It's not what you are eating, it's what's eating you…

Posts tagged ‘#HennepinHealthcare’

In defense of #HCMC ‘s Ketamine study and possibly protocol for potentially violent and violent patients…

Workplace Violence in Healthcare: What Does the Data Say?

https://bringmethenews.com/minnesota-news/hennepin-healthcare-vows-improvements-after-review-into-ketamine-use-on-police-subjects

IMPORTANT DISCLAIMERS: My normal disclaimers do NOT apply as far as my NOT being a  clinically trained medical and mental health professional or NOT being trained in law enforcement and/or public safety, as this blog addresses the safety threats to first responders and healthcare professionals locally, but this is a dialogue that above study  in first link, that addresses on a national level, the threat that healthcare workers are up against with patients who are ALREADY in an acute facility for evaluation and treatment when in mental  and/or medical crisis or combination there of or that first responders are potentially in danger, when responding to a crisis call.

I have in NUMEROUS blogs, advocated for patients rights, in this case though, as in a few other blogs that I’ve written, the patients that I’m advocating for ARE the first responders and healthcare providers that are in danger when verbal de-escalation techniques may not be the most effective, which can not only jeopardize a patient in who is in medical and mental health crisis, but the first responders and healthcare providers who are trying to stabilize them.

There are already local and national activists who advocate for verbal de-escalation, I don’t agree and I think someone who isn’t a peer as a first responder or healthcare worker needs to advocate for safety of people who work in these professions.

If this is a topic as a patient, that could be triggering, please do not read.

***

About 8 months ago, I blogged about a less than ideal encounter at Hennepin Healthcare’s emergency department, from the perspective of a patient, where I felt that I had been unfairly labeled and was also given prescription high strength ibuprofen that I never filled, as a patient who had a gastrointestinal bleed history and NSAIDs are an AWFUL treatment option for me.

The rare 4 times I’ve been in the emergency department at that facility and ONLY at that facility in the last 5 years in their emergency department as a patient, truthfully before seeing above 2nd link or similar stories last year , when either in the waiting room or when roomed and waiting for care, truthfully, I had wondered why some very aggressive patients wandering around had NOT been sedated.

Not just for patient safety sake, both the patient themselves who were acting out and other potentially non violent sick patients who were being treated but for physicians, nurses, other hospital staff, as well as there is police and/or Hennepin County sheriffs at this facility.

I’ve also blogged several months ago about a nurse who was violently assaulted at Anoka Metro Regional Treatment Center and also  when 3 1/2 months ago a man who was under the influence of illegal substances had made a terroristic threat against my apartment building about blowing it up and also mentioned about wanting to kill me when he first saw me.

This is how I personally de-escalate situations when being harassed for money, sex and drugs.

I look the person in the eye, tell them I’m sorry that I can’t help them but that I don’t have any money, that I wish I had drugs but that I’m on probation and get drug tested (not true and all I’ll add to that, is my medication list is up to date at both FUMC and HCMC online resources as well as in my DNR/emergency  info in my phone) and depending on how agitated or aggressive they are, I’ll give them a cigarette and wish them well and go on my way.

OBVIOUSLY, clearly that’s a technique that NO first responder or any physician or nurse working with an unstable patient can actually  do.

I’m not the medical or mental whisperer, I realize that part of the reason, even dealing with extremely unstable people with a propensity to be violent, on a regular basis, is largely due to luck.

The big deal with Ketamine issue at HCMC was informed consent and some of the consequences with some of the patients needing to be intubated, afterwards.

The problem is that no one could say with absolute certainty that the patient would’ve been better off, the patients around them, the hospital staff and the first responders had they not been given Ketamine.

I clearly have a bias…

But the thing is, it’s not the hospital staff that if I have a patient encounter that I am not thrilled with the evaluation and treatment that scares me.

It’s the patients who are aggressive and agitated who pose a threat to staff and patients who aren’t sedated who scare me at HCMC, which I live 2 blocks away from and truthfully at  any hospital.

And those potential patients who are roaming in Minneapolis and St. Paul who are in crisis of some sort, who also I find terrifying.

