Gear Grinding 8: I Got A Lot Of Problems With You People!

[Deutsche Gopher Fan]

Why is the stupid thing played before sports at all?

Would somebody please show some real balls and stop playing it? Cold War's over; we don't have to demonstrate our loyalty publicly like well-trained seals.

This.

[SJHovey]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

That’s how it works nowadays it seems. My last urgent care visit had one. I didn’t care.

My trachea has a slight "offset" to it, something that's never caused me any problems but was discovered quite by accident once when I was down at the Mayo Clinic in Rochester, MN. Apparently it's something that you can feel by pressing on my throat in the right location, and my doctor's eyes positively lit up when she discovered it. She asked me if I would mind if she showed it to some medical students and let them feel my throat. It's something they want to teach students to look for, but is apparently somewhat rare. I had no objection, but the next thing I knew I had about 20 medical students lined up in my room, all feeling the side of my throat and then "aahing" in appreciation.

It was actually kind of funny. I offered my "services" for a fee to be agreed upon to stop by periodically for future classes, but was sadly turned down.

[Deutsche Gopher Fan]

My trachea has a slight "offset" to it, something that's never caused me any problems but was discovered quite by accident once when I was down at the Mayo Clinic in Rochester, MN. Apparently it's something that you can feel by pressing on my throat in the right location, and my doctor's eyes positively lit up when she discovered it. She asked me if I would mind if she showed it to some medical students and let them feel my throat. It's something they want to teach students to look for, but is apparently somewhat rare. I had no objection, but the next thing I knew I had about 20 medical students lined up in my room, all feeling the side of my throat and then "aahing" in appreciation.

It was actually kind of funny. I offered my "services" for a fee to be agreed upon to stop by periodically for future classes, but was sadly turned down.

See i think that's a great example- id fully allow students in for something like that when the doc asked

[joecct]

Why is the stupid thing played before sports at all?

Would somebody please show some real balls and stop playing it? Cold War's over; we don't have to demonstrate our loyalty publicly like well-trained seals.

They don't play it in Europe unless it's a national team match.

[Kepler]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

They don't play it in Europe unless it's a national team match.

They probably do in Eastern Europe. They have the same dick size issues as the South.

[joecct]

They probably do in Eastern Europe. They have the same dick size issues as the South.

I believe in the Land of Vlad, they play the Anthem before every KHL game.

[CLS]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Why is the stupid thing played before sports at all?

Because in our society, it demonstrates that sports events are so much more important than events at which it’s not played, like the State of the Union Address, the convening of Congress, and most governmental functions.

Would somebody please show some real balls and stop playing it? Cold War's over; we don't have to demonstrate our loyalty publicly like well-trained seals.

What would they get out of it? The folks who agree with omitting it would either *not notice or would say something like, “I can’t see why it was ever there in the first place,” and be on their way. The folks who are offended would use it as a rallying cry to boycott the league and/or to elect a psychopath as POTUS.

*I wonder how many people have noticed that frequently the playing of the National Anthem is timed so that it’s played BEFORE the beginning of the TV broadcast so that it doesn’t cut into broadcast time. Probably not many, because if it is played during the broadcast, most folks are taking a pizz or grabbing a beer.

[aparch]

*I wonder how many people have noticed that frequently the playing of the National Anthem is timed so that it’s played BEFORE the beginning of the TV broadcast so that it doesn’t cut into broadcast time. Probably not many, because if it is played during the broadcast, most folks are taking a pizz or grabbing a beer.

Yep, exactly. For say a 7:10 game start when the anthem would be sung within the 10 minutes the broadcast is on TV, TV and Radio producers will routinely "Bury the Anthem" with advertisement time. A great spot to get your last two minutes of advertising in just before puck drop/tip-off/first pitch.

[leswp1]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Don't have an authoritative answer in any case, but do you mean the judicial doctrine of doctor-patient privelege, the medical ethics doctrine of doctor-patient confidentiality, or the legal definition under HIPAA?

