Home Forums Discussions General Discussion Old Yeller's ED Visit

Spoiler Alert: If you do not know the ending of Old Yeller, read on at your own risk. This is how the synopsis of the book would be written in today's medical documentation.

NDM:

Considered:

Old Yeller has rabies and is shot
Old Yeller is run over by a Corvette
Old Yeller drowns trying to cross the Atlantic Ocean
Old Yeller's Purino dog chow causes food poisoning

Impression:
Old Yeller is bitten while saving his family from a rabid wolf. Travis is faced with the harsh decision that he must kill Old Yeller after the fight with the wolf, which he does because he cannot risk Old Yeller becoming sick and turning on the family. Old Yeller had puppies with one of Travis' friend's dogs, and one of the puppies helps Travis get over Old Yeller's death. They take in the new dog and try to begin a fresh start.

Plan:
Social services to work with placement of all puppies including one with Old Yeller's family.

Even though the dog is dead, have the dog follow up with its primary care physician next week.

On file list where nothing is ever on file:

Marital status: single
Spouse name: Not on file
Number of children: Number of puppies unknown
Years of education: Not on file
Highest education: Not on file
Finaccial strain: Relies on Travis
Food insecurity: Not on file
Transport needs: Not on file
Transport medical: Not on file
Occupation: Dog
Smoking status: Never smoker
Smokeless tobacco: Not on file
Alcohol use: Not on file
Drug use: Not on file
Sexual activity: Assumed

Every other thing we aksed is not on file

History Of Presdent Illness:

In the late 1860s in the fictional town of Salt Licks, Texas, young Travis Coates has been working to take care of his family ranch with his mother and younger brother, Arliss, while his father goes off on a cattle drive. When a "dingy yellow" dog comes for an unasked stay with the family, Travis reluctantly takes in the dog, which they name Old Yeller. The name has a double meaning: The fur color yellow pronounced as "yeller" and the fact that its bark sounds more like a human yell.

Though Travis initially loathes the "rascal" and at first tries to get rid of it, the dog (a yellow cur[4]), eventually proves his worth, saving the family on several occasions, rescuing Arliss from a bear, Travis from a bunch of wild hogs, and Mama and their friend Lisbeth from a loafer wolf. Travis grows to love Old Yeller, and they become great friends. The rightful owner of Yeller shows up looking for his dog and recognizing that the family has become attached to Yeller, trades the dog to Arliss for a horned toad and a home-cooked meal prepared by Travis' mother, who is an exceptional cook.

Hi Bert,

Eagerly looking forward to the medical version of "War and Peace"!

Gene

Well it will be "Peace and War" as they will have to do the A/P backwards.

Well done!!

Hey, it's almost your lucky day.

I noticed that as of this morning I had dropped off the top posters for the last 30 days list. So I am just running up my post count now…

But only 10 away from #777.

Says Dr. 11,703!

So, I am 74 away. I may beat you to it. Doubtful. I was glad you were around, because no one else would have read my Old Yeller thread, But, it is so true. All those Not on files and NDMs and the labs and family history, etc. on the right. I saw one discharge summary where there were so many labs, that there we like 12 sheets with only 4 clinical ones.

Saw a GI note yesterday that was dictated. Wow, I miss those. So clear and easy to read.

Yes, to get back to the actual topic, I agree with you completely. Down here we have one specialist, an ENT, who uses Amazing Charts and has useful notes. The general surgeon we use most has fairly good notes. Some of the specialists will have pages and pages, but still a fairly good assessment and plan.

Emergency room notes are typically not bad, you can cut to the end and see a reasonably good assessment and plan. This is after you waded through pages and pages of pasted labs and x-ray reports.

One specialist group, though, sends about nine pages and none, absolutely none, of it pertains to what actually took place at the visit. I literally am unable to figure out what was done with the patient.

Going back years ago before Meaningless Use and MIPS, etc. they were mostly dictation. Even then, some would do the Assessment/Plan first, then the Subjective/Objective. But, in a way, that made sense, because as the referring doc, you already knew or know the S/O. So, you only need the assessment and plan.

But, with the ED you have no idea why they went. So, I tend to want to know why first so I can follow along with their thinking and what I would do. I don't think I will ever get used to A/P first, plus calling it MDMs. They do give their reasoning, which is a very good idea, but in doing so, the HPI tends to be included. Of course, many of these are like this because of large hospitals or offices having the same EMR which forces you to do it that way. I.E. you can't even get to the HPI section without doing the beginning. They were having to write down what they considered as the differential. So, someone with headache and fever, they would say they considered: sinusitis, ear infection, Influenza A, strep throat, meningitis, etc. I always thought it will almost a liability to write that you considered meningitis, yet nowhere in the note is there anything to show what you did to rule it out.

Attorney: you said you considered my had meningitis
Doctor: I didn't think so. It was unlikely
Attorney: Did you write this? Considered meningitis?
Doctor: Ummm, yeah, but...
Etc.

Attorney: Did you consider my client could have been exposed to Old Yeller? Did you consider Rabies?

I am frustrated with those "Transition of care" notes from the hospital that have either a single page or multiple pages but nowhere is there stated what the problem is that indicates way a "Transition of care" was needed. I sometimes cannot even tell if they were admitted, discharged home or sent to rehab.

Agreed. I had a girl once who I worked up, was admitted. They did CSF oligoclonal antibodies. Seven doctors including the ED doctor who ordered them were notified electronically. No one checked.

A week later I saw her in my office. She could barely walk. I said let's start from scratch. Let's look at the labs from the hospital, etc. Right there. Over 30 oligoclonal bands. She had severe Guilian Barre. Not MS. Fixed now, but an autoimmune disease developed or started it. The hospital blamed me for not seeing forty feet down the pages there were oligoclonal bands done.

My point is, on discharge summaries, whatever is left up to the PCP -- two outstanding labs, setting up a referral should be listed at the top in bold or red, etc.