Archive for August, 2009

Laws of Dinosaurs…

Posted on August 27, 2009. Filed under: Benign, Elsewhere in the blogisphere |

When I am being good and reading medical blogs rather than wasting time playing Facebook games, I check in on Musings of a Dinosaur, she was recently reflecting back over her “Laws of dinosaur”. It’s in her right hand column and worth checking out…  This inspired me to try writing my own laws of clinical practice for Primary Care Nurse Practitioners…

Here goes….

Law One: They say common diagnosis are common but you can bet your arse, you get the uncommon one when you are running late.

Law Two: Always assume that the last clinician to see your patient was incompetent and therefore start from scratch with your history taking and assessment.  Especially if the last clinician to see them was you!

Law Three: Remember all your patients are going to die, just make sure it isn’t today and it isn’t your fault!

Law Four (a): Always follow your instincts. If your sixth sense is telling you to get a coffee…get a coffee! (or do an ECG or whatever…but always get a coffee).

Law Four (b- subsection 1): Always trust you first impressions, you are not being prejudice but trusting your senses.

Law Four (b – subsection 2): Believe your nose, rather that an alcoholic in denial.

Law Five: Finding the diagnosis of a patient is not as important as finding out their agenda.

Law Sicks (a): Patients obviously think that you don’t know what a cough sounds like until they have demonstrated it.

Law Sicks (b): A limping patient can walk away from the surgery without a limp.

Law Seven: Unravelling the confusion behind a simple statement, is as difficult as unravelling a simple statement from behind the confusion, because too much information when you need less is as distracting as too little when you need more.

Law Seven (revised): Keep it simple but insure you understand all the facts.

Law Eight: Advising patients not to believe what they have found out on the internet, and then printing off an information leaflet from a web page may appear slightly hypocritical.

Law Nine: Always assume your patient is a specialist consultant professor in whatever you are assessing them for, but also assume they no nothing about what you are telling them about, and then try not to patronise them.

Law Ten: The most important things to know is what you don’t know (AKA know your limitations).

These are not to replace the Dinosaurs laws which I think are fabulous,  especially “there is no cure for stupid” and “poor planning on your part does not constitute an emergency on my part”, but merely my shallow attempt to add to them. Please add your own in the comments box!

Strange fact for the day…despite it’s unpleasant nature, in someones notes I just wrote “Penis erythemous” and it felt strangely poetic.

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He’s with us, not US!!!

Posted on August 19, 2009. Filed under: Apply topically |

Now before I crack into this little post, I would clearly like to clarify something… I am actually quite keen on Americans. I mean I’d have to say that because a fair chunk of my readers are from “across the pond” and some of my favourite bloggers are Americans, but despite the stereotype I like them! 

Anyhow…the reason I’m heading down this road is that the debate about the American health care system, seems to have turned into a bit of NHS bashing exercise.  This is partly due to a British Conservative politician going on American TV and having a moan about the NHS.  I was going to ignore it…I’m not too interested in blogging on politics really and try to keep the blog more for light relief on a rare coffee break.  However I found amusement in the ongoing debate following an editorial from the “Investor’s Business Daily”  which stated: 

“People such as scientist Stephen Hawking wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.”

Stephen Hawking awarded Presidential Medal of Freedom by Barack Obama

Stephen Hawkin as I am sure you know has an American accent via a computerised voice-box.  He is however a BRITISH physicist and after being used as an example against the NHS he stated:

“I wouldn’t be here today if it were not for the NHS,” and pointed out: “I have received a large amount of high-quality treatment without which I would not have survived.”

Not only does this make the editorial team at the “Investor’s Business Daily” look like a bunch of idiots, it also does nothing to quash the American stereotype of being slightly insular…It’s a stereotype and not my opinion, although having a “World Series” for a sport that most of the world has no interest in also seems to be a bit of a bummer!

Next you’ll be telling me you though that grumpy Doctor House was American….oh please!!!

“House old boy…is that you?”

