagnoses? From working with doctors right?
will u just get over your self just go to allnurses.com maybe u will be a medical hero there KID and yes I am calling u kid because of your mental age
 
DutchgirlRN said:
I would not believe anything I read on allnurses.com. That site is such a "farce" mostly made up of wannabee nurses, medical assistants that "think" they are nurses, and mods who "don't" work as nurses and are all on a power trip, sitting anxiously with their fingers on the ban button. With that said.....

I've been a nurse for 34 years and I've seen a huge difference in the relationship between doctors and nurses. When I first began, whenever a doctor would enter the nurses station if one of us was sitting there charting you best get your butt up and offer your chair to the doctor.

The doctor would announce when he was ready to see his patients and the charge nurse, then known as the head nurse, would walk behind the doctor down the hall carrying his charts. Don't remember any female docs back then. We were literally scared of the doctors.

In recent years, we chat as friends, we discuss patients, we ask for advice and they likewise ask us for advice about patients.

In the first 15 years of my practice we charted everything by hand, we had very few meds to pass, very few IV's, we had time to actually talk to the patient and give good bedside care.

Between 1999 and 2005 I worked days on a med/surg floor. I would have 4-5 patients. Of course with discharges and admissions it could be as many as 10 patients once the shift was over. I could end up with 5 totally different patients as I had started out with. But 5 at a time was the max. IMHO 5 is too much. 12 hours and it was all I could do to get everything done. I am very well organized and was always the one chosen to precept because of my organizing skills. I was rarely late clocking out when other nurses were always an hour or so late charting. I never got more than 10 minutes for lunch because my pager was always going off. I never got a 15 minute break. The patients over the years have, as a vast majority, become unthankful and look at the nurse as their personal servant. The family members have become increasinly demanding and agressive. The family members are the one who made me give it up after 30 yrs of working on the floors. I have no issues with doctors. There are a few who think they are so great and so wonderful but I just kinda listen to them, say Thank You, and go along my way.

It's wonderful to be able to be able to comfortably speak with the doctors. I wouldn't go back to the way it was for anything.

I now mainly deal with Interventional Radiologists and barr one I like them all and we are respectful of each others jobs.
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Its mostly low class patients that disrepect nurses
 
J1515 said:
With all due respect, that makes the ER doctor a *****, not you a doctor.
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Then with all due respect, include what I really posted, and quit trying to read the craziest damn things into someone's posts.
 
SOLDIER said:
Where did u get that experience to make that diagnoses? From working with doctors right?
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Yes, partly from doctors, especially as an orderly where I worked with a small town general surgeon who taught me a lot. If you ever want to know about that experience or his name is just ask. He might still be alive and you can contact him. Don't be pissed because I'm a voracious learner.


will u just get over your self just go to allnurses.com maybe u will be a medical hero there KID and yes I am calling u kid because of your mental age
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Are you just pissed because I've got the guts to call you out? I was a real soldier (81 mm mortars and then corpsman) and volunteered during Vietnam (1970). I was in boot camp three days after high school and was pissed at my parents because they wouldn't let me go earlier. Being a medical hero was never on my wish list; being a real soldier was. So don't tell me where to go.
 
Blue Dog said:
:laugh:
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fab4fan said:
*****s. The young can be so easily led. Tell your Mom to fight the good fight.

The only people with clients are hookers and attorneys. Since I fall into neither category, I take care of patients. If someone gets that overwrought about being called a "patient," in my book that person really isn't all that sick and probably doesn't need to be in the hospital, then.
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take a look at this forum:laugh:
http://forums.studentdoctor.net/showthread.php?t=689264
 
zenman said:
Yes, partly from doctors, especially as an orderly where I worked with a small town general surgeon who taught me a lot. If you ever want to know about that experience or his name is just ask. He might still be alive and you can contact him. Don't be pissed because I'm a voracious learner.




Are you just pissed because I've got the guts to call you out? I was a real soldier (81 mm mortars and then corpsman) and volunteered during Vietnam (1970). I was in boot camp three days after high school and was pissed at my parents because they wouldn't let me go earlier. Being a medical hero was never on my wish list; being a real soldier was. So don't tell me where to go.
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I won't call it guts to call someone out on the internet

SOLDIER is just a nick name but I was in the south african military
So please think before u speak
 
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All right.

This constant back-and-forthing between SOLDIER, zenman, and jdh is getting very irritating. Like I said before, TAKE IT TO PMs. If you don't, and insist on continuing this here, I will have to close the thread.

For those of you just joining us, yes, I'm speaking as a moderator for this forum.
 
J1515 said:
With all due respect, that makes the ER doctor a *****, not you a doctor.




The ER doc was most likely doing the right thing and this is exactly why nurses and NPs are not physicians. Maybe the pt had nonspecific changes on EKG? maybe the pt had elevated cardiac enzymes? Personal or family hx of heart disease? Risk factors for heart disease? Or maybe in the past the ER doc made the exact mistake you would have and missed an atypical MI in a patient with RUQ pain. Patients can present with atypical symptoms of an MI, especially the very old, very female, and very diabetic. If only you knew how many are misdiagnosed as having biliary colic, indigestion, gastroenteritis, pancreatitis, GERD. Thank god most doctors (especially the EM guys) are experienced enough to know this and catch it.
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Exactly. Gall bladder pathology not only mimics cardiac symptomatology, but apparently can cause A-fib.

It is the JOB of a physician to look for and exclude all the other associated conditions.

NPs are meant to look for and treat the COMMON things, the bread-and-butter conditions, with the COMMONLY accepted FIRST LINE treatment. That's the need they are supposed to fill, thats what the legislation to certify NPs was trying to provide to Americans. Because NPs treat COMMON conditions with COMMON therapy, they are COMMONLY correct. So a large part of the US, and urban fast-tracks and clinics have adequate care.

The job of the physician is to think of, investigate, exclude and/or treat all of the uncommon zebras and associations, and to know what the 3rd and 4th line therapy is.

This discussion is silly. We all know what we do. We all know that there or good and bad MDs and RNs.

Zenman, we all have experinces which have made us better clinicians. We are ALL voracious learners. We ALL have some old timer doc who taught us something extra. We have ALL been involved in clinical cases which stumped and surprised us - made us stop and think. Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water.

If anything, the mysteries and surprises of medicine have taught us something about humility. Humility in how much we think we know, and in what we are capable of doing. The humility comes so naturally to us that a lack of it destabilizes the way we think and write about the profession itself. Those who know, dont tell. Those who tell, dont know.

Take the Buddhist approach and silently think about what I wrote in blue, and DO NOT respond to it.
 
Getting back on subject...


1 am ..
Me: Hi, this is the float intern, I was paged
Nurse: Dr! Pt x is complaining of pain!
Me: Ok what does he have for pain medication?
Nurse: Morphine 4mg IV q4, got it at 11pm
Me: Ok (looking at chart) this says he has Vicodin too, when did he last get it?
Nurse: 12 am 2 days ago
Me: What ? Why haven't you given him his Vicodin?
Nurse: Because he just got morphine!
Me: Uhh but you called me because the pt c/o pain?
Nurse: yes
Me: so... why didn't you give him his Vicodin?
Nurse: Because he just had morphine
Me: Ok, give him his Vicodin, he has it PRN so that you don't have to page everytime he's in pain.
 
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