It makes sense. Lights go out, they have to perform. When they leave the reading room, it’s because they either have a break or are finally leaving (no, I’m not counting going out to take ultrasounds, going to the CT scanner, etc)
Our circadian rhythms are regulated purely based on differences within the thin spectrum that exists in the blue light emitted by Barco monitors and cell phones.
Night owl lab tech - I can’t wait for the daywalkers to leave so I can turn off all the fluorescents and bask in the soothing glow of computer screens.
Or an angry Cardiologist, asserting his claim to a dialysis order from overnight chest pain, rattling his stethoscope in response to Nephrology's territorial challenge.
0:53 - The stereotypical Cowboy movie song that I can only describe as "Wa wa waaaa.....'trilling wistle that kind of sounds like locusts in background'......" that plays at High Noon when two Cowboys are approaching each other for a Stand Off, waiting for a shootout while the townsfolk hide in the nearby shops. The spurs on their boots ring with each step as the approach the center of the town and "talk" to each other. Your rattlesnake description would be a perfect aound effect for the scene described in the first paragraph.
@@AznJsn82091They probably know their nephrologist well enough to know they'll appreciate it (and it's nephrology, not neurology). Also, you sound super fun at parties.
I've been trying to get a feature put in to let people specify communication preferences if they don't speak (say, picture board, particular AAC software, etc.). It's a nightmare.
Ok BUT that means you’re getting to the point where it’s so broken it’s not functional which forces an actually useful update, that all the doctors will hate because all the other ones ruin it, or it’s learning a new setup. It’s the circle of incompetence
The excessive warnings in Epic are actually a pretty big hazard, since they cause fatigue and providers get in the habit of just hitting dismiss without reading them. So the important messages get ignored. Some of the messages are truly strange and inaccurate though, and some of them are related to insurance and I really wish they'd bother somebody who cares. FWIW, I believe that the messages are set by each organization and not by Epic themselves. Getting paper-pushers to relinquish a pop-up is nearly impossible because they don't care about fatigue, they care about being able to assign blame should something negative happen. Epic works well for this, it'll record you hitting dismiss when you do that order. And we all know it, so we're going to put in that consult. If the people at the top were willing to carry more of the blame, maybe providers would stop quitting.
Having to learn about medical software and systems for QA and PI was a headache. Depending on the vendor/company and on top of their "vanilla" version, there may be the option of having custom changes or modules added on top, or the HIM dept can customize it based on their needs. Said HIM professionals may either be of the in-house dept or outsourced to the seller's. There's a ton of other details and headaches that can end up getting piled on, which just makes the entire thing a big ol' mess. Fun!
Some messages are definitely built in or come by default. Unfortunately making changes to an EHR like Epic is about as pleasant as walking on broken glass, and probably more expensive too! That's part of the reason why it's so hard to get rid of these things after the system goes live.
Like in those absolutely garbage criminal charges against a doctor and pharmacist for giving methotrexate daily instead of weekly. "But they clicked through warnings" it feels like it's rare that an order doesn't have warnings we have to ignore. And it should have malpractice and grounds for disciplinary actions / censure, but not criminal charges. The people creating alert fatigue should bear appropriate liability for their decisions, too.
I thought the dark glasses were a joke but I recently underwent a procedure done by a radiologist. The nurse dimmed the lights before he entered the room. And the corridors were dimmer than the rest of the hospital. I'm not even joking.
Rad tech here - a lot of the things we do require lower lights to more easily see screens and/or use light to position properly, so radiology is traditionally lower light pretty much across the board. I walk out into the bright part of the hospital and it hurts! Lol. I call us in radiology mole people.
@@WelcomeApathyaha im a radiographer too and I’m fond of calling us the little radiation mushrooms 😊 i will say though in terms of the lower lights it drives me bonkers when people turn off the lights near the monitors because the brightness on the monitors is so high and all the programs bar one are white and it physically hurts to do anything at the computer which is a lot of my job. Its like having a torch beamed directly into my eyeballs but i also have to complete tasks while doing so
@@katierasburn9571 I've slowly been turning down the brightness of all the monitors in my department (not the ones for viewing images, obviously) 🧠 sweet relief.