As far as some "third parties" go, I've encountered some nurses, physician assistants, and nurse-practitioners that I felt more comfortable with than the doctor. And I've frequently found that interns are more willing to give more informative answers to questions than the doctor. The doctor might answer "That's nothing to worry about" while the intern might say "You shouldn't worry about that because _____."

On the other hand, my wife had what she was told was an excellent cardiologist. Problem was, my wife never go to see her! It was always a nurse-practitioner, even after a rather significant diagnostic procedure. When my wife asked if she could see Dr. _____, she was told "The appointment has to be within a week of the procedure. Dr. ____ is on vacation." The first statement may or may not have been true. The second statement was a flat-out lie.

Anyone directly on the team to care for the pt can communicate. I am an NP. If I referred pt X to the Cardiologist then I communicate with them, they communicate with me. If the person also has a nephrologist and there is something significant we are supposed to communicate with them too.

As far as the NP seeing the pt- if the NP has been seeing the pt all along then it is actually better for the NP to be seeing them than the Cardiologist who may have done the actual procedure but hasn't seen the pt before then. I would much rather have the continuity than a guy who doesn't know all the nuances of the case but different letters after his name. It is not, however, OK for them to lie. That is bad medicine. I had people who never saw the Doc in 28 yrs until I retired. They didn't need to. Anything I needed the Doc for I would consult. That said, there were some people that insisted on the MD even tho I could provide equivalent care. No problem- see you later. No room on my schedule to begin with so that slot could go to someone else. Many of them came back. The protocol is NP is OK. IF they are not sure then consult MD. If that plan doesn't work either refer to MD or have them step into the room to give a consult. SOme practices alternate so if the Doc needs to see the pt they know each other. My Doc never wanted to do that so there were people who never saw her

[Slap Shot]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

My trachea has a slight "offset" to it, something that's never caused me any problems but was discovered quite by accident once when I was down at the Mayo Clinic in Rochester, MN. Apparently it's something that you can feel by pressing on my throat in the right location, and my doctor's eyes positively lit up when she discovered it. She asked me if I would mind if she showed it to some medical students and let them feel my throat. It's something they want to teach students to look for, but is apparently somewhat rare. I had no objection, but the next thing I knew I had about 20 medical students lined up in my room, all feeling the side of my throat and then "aahing" in appreciation.

It was actually kind of funny. I offered my "services" for a fee to be agreed upon to stop by periodically for future classes, but was sadly turned down.

I received a similar reaction when I posed for an art class in college.

[Handyman]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

I would have thought that was science class since they were using microscopes

[MinnesotaNorthStar]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

I received a similar reaction when I posed for an art class in college.

Which was weird, because they were drawing landscapes that day....

[CLS]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

...
As far as the NP seeing the pt- if the NP has been seeing the pt all along then it is actually better for the NP to be seeing them than the Cardiologist who may have done the actual procedure but hasn't seen the pt before then. I would much rather have the continuity than a guy who doesn't know all the nuances of the case but different letters after his name.

Mild disagreement with this statement, unless you substitute “may be better” or even “is usually/often better” for the absolute “is actually better.” Continuity and familiarity are certainly advantages, but IMO they aren’t the only factors to take into consideration. Sometimes an extra set of eyes and ears might detect something in the patient that the first person (whether it's the MD or NP) hasn't seen. Also, I don’t know what you mean by “better”. Is a patient’s confidence at all a factor in whether the diagnosis or treatment is “better”?

...I had people who never saw the Doc in 28 yrs until I retired. They didn't need to. Anything I needed the Doc for I would consult. That said, there were some people that insisted on the MD even tho I could provide equivalent care.

But surely in that 28 years there were times that a patient insisted – or maybe just suggested – that they see the doctor, and you thought it was a good or at least a reasonable idea. And I’m guessing in that 28 years there were times that you yourself suggested a patient see the doctor.

