Thursday, November 25, 2010

That was a pleasant surprise

Mrs. Worried is one of my favorite patients. She's intelligent, polite, and very involved in her care. She's been on the same medications for years, and we don't mess with them. She's also very forthright with us when she has concerns about the medications.
She called last week about her Xanax prescription. "I know you guys had to reschedule my appointment with Dr. Warmnfuzzy for about three months out because you're so busy. And that's fine, but I've only got three or four days left on my Xanax, and I don't have any refills and I wanted to make sure Dr. Warmnfuzzy did something about that before I see her, because I don't think I can be off it for three months!"
I reassured her that I'd talk to Dr. Warmnfuzzy and get her the necessary prescription. "But she's pretty busy and it will probably be at least three or four hours before I can get this done," I warned her.
She laughed. "Honey, I've got fifteen pills left. If I go through all of them before this afternoon, I don't deserve to be on Xanax!"

Wednesday, November 24, 2010

Time to chart veeery carefully...

Because it's not like I wasn't paranoid about my personal safety before I started this job....

Tee shirts with bizarre slogans are very popular among our clients. I've seen people wearing shirts that said everything from "Can't sleep... clowns will eat me!" to "If sex is a pain in the @$$, you're doing it wrong." The thoughts expressed may not be "appropriate," but they're usually good for a few laughs and conversation starters.

But tell me what I'm supposed to say to a wild-eyed, disheveled gentleman who reeks of stale sweat, vomit and booze wearing a shirt that says "I like you--I'll kill you last!"

Monday, November 22, 2010

We have standards?

Our electronic charting system annoys me regularly, but it has one very useful feature: the "pop-up reminder." There's a lot of stuff that we need to keep track of that doesn't need to be part of the "permanent medical record:" what pharmacy patients are currently using, who their primary care practitioner is, when does their probation supervision expire, etc. The pop-up function is very handy for noting these things.
I was checking charts last week and found the following pop-up in a patient's chart: "Not allowed to contact LuAnn for any reason. Do not put through to her voice mail either!" LuAnn is one of our social workers, so this was odd. When I had time, I asked her about it.
"Yeah, he was wildly inappropriate the last time I saw him. I mean, even by my admittedly low standards, he was really inappropriate."

Friday, November 19, 2010

Pot, meet Kettle. Kettle, Pot.

I received a warning from Dr. Analytic yesterday that my writing style in my recent office correspondence was "a bit sarcastic and maybe you could watch that."
And that's a pretty good point. I'm a bit crabby by nature and while I like to blame excessively bitchy days on a lack of coffee, there's a very good chance that this may just be my personality. (Oh how I wish I had the balls to wear this shirt to work some day!)
Then I realized that Dr. Analytic's automatic e-mail signature said "putting the 'fun' in dysfunctional!"

Punctuation matters more than you think

There are days at work when I'm on top of everything. Yesterday was not one of those days. I realized this as I was reading the crisis log from the night before. The log follows the time-honored format of listing the patient, the hospital at which they were seen by the crisis department, and what problem drove them to seek crisis services.
"John Doe. Random County Hospital. Delusional, found by police intoxicated, naked and directing traffic. Indigent."
"Jane Doe. Our Lady of the Wilderness Medical Center. Suicidal cobra."
I read this and had a grand old WTF moment. Not at John's plight, mind you. If ever there were a good reason for the sheriff to take one on an unexpected trip to the ER of the local psych hospital, that would be it.
But Jane's predicament was a different story. I mean, what the heck does a suicidal cobra have to do with calling our county's crisis hot line? Is it even legal to own a cobra in this state? If it doesn't talk and doesn't have movable eyelids, how do you know the snake's emotional state?
After I got done pondering these things aloud with the crisis workers, one of them politely pointed out that the crisis log's format had changed. It now had room for the client's insurance information. Jane was suicidal. With COBRA insurance.

Tuesday, November 16, 2010

Patient Tee-Shirt of the Day

I saw a patient wearing a shirt that said "I don't listen to the voices all the time, but they have some pretty good ideas."

Wednesday, November 10, 2010

Words you don't want to see in a chart, part 2

I was doing a routine chart review last week, and I ran across this entry in one of the doctor's notes:

"Abuse history:
She says she experienced domestic violence from her first husband, but then she went out and bought herself a nice baseball bat and after that he was very good to her until the day he died."

I'm glad it worked for her, but wow.

You deserve to be treated with love, respect, and dignity. If you are experiencing domestic violence and feel you're in immediate danger, please call 911. If you just need to talk to someone, call 1-800-799-SAFE or visit the National Domestic Violence Hotline for more information.

Monday, November 8, 2010

Toys You Won't See at Sears

I received a subpoena at work last month. Because many of our clients are "involved with" law enforcement, DHS, or other legal entities, this is pretty normal. You sign it, schedule the court date on your calendar, send a copy to the risk manager, and go on with the rest of your day.

But that got me thinking: My First Subpoena! That's a toy Fisher Price will (hopefully) never put on the market.

What about My First Flesh Wound! (Complete with itemized ER bill which charges $15.00 per tablet of ibuprofen, "MRSA and You" pamphlet, and "Gun Safety Means Using Both Hands" bumper sticker.)

Or My First Jailhouse Tattoo! (Comes with a syringe, your choice of three ballpoint pen ink colors, two stencils (skull or swastika) and a voucher for a free hepatitis C test at the local laboratory.)

I shared this idea with my husband. "What about Lego's "My First Meth Lab?" They could include a couple of the SWAT team Lego men, breakaway doors, and interchangeable heads that go from normal to unhealthy to a skull for the meth users!"

Friday, November 5, 2010

Overheard at work

Secretary: "I'm sorry sir, but Sherri Socialworker is in a meeting. You can leave a voice mail if you like."
[pause, listening to client talk]
"No, you can't talk to her right now. She's in a meeting. Would you like to talk to a crisis worker instead?"
[pause, with angry voice coming out of the phone handset so lound I can hear it even ten feet away]
"I don't like you swearing at me like that, so I'm going to hang up on you now." Click.