Aren't board rounds at 2:00?
These aren't board rounds. I just want to remind you all of a few things, OK? So we do a great job coming up with the right diagnosis and treatment plan for our patients, but there are still some opportunities for improvement.
First off, always sit down at the bedside of a stable patient. It will make you a better doctor. Second, if there's a discharge to be done, do it before you pick up a new patient. The patients are very aware of the time that they spend with us, so please don't keep them here any longer than they need to be.
They complain about the wait.
I get it, but for the sake of efficiency and running smoothly on our end and opening up beds and opening up rooms, let's discharge before we start with somebody new, OK? Thank you. Lastly, in your medical records, make sure that your decision-making and your notes reflect not just the diagnosis but all the thought that you put into ruling out all the critical illnesses in the differential.
More work? I do enough charting as it is.
The hospital won't admit this, but it's less about charting and more about profit.
OK? Good. That's it. Goodbye. Go.
[about Dr. Mohan] Hi, how's she doing?
Still need ten more of her.
Never thought I'd see the day where you'd wish for more Samiras.
You can blame Gloria for that. If I don't get patient satisfaction scores up around here, they're bringing in an outside management company to run things.
This is Dr. Tracy Morris, regional manager of ECQ America.
The contract management group.
MMorris
It's a pleasure to meet you.
Likewise. But if you'll excuse me, I'm a little slammed, as per usual.
We were upstairs with the executive team going over a proposal.
MMorris
We're interested in having your emergency department join us.
The 500 or so ERs you have aren't enough?
MMorris
What can I say? Business is good.
MMorris
Everyone benefits.
Do they, though? Your contract management's corporate mandate is profits for shareholders above everything else, yes?
MMorris
Your hospital's board was very impressed with ECQ's metrics on patient satisfaction, throughput time, and billing collections.
Does your proposal include the part where you cut the pay for all my doctors?
MMorris
Maybe I can find an incentive for you. How does regional medical director sound? Lighter workload, better benefits, stock options.
Did you go to business school or medical school?
MMorris
Both. We look forward to your decision.
MMorris
Hopefully we'll get a chance to work together soon, Dr. Robinavitch.
[Dr. Morris leaves]
I can't believe you're seriously considering this.
Bottom line is, our current numbers aren't good, and theirs are.
Just because their dashboard is pretty doesn't mean it's good for patients.
If you want to keep this ED, improve metrics. There's a lot of OFI. Opportunities for improvement.
Well, you could have just said that.
I need you to care about patient-satisfaction scores.
I would love nothing more. But right now, the average wait time is six hours, and that's before you see a doctor. You need to hire more staff so we can open more inpatient beds. Are you prepared to do that?
I need you to improve scores with the resources we have, or we will explore what ECQ has to offer.
This is bullshit. You know this is bullshit. And if you don't, then we are all in trouble.
Maybe you need some time off.
OK, you're gonna pretend you're a pirate with your foot on a keg of rum.
Yep. This is the Captain Morgan technique for hip reduction.
[Doctor Robby chuckles]
The guy on the rum bottle?
I'll stabilize the pelvis.
OK, you're gonna step up here.
Actually, let me just...sorry.
Yeah, and you are gonna put your right leg behind his knee.
Yeah. And you are gonna use your leg as a hinge to put anterior force on his femur.
Push down on the lower leg with your left hand.
You got this. Put your back into it. The hip is a big joint with lots of muscle stabilizing it.
Oh, shit... I mean, shoot.
And that is what a hip reduction feels like.
Neurocysticercosis, a parasite in your brain.
JMJoseph Marino
I thought I just had a migraine, but I have bugs in my head?
Well, not exactly. You had larva from a pork tapeworm that made multiple cysts, but they're all dead now.
JMJoseph Marino
A worm? In my fucking head? Are you kidding me?
No, no, you don't have a worm in your head.
JMJoseph Marino
You just said that I have...
I said you had a worm in your head, but it's dead and long gone. What we're seeing on the CT is scarring around those dead cysts.
JMJoseph Marino
Like dead worm eggs?
JMJoseph Marino
Is my brain like Swiss cheese? Am I dying?
No, no, you're not dying. Joseph, you're gonna be OK. The cysts are tiny, and they're calcified over. There'll be no further damage.
JMJoseph Marino
Can you fix it?
Unfortunately, no. The little calcified spots will stay there.
JMJoseph Marino
So there's gonna be a worm graveyard in my brain forever?
Yeah, but they're resting in peace.