... The protocol is NP is OK. IF they are not sure then consult MD. If that plan doesn't work either refer to MD or have them step into the room to give a consult. SOme practices alternate so if the Doc needs to see the pt they know each other. My Doc never wanted to do that so there were people who never saw her

I agree with the protocol. My personal preference is that the doctor occasionally see the patient (doesn’t need to alternate), but I have no problem with your system if the doctor is available at some point. The problem we were having was that she didn't seem to be available at all.

Another example – last summer I had swelling in my knee. I called the orthopedist and the first person who had an available appointment was a PA. She manipulated by knee and said “You have a torn meniscus.” An MRI confirmed the diagnosis. She provided initial treatment and ultimately recommended scoping. I had complete confidence in the recommendation, not only from my overall impression of her, but I also figured that I probably had a “routine” torn meniscus (other than possibly that it was caused by wear and tear rather than an injury), and an orthopedic PA probably has seen hundreds of torn meniscuses (menisci?). But if I had reason to believe that there was something unusual, or if I were a professional athlete and my livelihood depended on proper diagnosis and treatment, then I might have felt differently.

[leswp1]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

Mild disagreement with this statement, unless you substitute “may be better” or even “is usually/often better” for the absolute “is actually better.” Continuity and familiarity are certainly advantages, but IMO they aren’t the only factors to take into consideration. Sometimes an extra set of eyes and ears might detect something in the patient that the first person (whether it's the MD or NP) hasn't seen. Also, I don’t know what you mean by “better”. Is a patient’s confidence at all a factor in whether the diagnosis or treatment is “better”?


But surely in that 28 years there were times that a patient insisted – or maybe just suggested – that they see the doctor, and you thought it was a good or at least a reasonable idea. And I’m guessing in that 28 years there were times that you yourself suggested a patient see the doctor.

I agree with the protocol. My personal preference is that the doctor occasionally see the patient (doesn’t need to alternate), but I have no problem with your system if the doctor is available at some point. The problem we were having was that she didn't seem to be available at all.

Another example – last summer I had swelling in my knee. I called the orthopedist and the first person who had an available appointment was a PA. She manipulated by knee and said “You have a torn meniscus.” An MRI confirmed the diagnosis. She provided initial treatment and ultimately recommended scoping. I had complete confidence in the recommendation, not only from my overall impression of her, but I also figured that I probably had a “routine” torn meniscus (other than possibly that it was caused by wear and tear rather than an injury), and an orthopedic PA probably has seen hundreds of torn meniscuses (menisci?). But if I had reason to believe that there was something unusual, or if I were a professional athlete and my livelihood depended on proper diagnosis and treatment, then I might have felt differently.

Medically in most cases the wisdom is it is better to have continuity with one person unless there is something happening that isn't explainable. When people come into a case they may have a propensity to order things that may not be necessary because they don't have the full context. New eyes are good if there is something that hasn't been figured out. If the patient insists on the Doc- go for it unless it is being used to split the staff or try to play them against each other. I think I said in the protocol you refer or at least get the Doc in if there is a question.

If the patient is insisting they see the Doc then- IMHO- they should. Many Docs won't do that- they feel the patient should see who ever is offered. The Doc I was with got like that right before I retired. I didn't agree with that.

As far as the meniscus goes- It would be more likely that the PA would be telling you there was something unusual and punting you than you knowing it was unusual but I get your point.

Take home- no matter whether the person treating the patient has the qualifications or is the best person for the job if the patient doesn't buy in then it is not going to work. Mr les is an athletic trainer with a few decades of experience so I got a lot of knowledge from hanging near him. When I was working as an NP I did most of the Ortho stuff in the office. If I had a question he was a great consult. There were times when a patient refused to see me because I wasn't a Doc. The Doc would get the patient on her schedule and then drag me in to consult on the pt. That always made me giggle inside a little

[Slap Shot]

Re: Gear Grinding 8: I Got A Lot Of Problems With You People!

which was weird, because they were drawing landscapes that day....

Haha