July, 2007 Archive

July 21, 2007, 5:10 am

For the Love of Strange Medicine


Every inducement to what?

Is the nurse holding coffee pots or metal urinals?

At first glance this ad appeared to be for some mighty sturdy urinals.

In reality, those are Thermos brand coffee pots.

What was I thinking?

If it confused me, imagine how the patients must have felt!

I hope nobody confused their coffee pot with their urinal.

That would be bad.


When did hospital administrations begin dictating what physicians will or will not do in the emergency department?

I’m not talking Joint Commission requirements, I’m talking the practice of medicine.

I’ll use this fictitious story to illustrate my point.

Sorry if it seems a bit over-the-top.


When a patient arrives in the emergency department, they are evaluated by the emergency physician. This occurs every time the patient presents, even if the patient is well known to the physician.

Even if it is the seventh time the patient has presented with the same complaint in four days.

The physician examines the patient. Based on their assessment and the patient’s history, a diagnosis and plan of treatment is prescribed.


Let’s say the patient expects a certain medication in a certain amount on every visit. Say the patient arrives in the department looking like they have already received a great deal of medication.

The physician on duty believes that administering this medication to the patient would not be prudent as the patient appears to be “dependent” on the medication.

Addiction is such a strong word, don’t you agree?

However, the physician has other treatment modalities (ie, medications) available for treating the patient. Given the nature of the complaint and the treatment requested by the patient, the physician discusses his concerns regarding “dependency” with the patient and explains why the requested medication will not be provided during this particular visit. They order something other than what the patient requests.

(For the sake of our story, let’s assume that the physician is seriously concerned about administering the amount of medication the patient insists on receiving. Withholding the requested medication is not a punitive decision.)

The patient is pissed. Excuse me, I mean the patient is experiencing anger at the unwillingness of the physician to administer what they want to be given.


The patient is so angry that they take it all the way up to the head administrator of the hospital.

In person.

The administrator is concerned. Although the Admin is neither an RN nor MD, they do see an unhappy patient/client/health care recipient who feels they were treated inappropriately.

This needs to be addressed.


A meeting is called to address the patient’s issues.

The bottom line: the patient gets what they want. Every time they come in, from anyone who happens to be on duty.

This message is relayed back to the ER and the physician who did not treat the patient per the patient’s request is reprimanded.

The patient is now given exactly what they ask for every time they come in by every doctor in the department.


Given this scenario, fictitious though it may be, a few questions come to mind:

1. What happens if the physician absolutely believes that the requested treatment will be hazardous to the patient, but is required to order the treatment or risk being reprimanded?

2. If the requested treatment is ordered and the nurse administers it, are the physician and the nurse now enablers of the addiction? What if the nurse says “no”?

3. Do you, as a health care provider, ever feel like a drug dealer/pusher/enabler/codependent? How do you handle those feelings?

4.  Where is the line between true concern and being judgmental?

Which brings us back to my initial question. When did hospital adminstrators begin dictating health care decisions by medical personnel?

If it is occurring in the real world, someone forgot to send me the memo….


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July 17, 2007, 12:30 pm

The Public Library of Science

plosYou are writing a paper. You need to do some research, so you google your topic.

Ah ha! There it is! The perfect article for your paper. The abstract is right in front of you, but you must go to the actual journal for the full text.

Hmmm…you can access the full text of the article, but you must pay to do it! Anywhere from nine dollars to almost thirty dollars for twenty-four hour access.

“No way”, you say! “I have access to my university’s online library, I’ll just go there and look it up for free!”

Except the journal isn’t in the online database or it has to physically come from another library, and you happen to live two thousand miles away from your “campus”.

Reluctantly, you pay for access to the article. Or not.


What if scientific and medical literature were considered a public resource, available to use any way you chose at no cost; all you would have to do is give credit to the author and source as described in the Creative Commons Attribution License?

This is already happening. It’s called open access publishing and the Public Library of Science (PLoS) is at the forefront of this new movement. Everything published in PLoS journals is immediately available for printing, copying, distributing and hosting. In addition, the complete works are archived in a “public repository” (like PubMed) making them easy to find.

Every article is peer reviewed. Let me quote the actual FAQ page:

The articles in PLoS journals will be published only after they have undergone a rigorous and constructive peer-review process that will be managed by academic editors in collaboration with experienced professional editors.

In addition, readers can rate articles and respond to them, offering additional feedback.


PLoS Medicine - www.plosmedicine.org

The journal I watch is PLoS Medicine.

There is also a PLoS community forum entitled PLoS One . My friend and fellow blogger Bora/Coturnix of A Blog Around the Clock has been hired as an Online Community Coordinator! Yeah!!!!

You can “Stay Connected” by signing up for newsletters and journal updates.

You can help Support PLoS and Open Access by checking out these ideas.

Open access and the Public Library of Science.

What a great concept!

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10:54 am

Food For Thought at Grand Rounds


Is this a cool button, or what?

Two years of blogging and I still can’t make a button or banner!

It is a very creative touch to this week’s Grand Rounds!

Vitum Medicinus hosts the medical blog carnival this week. The entire presentation is creative, and each submission received an award.

Emergiblog is proud to announce the receipt of the “Desperatus Inclusivus” award! (Hey, when a theme is announced I take it seriously!)

It was worth it to get a caramel frappuchino photo with my link!

Congrats to VM for a great edition! May you enjoy a “Carmelatus Frappuchius” on me.

With an add-shot!


Hey! Where did all the links go?

They are down at the bottom under the posts at the moment. Just a little bit of furniture rearranging here at Emergiblog.

This is definitely a case of “Open During Remodeling”. Pardon the dust and step over the blueprints during the construction!


Monkey Girl takes on the next edition of Change of Shift at Musings of a Highly Trained Monkey.

Get those nursing posts ready and send them to MG at “ermonkeygirl at hotmail dot com” or through Blog Carnival!

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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