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