DOCTORS’ LOUNGE
DOCTORS’ LOUNGE
I Motions product is definitely not to be found in the navigation of Benefind, the computer program that replaced Kynect’ s: rolled out in haste, it has failed Medicaid recipients over and over.
Health systems’ EMR ' s still do not talk to each other in any meaningful way: faxing and faxing and faxing and faxing and faxing ad nauseam is how we send each other records. There is no central interface. Making the patient capable of accessing his own records on demand is the best current solution to informing all who care for him of what has gone before. But when the patient is critically ill or brain-injured or delirious this plan fails, just when it is imperative to know, for instance, if they have
anaphylaxis to CT dye. I have hope that the Baptist Health version of Epic will talk to the Norton version, but no one as yet has taught us how to carry that off inside our own programs.
Paying for medical care seems to be designed to frustrate rather than enlighten us. People who have health insurance need an immersion course in Deep Learning just to pay a hospital bill. They have to wade through an Explanation of Benefits that boggles the mind, because there is absolutely no actual data on what the care received really cost( it is very difficult in an elective situation to shop around for better prices up front – but it can be done if you wait on hold for days, and keep insisting that someone who can give you a number comes to the phone). Wild mark-ups, insurance carve-outs, discounts and the simple laws of supply and demand affect every bill. Who owes what to whom, afterwards, when you have had a complex or critical illness, is a moving target of a number for months.
At the moment, I believe I am thinking a lot more Dark Thoughts than Deep Thoughts. There’ s probably an app for that.
Dr. Barry practices Internal Medicine with Norton Community Medical Associates-Barret. She is a clinical associate professor at the University of Louisville School of Medicine, Department of Medicine.
FROM THE BLOGOSPHERE
ANOTHER ABDOMINAL PAIN
Shaun Reynolds, MD
I
had a patient in her 30s who presented with one day hx of nausea / vomiting and diffuse abdominal pain- most severe in her epigastric and LUQ, radiating to her back; could not eat or drink since the pain started; history significant for R nephrectomy because her“ kidney wasn’ t working right.” Pt says that this pain feels just like the pain she had from that kidney.
Exam: VSS, afebrile. She is curled in the fetal position and yells when touched anywhere on her abdomen. The worst tenderness is in her epigastrium and LUQ. She has a large RUQ scar from her nephrectomy. No CVAT, negative murphy sign.
At this time my differential included pancreatitis vs PUD vs gastritis vs pyelonephritis.
Labs came back with lipase wnl, normal WBC, UA with a lot of epithelial cells and a few WBC. Acute abdominal series xray is wnl.
I reassess patient after dilaudid and zofran and she states nausea has resolved but still has severe epigastric / LUQ pain. On reexamination the rest of the abdomen is nontender. The amount of pain she is experiencing in her epigastrum / LUQ concerns me and it’ s not pancreatitis based on the lipase so I order a CT abd / pelvis.
The radiologist walks over to the department to tell me that the patient has appendicitis. Her appendix, which is thickened and with fat stranding, is in the mid right abdomen instead of RLQ. My assumption is that the reason her appendix is so high is from scar tissue secondary to her transabdominal nephrectomy.
I post this to remind everyone that while the RLQ is the most common place to have pain from appendicitis, the pain can be anywhere( previous abdominal surgery( in this case), retrocecal / pregnancy, etc).
Dr. Reynolds is an EM2 at University of Louisville Hospital.
MAY 2016 35