Interesting ER paperwork

[dreamer]

OK so my easy child had to go to ER to be rehydrated due to "hyperemesis gravidarum"which is basically extreme level of nausea/vomiting/morning sickness for prolonnnged period of time...... she is preg, has morning sickness 24-7 that even zofran did not take even the edge off of. so off to er for IV fluids and IV zofran.
THe paperwork? for several years I have found this noteworthy, and more than a little..um.scary. The General COnsent form....."General Consent and Acknowledgement" at bottom left corner it has ADC 10000-00 01/07
in the first section it actually says "I understand that the practice of Medicine is not an exact science and, therefore, that no guarantees have been made regarding the liklihood of success or outcomes of any diagnosis, treatment, test, surgery or examination performed at XXX"

The home care instructions pages, given at discharge say "Portions Copyrighted 1987-2008, LOGICARE Corporation"

"IMPORTANT: We have examined and treated you today on an emergency basis only. This was not a substitute for, or an effort to provide, complete medical care. In most cases, you must let your doctor check you again. Tell your doctor about any new or lasting problems. We cannot recognize and treat all injuries or illnesses in Emergency Department visit. If you had special tests, such as EKG's or X-rays, we will review them again within 24 hours. We will call you if there are any new suggestions. You were treated today by Smith, John (alias provided by dreamer)."
Funny, easy child does not smoke, but it has a long paragraph in it about how to quit smoking....and then it has a long paragraph about coping with pain. The last page has a section for patient to sign, and another spot where it says the nurse has answered all questions we have.....but, noone asked us to sign, noone showed this to us, noone went over it with us, it was handed back to us with our insurance cards, folded. it also says "YOU ARE THE MOST IMPORTANT FACTOR IN YOUR RECOVERY. Follow the above instructions carefully. Take your medicines as prescribed. Most important, see a doctor again as discussed. (and this next is unedrlined) If you have problems that we have not discussed, or your problems get worse. Call or visit your doctor right away. I have received this information and my questions have been answered. I have discussed any challenges I see with this plan with the nurse or physician. (Patient signature line)
(patients) or Responsible Person has received this information and tells me that all questions have been answered. (RN Staff Signature line)"

Our doctor, the ob-gyne sent us there for IV rehydration. doctor had ordered Zofran, but it did not help. ER gave IV zofran in IV with rehydrateing fluids. Post IV no vital signs were checked, no discussion with us about anything, no nurse to answer any questions. easy child, me nor any hospital staff signed the last parts at all. Next doctor appointment is 2 weeks away+. doctor considered makeing that appointment even further away but then changed mind after "I" questioned the wisdom of too long between appts when easy child had LOST 10 pounds in 3 days (and was NOT overweight person to begin with)

How ironic, easy child was there becuz she has been unable to keep any food or drink down in a full week at all.....and she had comlained of the zofran not helping at all even before rehydration and again after. Dureing rehydration she did suddenly get hungry and requested some jello- but was denied.....even tho they had already added zofran to her IV. I find it ironic, she is there becuz she has no intake at all, and it necessitated all this, and now she thinks she might be able to eat or drink and they refuse to let her? Altho then she said she still felt just as nauseas, after all, by the time rehydration finished. She did not think zofran IV helped any better than oral zofran, yet that is what they sent her home with.

I have always found this consent form very unsettleing......there is more on it nearly as unsettleing.......
over the years it changes a little here and there......but it always seems to me that it is trying to dismiss hospital of any liability for anything at all. It also does say that the docs are independant, and not employees of the hospital and also not necessarily approved by any insurance or PPO or HMO that the hospital itself might accept.

This hospital is part of a large group of hospitals, the only hospitals in our area......in order to not use these hospitals from this group- we would have to travel, like I do for my sons eye doctor etc, to the city. This is not feaseable for things that need to happen quickly or ongoing issues etc. This is also the same group all the docs in our county work with.

BUT this is what we have been dealing with for 20 years........I have posted several times about our hospital previously, so I thought I would take the paperwork we got here this trip and post it.
I sure do not find it reassureing AT ALL.