I digress! People complain about the NHS it’s true, but people complain about health care from any provider.  I have worked within the NHS and been on the receiving end of NHS care at a life and death level on two occasions, and I love it (I love the NHS that is, not particular in love with life and death situations themselves).  Sure it’s not perfect, but as the biggest employer in the country there is always going to be a few imperfections, maybe even in some cases a bit of a postcode lottery, but apart from a few variations the NHS provides a good standard of care for everyone, regardless of your financial package and insurance policies.

Whether or not Obama is going to win this battle, or even whether it is the right thing for America, well I have no idea. Either way it’s a big country and I’m sure they are big enough to look after themselves without having a go at the NHS and without the unnecessary opinions of our politicians.  Here endeth the sermon…

Just one more thing…my mate is raising money for Cancer Research, by swimming in the fricking cold September waters.  She is a bit of a contributer on this blog and could do with some support, so if you want to donate a few quid to a good cause and a friend of mine…then click here… Donating isn’t means tested and won’t effect your long term health care…(although it might mean Rachel gets Pneumonia and needs NHS treatment!)  Ta!

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The less romantic regulars.

Posted on August 13, 2009. Filed under: Benign |

Back in June Kim posted a rather poetic account of a shift in the ER where lots of her regulars turned up at once, bit of a “four weddings and a funeral” post, well more of a “one recovering drug addict, a few births, one wedding and a funeral”.  I posted a comment and then felt the need to go on… so to save her comment box space, I’ve poached her topic…(mine will be less romantic no doubt…)

Less romantic regulars!!

Both in my past life as an Emergency Department nurse and in my present Nurse Practitioner life I’ve had “regulars”.

It’s expected in Primary care, after all they lack much option but to come back and see you, but some do more than others. Obviously the mums with lots of children come a lot and it’s lovely to get to know them. You get to see the kids grow up and then finally issue the kids with contraceptives, which they forget to use and you get to watch their kids grow up…I’ve not been here quite long enough for that part yet.

I have some regulars who will only see me.  We all have them.  But sometimes it’s a bit of a heart-sink.  I sometimes have the urge to say: “Well your depression is quite bad, and seems to be induced due to problems with family members/partners/work, so perhaps you’d be better moving to a new area…starting afresh and somewhere preferably outside our catchment area…bye!”  I of course refrain.

Mostly it is a nice bond that forms though. 

One for the girls!! A nice Bond?  I prefer a nice blonde!

For Emergency departments it is a different issue all together. The regulars there are typically social drop outs, addicts and of course just the damn right clumsy.

Years after leaving the Emergency department a few characters remain in my subconscious, one of which I expect is no longer around.

One such example was a young chap, who every weekend (twice or three times some weekends), would be bought in by ambulance after a concerned member of the public rang for help having found him bleeding and unconscious in the street.  He was a mess, so drunk that he couldn’t remember how he cut his head open (again), it may have been a drunken brawl or perhaps just an alcohol and gravity induced kiss with concrete.  He would swear, dribble and invariable smelt of urine. 

Now if you didn’t know him you would probably stitch him up and turn him out, but if you did know him you knew that he would be returned in 30 minutes by another concerned member of the public. So we’d lay him in a corner to sleep and then very nicely presented him with a cup of coffee and some toast before the next shift came on…by which time he had sobered adequately into a nice professional sounding gentleman, who apologised in case he’d caused any problems and said “See you!” (which of course we knew we would) A real case of Jekyll and Hyde alcoholic!

Then there was our elderly “gentleman”, who would come in under similar circumstances; nissed as a pewt and shout abuse at everyone who would pay attention to him…quite a vile chap. We knew the best thing to do was leave him alone until he was sober enough to storm out. You knew when he was in the department as patients relatives would come up to you in a worried frenzy: “Urrmm, nurse, nurse, that man’s trying to hang himself on the cord in his room”. It seemed harsh, but we used to reply:

“Thanks, but don’t worry about him.  He normally does that.”

Obviously if you are going to hang yourself you do it somewhere where you won’t get attention and certainly not on a nurse call cord!  We always left him to it and never did he so much as pull the cord hard enough to ring for a nurse, let alone hang himself!

