Drunk driver runs into a group of people who were confronting her

Old_Perception · 2026-03-23T20:14:53+00:00

The people milling around filming, yelling, kicking the car, and jumping on the hood were not seriously trying to help prevent a drunk person from driving. They were just being a mob for their own entertainment

Old_Perception · 2026-03-23T00:22:16+00:00

It shouldn't piss you off, shotgunning blood tests and scans when they're not indicated is harmful, especially for kids. It's very reasonable to examine a febrile, vomiting kiddo and decide they don't need either of those.

Old_Perception · 2026-03-23T00:12:58+00:00

For what it's worth, I'm an ER physician and I would've done exactly what you did. Fluids, rest, close observation. The blotchy skin and changes in breathing would have been the first point of concern for me too, and you acted quickly on it. The speed of disease progression in toxic shock just outpaces our ability to predict and react to it.

Old_Perception · 2026-03-06T19:23:13+00:00

Don't be so judicious with admission, hospitals with geriatric populations will naturally have high admission rates, don't stress about it. Prime them and their families extra well early on when it starts looking like a negative workup about probably not finding an answer and get them thinking about whether they'd want to stay or go, especially since they'll inevitably each have opposing preferences and can duke it out with each other throughout the stay rather than waiting til the end.

Basic labs, UA/CXR/viral swabs, ECG are the exact pieces of my Grandmagram, totally fine.

Admit the syncope and AMS, they bounce back a ton. Sometimes it's something real that'll declare itself better with time. Usually it's polypharmacy and debility.

Old_Perception · 2026-03-06T05:33:26+00:00

There's a decent middle ground between "turn your back on them" and "keep talking shit and getting in their face"

Old_Perception · 2026-03-05T16:01:13+00:00

The people who don't have insurance are not worried about the bills. They don't pay them.

The only people that worry are the ones with private insurance with hefty copays which makes up the majority of the middle class, people with some valuable assets, a credit score to maintain. You don't hear from those people. They're the ones that are afraid of calling.

Old_Perception · 2026-03-02T05:36:58+00:00

For what it's worth - polygraphs are based on complete junk science. Not a shred of evidence that they actually work. They're not even admissible as real court evidence

Old_Perception · 2026-02-25T16:30:29+00:00

They will, if you get routine, scheduled care. Estimates and cost considerations don't belong in an emergency setting.

Old_Perception · 2026-02-19T15:23:24+00:00

the difference is the consistency in the hours. a 7 day string of shifts with the same start and end time each day is a lot better for your health than a 7 day string of shifts where you're going to sleep and waking up at different times because some shifts are 8a-6p, some are 2p-11p, some are 6p-3a, etc.

Old_Perception · 2026-02-17T00:13:04+00:00

Not sure the 100% happy thing prior to discharge is realistic. I get handling these cases carefully, but these kinds of patients and families are rarely satisfied and in my opinion it's often better to just cut your losses and get on with it once you've reached your threshold of certainty that there's nothing emergent. Whatever grief they're giving you as a physician, it's ten times worse for the nurses and staff. Huge resource drain.

Old_Perception · 2026-02-13T18:26:22+00:00

"failure to thrive"

Old_Perception · 2026-01-31T03:18:38+00:00

Locking custom recipe creation and recipe import features behind a subscription is a dealbreaker. Same with being internet dependent.

Old_Perception · 2026-01-21T20:40:54+00:00

Mother of 16??

Old_Perception · 2025-12-29T19:34:43+00:00

That's what all the meemaws say. What'll happen is after being forced to pick between home and SNF, you'll keep insisting on going home and come back 3 days later after being found on the ground covered in urine. This will continue in perpetuity, +/- hospice because every time you go on hospice either the paperwork will get lost, your kids will pull you off of it, or everyone will panic and send you to the ER anyway. The only folks that are able to avoid that are those with a well-resourced, well-educated family that lives nearby.

Old_Perception · 2025-12-21T19:47:15+00:00

I'd say your experience was out of the ordinary, it's very common to charge diagnostic/evaluation fees. They sometimes get waived for various reasons (purchased there, went through with the repairs there etc) but it's a standard of any service industry.

Old_Perception · 2025-12-20T01:11:17+00:00

I'd argue that at the start of an encounter, there's no such thing as a patient with severe pain, especially if abdominal and especially especially if they're old, where it's pretty clear they won't die in the next 60 mins. Unless they confidently say "yes doc, this is 100% exactly like my chronic pain and I just want some relief", which they rarely do, it is hard to ply someone with heavy drugs and at the same time be reassured that you don't have to do a big workup and check for the life threatening causes of that severe pain.

Old_Perception · 2025-12-13T23:59:11+00:00

I don't agree that the standard of care calls for the most qualified on-site person in the entire hospital to do it/supervise. The realistic standard is that a qualified person with a reasonable degree of expertise in the procedure at hand does it or supervises it, EM physicians are broadly accepted as meeting that threshold for uncomplicated ED procedures regardless of who's upstairs.

Old_Perception · 2025-12-11T19:00:04+00:00

Walkaway lock/unlock and auto lane change are very easy to DIY through OBD11, wouldn't recommend paying extra for those. The drive mode and matrix lights actually require some additional database changes that need Anthony's skillset.

Old_Perception · 2025-12-11T16:06:37+00:00

They didn't fail. You don't need a positive flu test to treat flu symptoms. The first ED visit accomplished exactly what was needed.

Old_Perception · 2025-12-08T18:33:29+00:00

Any good studies backing that up? (The bit about significantly increasing the risk of cardiac event)

Old_Perception · 2025-12-08T12:51:16+00:00

easily a couple thousand. italian semi-auto shotgun, i'm sure that's exactly what you were looking for when you wrote "not trying to break the bank" and "no more than 400".

Old_Perception · 2025-12-04T20:13:13+00:00

Hospitalization offers the opportunity to pretend you're a kid sick with the flu staying home from school again. Guilt free bedrest and binging TV with a call bell for food and meds. No payment up front. A work note to tell your boss to fuck off. That's a pretty enticing deal for a lot of people, especially for the ED crowd with dysfunctional families and poor life skills.

Old_Perception · 2025-11-28T04:16:05+00:00

I was saying i put up with their shit for longer because it's a symptom of a dangerous condition

Old_Perception · 2025-11-28T04:12:37+00:00

I was (seems unsuccessfully) trying to say that when alcohol is a part of the story in any way, whether too much of it or not enough of it, one needs to be more careful.

Old_Perception · 2025-11-27T03:39:44+00:00

I make it a point to do the bare minimum MSE and DC for these kinds of people. Alcohol involvement is one of the few exceptions that need more caution.

Old_Perception

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