I really have to wonder if those advocating on non medication interventions have ever been a patient, visitor or volunteer  at HCMC’s emergency department.

And in my case, I can just choose not to get treatment there, any longer, now that I have a DNR and just wait for my biannual medical visits with my longterm PCP of over 20 years in Princeton, a much smaller town, outside of the Twin Cities.

However HCMC’s  first responders, entire hospital staff and patients in medical crisis who don’t have a predisposition to ever be violent and either need a level 1 trauma center or hospital closest to them, don’t have that as an option, to opt out.

This is a topic that needs more discussion, when patients in crisis, who are potentially a threat to themselves, really can’t give informed consent and are potentially a threat to first responders, healthcare workers and innocent others, and the injury risks and rates HAVE to be reduced, if they can’t be eliminated, for healthcare workers.

Note:  Again, I welcome respectful differences of opinion, even if they are opposing. Anything that threatens the welfare of myself or any of my readers will be reported to the proper authorities.

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An Open Letter to #HennepinHealthcare’s Emergency Department’s physicians…

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Dear Dr. S and Dr. C (purposely not using last names, for physician’s right to safety and anonymity),

I was in your Emergency Department on 1/15/2019, in the morning around 8 a.m.

I understand as I presented as a very unkempt but for the most part, polite 49 year old obese tobacco using patient complaining about a bad cough, but more concerned about the severe left flank pain that occurred every time I coughed or sneezed that a pulmonary issue might take precedence over a digestive one.

I stopped being quite as polite when I checked my tests online and found after almost 3 hours of being there that I only had a urine analysis and pregnancy test, that was run.

I could understand with your facility being a level 1 trauma center that you may not have had time to read my chart, which doesn’t contain much, as I’m a Fairview patient.

Even though I did have a bilateral salpingectomy with endometrial abalation and d/c at your hospital, over 5 years ago and that my chart while not up to date with diagnoses, is update to with medications I am on, which gives an idea of my health issues.

However, while you got Lisa the vulnerable patient yesterday, you’re getting Lisa the activist today, in hopes it helps with others like me, who honestly thought they had an acute health issue and was NOT drug seeking.

This is what I can’t understand and is unacceptable to me, and when things are that way, I try to say something, make it a teaching moment, regardless of the socio-economics, education and profession of those who’s biases effect how I and others, get treated.

NOT every patient who goes through your ED, is looking for opiates, some of us patients who are obese to morbidly obese, have done everything under the sun, to lose weight (hence my side gig as an activist, like one of 3 GLOBALLY, who helps people in medical and mental health trauma with serious gastric bypass complications, on the scale that I do, as well as other medical and mental health activism that I do).

My visit yesterday at Hennepin Healthcare’s Emergency Department, wasted time and money.

It caused me unnecessary duress, because you have patients with barriers that have a propensity to possibly be violent, which caused enormous anxiety.

But the worst duress I experienced, was the assumptions and absolutely NO questions asked about certain things by physicians, that could’ve made my visit a lot more pleasant.

I did see, after I pushed for a blood work up, that were ordered FOUR hours in to my visit, my labs were good.

I also saw today, that I was prescribed a script that was ordered and filled at your pharmacy of high strength ibuprofen when I have a bleeding ulcer history and NSAIDS are an absolute terrible treatment option for pain for me ( and again, I did NOT ask for ANY medications, nor will I get or take script).

Unfortunately, when the IV came out, my vein spurted which wrecked my discharge paperwork and the pants I was wearing and all over my hands and some of the staff was ready to send me home with no help, until another set of staff saw that I was tired and shaky and helped me and I was appreciative of their help.

For quiet non violent introverts, your Emergency Room department is a terrifying place to be.

As I’m sure it is for a lot of people, introverted or not.

For those of us who’ve been labeled  due to mental health issues, it’s even more amplified, with anxiety caused by patients who are violent and fear of medical professionals who’ve labeled me, in the last 17 years, not just for mental health issues, but because I had bariatric surgery.

And while some staff was great at the hospital, what will leave a last impression from what will be my last visit to your facility, is that a busy physicians didn’t take the time to ask me anything, either assuming I didn’t know or wouldn’t be truthful and while you were nice, once I said something about being upset about that, that’s NOT okay.