Then there was the poison dwarf…

She regularly tried to do self harm…but not simple wrist cutting…oh no, she would do the bizarre and scary. She ate things…then have to be admitted for surgery. Then she would open her surgical abdo wounds and insert spoons etcetera!  On one occasion she came in with an entourage of men in uniform (Paramedics and Police), spraying blood from her mouth as she was chewing on several razor blades.  She wouldn’t spit them out, and nobody would put their hand into her mouth to retrieve them for fear of loosing a finger to a bite or a razor blade.

Ahhhh, yes, the Emergency department regulars…how I miss them?!

Now I’m just going to eat the Kit Kat one of my Primary Care regulars bought me…ahhh!

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Not scared enough??

Posted on August 6, 2009. Filed under: Apply topically, Benign |

Bored with swine flu?  Increased war zone fatalities not decreasing population adequately?  Need something new to worry about?  Why worry about new killer bugs when you can worry about good old fashioned BLACK DEATH!?!!

AH YES…The scare mongery media have got bored….(although I think if the government were in trouble about something, this would have more attention…)

The BBC reports a second death from pneumonic plague….DOOOOOOOOOOOOOM!!!!! The report states that “…it is caused by the same bacteria that occur in bubonic plague – the Black Death that killed an estimated 25 million people in Europe during the Middle Ages”. 

(link for those out of the loop)

OMG…..what shall we do?? How about a nice digestive and a cup of camimile tea…. and look at the facts…

People infected with the plague usually experience flu-like symptoms, including fever and nausea, after an incubation period of three to seven days. If treated early with antibiotics, plague is curable….. oh my god it’s curable….oh how dull….

OK lets work harder….everyone is bored with invisible bacteria…lets go for a more visible threat…how about “Ladybird flu”? It’s a killer cross between a bird flu (avian flu) and the variant of the worst flu known to man….yes….Man flu!  It is transmitted by “killer” ladybirds.

ladybird-ireland-image-picture-phot.jpg image by gardenplansirelandArrrg!! Scary!!!

Symptoms of Ladybird flu are….urm….fever, and your skin turns red (probably due to the fever) and then you develop black spots…  oh crud, someones already got those symptoms for diagnostic purposes…

Damn you Rocky Mountain spotted fever and of course Anthrax…

OK, so the new symptoms are that after you developed the red skin and black spots, you get severe back ache and then your back splits open and wings emerge from your back…and start repeating tongue twisters.Flew or Flu?

A flea and a fly flew up in a flue.
Said the flea, “Let us fly!”
Said the fly, “Let us flee!”
So they flew through a flaw in the flue….hmmm, not sure anyone is going to buy this one….

Lets just find another historic disease and spin it for the media… don’t want the public to start feeling they might be healthy again…lets say…hmmm Smallpox….actually no lets not, that is actually quite fricking scary!

How about….”Highly contagious weeping sores rife amongst children and can be spread to adults and across species“…  Good…. Lets add a bit of science….”caused by staphylococcus bacterium“…. oh yeah sounds good.   OK, OK, it’s just impetigo and the death rate is close to non existent….and easily treated with antibiotics….not so good…..

We need something not treatable with antibiotics to get the media really interested and scare the general populous…. I know the media will love this one….

How about….

“Disease which may quickly spread around the whole population” that is “Untreatable with antibiotics”, that “Guidelines state that treatment is not recommended”…. Warts or verruca’s not really that scary sounding though…

How about a sexually transmitted parasite that increases in size inside your abdomen and then pushes it’s way out through sexual organs and spends then next few decades causing havoc and costing tax payers thousands of pounds? Yeah, pregnancy…not that scary really (well pretty terrifying, but people are aware…)

Why am I wasting my time trying to think of something to scare everyone? I’ll just wait a week or so, the media will think up some health scare to sell papers or the politicians will have something to hide so they’ll distract us.

Before I close, I must draw thy attention to my blog mum…she has just celebrated her 4th blogiversary and produced a cracking addition for Grand Rounds.  Keep up the good work Kim!!

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