 

[dreamer]

I copied all that in quotes exactly how it appeared, all the punctuation etc is how it appears in paperwork.
Interesting to note, easy child had been on oral birth control for over a year, but never had any physical exam by gyne......then she did home preg test, it was positive, docs nurse saw her for first appointment, noone examined easy child, just did labwork......easy child had a WIC appointment already, and met with WIC health care team, who also did NO exam of ANY kind.....simply blood pressure, weight, height at all appts so far, and easy child had a 2nd doctor appointment this week due to the serious nausea vomiting etc, but still noone has done more than just take her blood pressure and weight anywhere. doctor said she thought she might do first exam maybe in about 2 months? Altho an ultrasound is scheduled for next week. easy child missed no monthlies. At the moment due date is set as Feb 22. The morning sickness hit 10 days ago. It lasts 24-7.NOTHING has brought any measure of relief, not ginger, not tea, not clear liquids, not motion sickness wrist bands, not crackers, not tepid bath, not mint, lemon drops, not even the zofran, not oral, not dissolve on tongue type and not in IV. Rehydration did temporarily permit her to be far less listless and lethargic than she had been for almost a week, for maybe 2-3 hours.
So, even tho she already told both doctor and ER that the zofran was not helping, it seems noone paid any attention. And noone seemed to feel it important enough to have a sooner follow up appointment. :-(
Nor has any of the docs, nurses etc bothered to try to explian to easy child just why such serious dehydration is a problem, why it is not good.
Sure sounded to me like they all want to either talk to ME......instead of HER or they are just so stuck on their often repeated set of words to all expectant mothers, they blah blah blah their way thru in monotone and never stop to hear or listen to the patient at all. Not just ob/gynes office, but also wic and er.
This ob gynes mom delivered my easy child, this ob gyne herself delivered my son, she was preg with her first same time I was preg with my son.....her RN in her office is same one I had for my last 2 preg.....BUT My pregs were quite different. I had 14 miscarraiges over the years BUT I NEVER had even tiniest bit of morning sickness AT ALL. I waitressed 20 hours a day dureing preg with difficult child, I was still nurseing difficult child when preg with easy child and I was working 16 hours a day as a nurses aide in nurseing home when preg with son. My labor with difficult child lasted 5 hours, my water was broken by doctor at hospital, with easy child my water was broken at hospital by doctor, labor lasted 15 whole minutes, and with son, water broke at home, but even with pitocin max dose, he took 19 hours to be born, and he was 6 weeks early. I let hospital same day as I delivered each child, and each baby also came home with me......well before even 24 hours had passed since their birth and I immediately resumed all my normal daily activities. Went out to eat on way home with newborn difficult child, stopped at grocery store on way home with easy child, and did my own shopping with her in cart. When son was born, I had final exams for trig class at comm college, and I took brand new son with me in a carrier on me, he laid there against my front while I took my trig final, then we left there and stopped in at nurseing home where I worked to show him off. Then I came home and made dinner for whole family. When I had son, my 2 older kids were at hospital in delivery room with me and husband.

I understand I am not quite "normal" LOL.....but.becuz mine went that easy, I KNOW it IS not normal......and dureing preg I never got large, even when I was in labor, I did not LOOK preg. I began tall and overweight, and my babies laid in such a way, I never even wore maternity clothes at all, and hospital never believed I was preg much less in labor when I showed up to deliver. I did not gain weight when preg, I never ever waddled, LOL......I lost 80 pounds preg with difficult child, approx 60 with easy child and stayed same with son.

SSSsoooooo if any of these docs, nurses etc are thinking easy child can learn from ME, they could not be more wrong. And it sure seems to me they should know very well that EVERY pregnancy IS different, anyway, even in the same woman, each of her own pregs can be very different from her other ones. I had to have blood draws every day while preg with difficult child...with my son I had to have daily hormone shots to sustain the preg. So I am not sure why noone at all anywhere seems to be makeing sure they are speaking TO my kid? and why is noone examining her? all that time on birth control, and now so many visista already with this preg and still noone has done more than labwork and vital signs. and nothing else at all.

 

[Josie]

I'm not sure if this will help your easy child but I found that the prenatal vitamins made me vomit if I had them on an empty stomach. I also found that if I ate something, no matter how nauseous I felt, I would feel better.

I am very worried about most of the medical profession. I have found that if I can find the answer easily on the internet, the doctor will generally do what I have found. If it is a more difficult problem, most of them seem to be unhelpful. I feel like I have to figure it out on my own. It is scary.

 

[dreamer]

yeah, we looked online..found many suggestions, and yeah, I thought about the vitamin, too, cuz yes, that did upset me, too. But she has been unable to take even that now for 5 days, everything just comes right back up as soon as she gets it in....we got ginger ale, warm tea, ginger cookies, mint, lemon drops, saltines, plain baked potato, watermelon....

after rehydration today she did finally get approx 1/2 cup jello in....and it stayed so an hour later she tried some plain rice, but the rice did not stay. :-( even with zofran on board. her new zofran is double dose of what they gave her monday......