So please, for the mental wellbeing of your future patients, if they are ambulatory, alert, articulate and polite, don’t label or practice medicine with preconceived notions about a  patient.

Actually, just DO NOT  practice medicine with any preconceived notions about a patient, like EVER.

As in my case, I loathe seeking medical attention and my visit from yesterday made it that much harder, way harder than it should’ve had to be.

As well as it made it more difficult for yourselves, and I have the utmost respect for physicians (as well nurses and all other hospital staff)  of any specialty, but especially for those who work tirelessly and usually without thanks, in an Emergency Room.

So thank you for your time yesterday and today, and hopefully going forward this will help both patients and physicians in your hospital, going forward.

Respectfully, Alissa “Lisa” Kasen

Update: 1/17/2019, when I wrote this yesterday, I tweeted it to Hennepin Healthcare and to my delight, they actually tracked me down and called me, today,  to address my concerns, which is much appreciated.

A kinda (but positive) belated review of UR/ER for HCMC/#hennepinhealthcare…

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Disclaimers; I’m writing this blog in hopes that it helps both patients and providers of what used to be formerly called Hennepin County Medical Center but is now called Hennepin Healthcare.

The last blog that I did about HCMC, was NOT good in 2014. It wasn’t because a doctor that I had seen who was super kind, but she refused to treat me at all in the Urgent Care even though I didn’t want to go to their ER, so I left without any care, because their ER did and still scares me, but hopefully the insight I give can help what was great respectful attention by their physicians, something I’m not used to getting as a former “frequent flyer” at Fairview University Medical Center, for teaching purposes, if they or other patients who are local can find any value in this blog.

***

February of 2018 was not a fun a month medically or with anxiety.

I’m not shy about being a medical activist of sorts, but one who loathes seeking ANY kind of medical attention at all, but especially with any provider that I have no previous history with, such as my Fairview PCP who’s been my doctor for like almost 20 years now, but is 50 miles away from where I live.

I’m a complex patient with a lot of quirks.

The one good thing is I am fully aware of what my barriers are and at the same time can identify pretty clearly what’s a barrier but also what could be a potential medical event in me.

I ended up with an episode of A-fib with no cardiac history that actually didn’t send me to the UR or ER about 2 weeks prior to the visit I had on 2-28-2018.

I did end up going to the Urgent Care originally on that date when I had severe radiating upper quadrant pain and for a long term gastric bypass (and reversal!!!) patient, I still not only have my gallbladder, but appendix and tonsils, pretty much all my parts I was born with.

The nice urgent care PA that I saw originally did want to send me over to the ER. He knew my hesitancy though, so he did everything to rule out stuff he could in the Urgent Care by doing an EKG and chest x-ray which was normal and then he strongly suggested I go over there and this time I decided to do so, knowing my youngest’s birthday was in 4 weeks and if something was wrong but easily correctable, I didn’t want to be super sick and ruin her birthday.

The hardest part for seeking medical attention in an acute care setting truthfully boiled down to this particular reason:

Last time I was in an ER was at HCMC in 11/2014, 2 days prior to above mentioned UR visit first due to intractable projectile vomiting then for what felt like could be pneumonia or apsirating the vomiting.

Last time I was in an ER at FUMC was over 5 years ago and it was so bad, the ER doctor treated me like a drug seeking hypochondriac who resented that I got my PCP involved and sent me home not knowing I’d be stuck having to get home in a cold snow storm walking while weak and in an altered state of consciousness due to severe pain for a mile,  prior to the Blue Line being built as I couldn’t obtail a medical ride home (something I’m eligble for but there was no availability at that time of night) , got lost on campus and it took me 2 hours to find a bus that would get me home, even though I only live 2 miles away and put me at further risk.

I never held against that doctor of not suspecting at the time my medical event, which was to get worse was due to an IUD (Mirena, which I ended up Mirena crashing) but I had a lot of severe symptoms such as projectile vomiting blood and intractable atypical migraines (for me, as I do have a migraine history) that she didn’t run one diagnostic on me, in 2/2013.

