Friday, February 19, 2010
Laying on Hands
You know what medical phrase I really hate? I hate when someone, usually an ER doc, asks if I could swing by and "lay some hands" on someone. Typically, the patient comes in with a chief complaint of abdominal pain but the work-up in the ER (CT scan, ultrasound, labs) comes back completely negativo. But the patient still complains of pain, so the ER doc wants a surgeon to check the patient out before discharging home--- the classic CYA consult.
But I absolutely loath that phrase. Laying on of hands. I can't help it. Makes me sound like I'm some sort of 19th century itinerant faith healer, a modern-day Esau performing sacraments in the trauma bay.
Anyway, that's the end of this blog post. I still love you ER guys.
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I LIKE that term...but then again I Like ABBA and Gossip Girl...
I hate those ER guys too...like the one who asked me to "Standby" while he pushed 10 mg of Vecuronium/150mgPentothal to intubate some 500lb whale without a neck,sleep apnea, and Incisors that would put Bugs Bunny to Shame...Wanted to "Lay Some Hands" on that A-hole...
When I was in Med School, umm about the time Iran-Contra was big news, it was totally different...Surgery Residents would bitch at you for EXAMINING the patient first, like your 3rd year clumsy palpating and percussing was gonna screw things up for them...
There was this one snooty Internist who used that term alot..."The TRUE DIAGNOSTICIAN merely needs to LAY HANDS ON THE PATIENT!!!, to ascertain the Diagnosis..." this from a guy who never met a patient he didn't draw a CBC/PT,PTT/SMA-20(+ Magnesium!)Thyroid Functions, 24 hr Urine, etc etc
I'm always happy to go "lay hands on the patient." Then, I usually activate my X ray vision and my magic surgeon wand to make diagnoses that previous examiners, labs, and imaging could not elucidate. Happy to just "swing by" and "pop my head in" to "lay hands on the patient."
Why don't you refuse?
I enjoyed visiting your blog
I must say, as a patient, I'm particularly impressed by the palpation skills of surgeons. One time, numerous internists, ob-gyns, and even a gung-ho radiologist mooshed around my abdomen and could find no source of my pain. Then a surgeon touched me and immediately (and accurately) said, "You have a mass." I there's something very educational about touching a patient and then being the one to open up the package and actually see what's inside.
But I get what you mean about the hokey sound of "laying hands on" someone.
Actually I find that most surgeons do a better and more focussed history-taking than the ER guys do for these patients.
They still probably don't need an operation, but I can often figure out what they do need and help get them that.
So I guess I don't mind these calls, even though they are CYA for the most part.
my pet peeve is the "curbside consult".
You guys come across as a bit bitter.
I hear complaints when the consult isn't called soon enough, or isn't called at all, or called too early. . .
If your goal is to never get an inappropriate consult, people will get the message - and you won't get called for some appropriate ones.
Easy, baby. This isn't surgery vs ER doc round 12. I just don't like the phrase. Sounds hokey.
I actually like the term. For me, it is code for a thorough examination, unlike any that an emergency doc has ever seen before. :-)
For example, I might mention to a fellow resident about a consult that I've laid eyes but not hands on the patient.
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