It can be a fine line to research ourself and then go try to talk to docs, cuz lots of docs get offended if we do our own research....and then seem to want to deliberately NOT do what we found, like their ego is hurt....sometimes I know insurance dictates more than docs might....some docs I think just decide to not bother, maybe they are just running on autopilot or something...
in the post about um.....are we panicking? I was talking about how seems to me just EVERYTHING isjust not working the way it was supposed to be going or something.
Last week my garbage man came and got my garbage curbside, and now it is so expensive, and they dropped half of my garge out, caught my required bag on edge of truck and tore it, and they drove away leaveing all that garbage there. I do not know the last time our food order in a fast food or sit down restaurant was right, even when we went to more upscale nicer (and expensive) places.....it is like you have to beg scream, threaten etc to get people to do their job and then tip them triple or something and then fall over in extreme gratitude becuz after you begged screamed and threatended and bribed them to do it, then they kinda halfway did it and now expect you to have undying gratitude. and it just seems like it is everywhere, everything, yes even the docs, the servers, the everything......

When ob gyne nurse was gathering history (which they already have, mine, PCs, whole familys cauz these have been our docs all my kids lives, and my docs) they shot out the questions so fast and so jumbled together, I knew what they were saying cuz well, been there done that and I AM a nurse......and I KNOW what they ask etc.......but easy child - I doubt she had any clue what they were even saying at all, she just kept nodding......and I said to nurse and easy child hey, slow down, I do not think she even knows what you just asked, and I do not think you have any idea what her answer REALLY was.....and truth is, while I KNOW the answers, it is time for her to also know the questions and the answers, and WHY they are important. Maybe you, nursie, ask these questions by rote a hundred times a day, BUT easy child never heard them before....and you have not heard HER correct answers.

dumb people, asking about the family history, and PCs broother, my son, the child this doctor delivered for me-he HAS cerebal palsy......and it is in the records, but the nurse was going so much by rote, she skimmed over, did not pay attention, and I stopped her and easy child and said hey! wait! UH scuse me, pay attention here...if it can be helped, I prefer to not have a grandchild have cp, to- or if one does, I prefer it to be caught as a baby and not have to be an undx'ed problem until age 9 like MY son, hello?
I am not sure, but it crossed my mind that maybe easy child is so naive, maybe she did not really grasp just what history is all about and why it is important, and seemed almost like easy child thought it is just a social thing?
but as fast as nurse asked the questions, half the time even I did not understand what she was saying.

 

[dreamer]

ok like um.....anyone with diabeheartkidcystautoimm in one breathe and then nurse muttered nononono under her breathe. Um WAIT, um, my bro has type 1 diabetes, I have type 2, PCs daddy has heart disease, my mom has kidney disease, I have lupus and ra....hello. PCs bro has cerebal palsy and seizures......hello, PCs mom, dad, and sister all have bipolar.....dad has schizoaffective with psychosis.....baby to be has an uncle on his daddys side with new diagnosis of seizures'epilepsy......um dontchya think this is relevant? the answers are NOT nonono under your breathe.

 

[Andy]

Jelly Beans? I have heard that jelly beans (eat them ) helps with morning sickness.

easy child needs to call her doctor ASAP, "I need to see you NOW!!! I was just in the ER and would like to avoid another trip to ER. I need help NOW!!!" Sometimes the receptionist will give the phone to a nurse. Just beg and plead and whine that easy child can not wait 2 + weeks (pretend you are a difficult child who is insisting on having 20 sugar cookies ten minutes before supper). She must be loosing lots of energy with this. If she is still refused an appointment - Is there a patient care program at the doctor office? Have easy child go in atleast once per day to have vitals done (ask the nurse if she will do atleast that much if easy child stops in each day - should only take a few minutes).

Paper work is getting so political. The hospital is just looking for a legal way to get out of doing something wrong. If they were more concerned with actual patient care than to cover their butts when they do something wrong, maybe patient care would be a better quality. I would ask the hospital why no vitals were taken - medical staff knows more than anyone that something can be wrong even while the patient feels fine and if the patient is feeling ill, you better check the basics for clues.

 

[dreamer]

she has been IN the docs exam room.....and she did see doctor and doctor sent us to er for rehydration, but, doctor has not done any exam......and doctor only saw her after the problem with the sickness....doctor DID have easy child come in that same day when we did call...
At that visit doctor at first was gonna set follow up appointment post rehydration for quite further out than she ultimately set it, partly becuz I said something to doctor.
Yes, easy child was quite listless, lethargic, dizzy, it was very scary.

Mostly I was so bothered by the paperwork our local er has you sign when you go in, tho.

update to easy child? Yesterday she was able to eat a little turkey meat and mashed potatos and even a bit of soup, YAY!!

 

[Sara PA]

Glad to hear she's a bit better.