Truthfully the nurse I ended up having last month was kind of a jerk (I’ll elaborate more, later).  I was nervous and slightly wordy and I think I got on his nerves.

The resident and the doctor in charge though of the ER, was AWESOME.

They were patient and kind, they took me at my word (it also helped with my history of not seeking frequently acute attention) that I was in a lot of unusual pain for me.

They didn’t label me and they didn’t make me feel bad, being at a level 1 trauma center, when it ended up being a potential gallbladder attack.

The ONLY disconcerting thing about the visit was that my anxiety was high because there was patients who were out of control, such as one screaming patient being restrained to a gurney, the other was screaming and wandering around the ER.

When that happened, I did tell my nurse I was going to have a cigarette because I was having an enormous amount of anxiety and a terrible panic attack and when I went to do that the first time, the nurse was kind of a jerk.

FUMC will NOT let you out of the ER, once you’re roomed and I sorta get it, unless you’re not on IV narcs which I wasn’t on nor was I asking for.

But the nurse didn’t seem to understand that with other wandering patients, I didn’t want to appear to be a security risk, as a stupid smoker nor did I want any doctors having to go look for me, as I had a diagnostic that still needed to be done.

When the 2nd time I went to have a cigarette and told the same uncaring nurse, the resident in charge of my care, overheard and said that she would be in after I came back.

She made no judgement about my smoking outside, when in an ER, she got that I was trying to be respectful of her time and was super kind, respectful and caring.

Because I live only 2 blocks away and my anxiety was high, it was okay with her, after my ultrasound that showed gallstones, that I could go home, but with the understanding I’d come back if there was something wrong with my bloodwork, which I appreciated.

A few days later when I spoke to my PCP on the phone and was explaining the difference in quality of care between hospital systems, because I needed a referral to a general surgeon for a potential cholesysectomy, if not a hernia repair (I’ve had a hernia for the last 7 years because of my open rny reversal) she asked what hospital to do it for.

She understood that I’d rather go to a hospital where the patients scare me a lot. than the doctors do. That I’d be okay with an outpatient procedure at HCMC vs. FUMC because the quality of care in consideration, is better.

I don’t think either hospital system is going to read this blog, even though I will forward it to HCMC, okay, now called Hennepin Healthcare, as while it’s not for me to second guess a hospital that has a psych ER, of why patients are in a medical unit, maybe that needs to be addressed first as medical issues being addressed, before they get transferred to psych.

But I am good patient. I’m honest that I’m not fully compliant in things. I know my traits, such as if I’m nervous, even if I’m sick, will make anxiety prone and pace and I’ll explain that to medical staff, in case it scares them.

I’m also super polite and respectful of authority unless a doctor treats me like total crap and while I can be blunt and abrasive, I’m not abusive nor do I have any violent tendancies other than I can be mean in my wording, when super provoked, and if that happens (which it has multiple times in the ER at FUMC, I’ve just disconnected an IV in an ER of saline and gone home, that’s it, it’s a big deal but doesn’t make me a safety threat to anyone other than myself but I get treated like I’m a safety threat potentially to the entire hospital, short of security being called).

The only thing I do want to get across to Hennepin Healthcare, is that truthfully, even though I’m a mental and medical health advocate and blogger, I AM afraid to be in their ER and I’m afraid to have an inpatient procedure there, as truthfully I’d admit, I’m not above being admitted and wanting, if not leaving,  to go home, if I’m scared enough and I get that where that can be disconcerting if not a liability to a hospital, but I can’t stay somewhere when vulnerable but not feeling safe.

But I’ll take my chances at Hennepin Healthcare vs. FUMC  where I trust that the respect will be there and I’m not so quick to be labeled.

At least if it’s outpatient care and that’s something I hope they will address further within their hospital as far as potential safety risks to patients and appreciate that the time I’ve taken, because I wasn’t given any kind of followup inquiry on how the service was for that UR/ER visit, that they take both in consideration my appreciation of their kindness but my fear of unstable patients not being monitored closely and a burnt out ER nurse who had absolutely NO reason to be rude to me.

Note: I realize this was SUPER  wordy. I couldn’t convey anything of due importance in giving feedback that read like a Tweet.

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