Saturday, April 01, 2006

Soul Patrol!

If you're wondering who the original Soul Patrollers are, look no further than the official Taylor Hicks fansite, which I think is the best of its kind since Clay Aiken's.

No surprises over this weeks' elimination of Lisa Tucker. I keep hoping Bucky will get booted off, but he's always safe.

Taylor, on the other hand, is apparently leading by unbeatable margins in the votes. According to, he commands at least 30-40% of the phone-in tallies across the U.S., while Chris and Kellie alternate 2nd place with a much lower 15-20%.

Haven't followed an AI season this closely since 2003. Who wants to bet that Taylor will win this year? :)

The New Batch

Scrolled through the MOPEX list yesterday. Saw a couple of familiar names, one of whom SMS-ed me just as I came across his name, heh heh. Looking forward to meeting the next group, but my patience is wearing thin nowadays, so whoever learns the fastest and shows the highest EQ will definitely become my favourite. I could care less about the number of A's you got. Totally irrelevant where clinical acumen is concerned.

ER Issues -- Continued

It's interesting how a case of obvious acute osteomyelitis bounced back to me the other day, citing the reason that "since the patient is not keen for surgery and needs further DM control", he should be admitted to the medical unit instead.

First of all, his DM isn't controlled because he defaulted treatment. Second, acute OM ( if I remember correctly ) falls under the purview of orthopaedics, unless the guy has some other serious condition which ortho can't handle ( e.g. acute coronary syndrome, renal failure, acute stroke ).

Sometime last year, a case of a 100-year-old woman with a perforated viscus was still accepted by General Surgery, even though it was understood that management would be conservative. The surgeons never once told us to "admit to medical 'cos there's nothing else we can do".

So I informed my consultant about the ortho input, and she gave me the go-ahead to ship the patient up to the ortho ward. Checking up on his records a few days later, I found out that he consented to a ray amputation.


There's a lot of tension between A&E and other specialties, more so in certain hospitals. Sometimes, I wish all ER physicians could be granted admission rights to whichever department they choose, but with the shortage of beds and yes, significant number of unwarranted admissions ( usually by our MOs ), such an arrangement might prove disastrous.

However, the inpatient teams should also understand our own difficult situation. ERs are predominantly run by medical officers, many of whom are junior, most of whom have little training in the field of emergency medicine ( which encompasses everything from medicine to surgery to paediatrics ). Personalities range from paranoid ( admitting or asking the seniors about EVERY case they see ) to complacent ( NOT asking or admitting ) to dangerous ( missing an AMI or acute abdomen ).

Sure, they keep saying the senior ER doctors SHOULD or MUST vet all admissions, but does anyone bother to look at the big picture? We have the HIGHEST number of P1 cases in the country. The resus room is constantly packed to the brim with critically ill patients. P2 is no better -- compounded by the backlog of cases stuck in observation waiting for beds in the wards ( which still don't discharge enough and often not till after 2pm ).

So the REALLY IMPORTANT question is, if you'd like the seniors to do the best job they possibly can at gatekeeping, how many seniors are you willing to employ, 'cos the current number is far from sufficient. One professor went so far as to suggest that all ERs be run EXCLUSIVELY by emergency medicine specialists, but I propose that we still retain a realistic number of medical officers, preferably those who are more senior and basic specialty trainees.

Why did they stop rotating MOTs through A&E anyhow? It's a useful posting after all. Surgeons need to know how to manage medical conditions while internists would benefit from learning about acute abdomens and fractures, instead of just referring hundreds of blue letters all over the place.

Just being honest here. Feel free to comment.

On the upside, I had a very constructive session with a group of ENT specialists a few days ago. Our task was to draw up some guidelines for referrals in the P3 area ( consultation ) after a couple of PR problems surfaced.

I totally agree that patients have unreasonable expectations, some propagated by the referring GPs and OPS doctors, some reinforced by our own A&E MOs. The key is to follow these guidelines, consult us seniors if there's any deviation, and at all costs, DON'T MAKE ANY PROMISES!!! I've batted away quite a few nonsense referrals myself, sometimes even making lousy excuses when the subspecialty MO / Registrar is the one who's being a little unreasonable and refuses to see the patient. "Oh, the doctor upstairs is VERY busy. S/he's resuscitating or operating or whatever." -- even though I could hear him/her chomping on his/her dinner during our phone conversation.

One of the ENT guys hit the nail on the head when he said, "It goes both ways." Yes, the A&E makes boo-boo's on and off, but the other departments make their own mistakes too. Rather than turn it into a slug-fest where everyone tried to pin the tail on the donkey or whack the pinata, the various HODs need to discuss the issues in a civilized manner instead of making false accusations and bullying the A&E into doing things we know are wrong and downright stupid.

Perhaps a good way of defusing the situation would be what the ENT people did: ask the Registrars from ENT and A&E to do the troubleshooting then feedback to the HODs. Kinda like an ambassadorship of sorts. :)

Gotta Wait A Little Longer

Yes, Jamie Cullum's concert's been postponed, but as long as it doesn't clash with my overseas trip, I'm happy. Much prefer the new venue. Let's hope it sells out so we'll all have a rollicking good time. I've got 2nd row seats, woohoo!

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