Most nephrologists still err on the side of caution when asked about using iodinated contrast in kidney disease patients. The studies disputing if contrast-associated acute kidney injury is real mostly comes from radiology literature. Newer, lower osmolality contrast agents appear to have significantly less renal toxicity than the agents that were initially studied when this condition was first described. There are still recommendations we make for patients at risk for contrast issues.
X-ray students are taught that iodinated contrast is contraindicated when patients BUN and creatinine are abnormal, or there’s a history of kidney disease. So even techs will question an order with contrast.
And that's just the CT contrast, wait till we get into MRI territory and fun stuff like nephrogenic systemic fibrosis. Although I believe most of the contrast solutions associated with that are no longer used anyway.
I had a patient with hemoptysis which ER hesitated contrast for low baseline GFR. Then IR came, laughed and dipped the patient into iodine while embolising bronchial artery. Then he lectured us that GFR won’t mean anything if the patient doesn’t have blood to filter. So nephrology had a point 😂
It honestly depends on the case. If we're looking for a dissection/aneurysm or PE, sure. But a lot of times they order contrast for things that can be seen just fine without. Why run that extra risk if you don't have to?
You can easily chance Epic. Just full out a form, have management sign it, get everyone on your side, wait multiple fiscal quarters, constantly follow up, and then move to a different job before hearing if anything happened.
I have a particular talent for finding Epic bugs it seems. Hours after a required functional/cognitive assessment went live I managed to find a way to get it completely stuck. If you are an Epic user in Oregon it’s because of me you have to type 777 or 999 if a patient answers yes but doesn’t list age of onset. Sorry/you’re welcome!
Had surgery 2 days ago. Told the folks in the OR that I'd been watching Dr. Glaucomflecken to pass the time. The nurse and the anesthesiologist both said "I love his stuff!" The last thing I remember before losing consciousness was the anesthesiologist quoting "How to Ace Your Neurosurgery Residency Interview." Great stuff.
@@biolumatenah that depends IR got like 10 or more type of coils with different length and everything. Those sphere type usually used for berry aneurysm.
@@biolumate 1st coil of a cerebral aneurysm procedure is usually a spherical shape. Subsequent soft platinum coils will conform to whatever shape they are placed into.
Interventional cardiologist here. If we do a cardiac Cath and creatinine rises by more than 0.3 post cardiac Cath we get blamed. But so much goes into the creatinine change. Fluid status , hemodynamics , diuretic use , other imaging studies.
Not to mention all the very probable microatheroemboli from your illicit intraarterial instrumentation getting dislodged and shot down into the kidneys.
You know billing is why EMRs exist. If it weren’t for billing we would all have paper- no née to actually ever read anyone else’s notes. If you’ve ever read them they are basically CYA
Yay, I’ve been wishing for radiology to get into a fight for a long time and now we get interventional radiology and diagnostic radiology in a swift close combo. Thank you ♥️
Oh, don't be so serious, you can get a warning box from Epic removed. Just have to bug the right person in IT, be part of 5 steering committees and be a physician builder, just so you can ask. We then require a sacrifice of 35 clicks to complete any work.
DOCTOR GLAUCOMFLECKEN! I'm a nephrology nurse and you really hit the nail on the ascending loop of Henle with this one! I genuinely had this precise scenario pan out on a shift recently. Radiology contacting me stating the patient will need dialysis post CT contrast, nephrology contacting me saying that no, they don't, back and forth until I eventually stopped being the middle man and made them fight it out between themselves (salt bae won btw)! Too accurate. Thanks for all you do, you have me in absolute stitches every time and it makes me love this field all the more!
And in breaking news, a radiologist is found dead with 14 bags of IV fluid intravenously introduced into their body, a salt circle around their body. Authorities have yet to find the culprit responsible for the incident, but a med student comments the following: "I guess we should get interns to redirect nephrology consults in the future"
@@MyFiddlePlayeris that actually true? I know they really have to be careful, but I have one radiologist who I mainly work with in the breast imaging center who can be verrryyy particular about things. (Not necessarily a bad thing but it's more of a his way or the highway type deal). I've gone in to show him ultrasounds on cases and he'll say stuff like "so if **I** get sued and this is on here then...blah blah" Funnily enough he kind of swings the other way with different exam types and won't say much about findings I'd consider to be more significant for lack of a better word. He's just the boob-pro I guess lol
I learned the other day that it's Epic's fault I get panicked calls from nurses half the time I get blood drawn. A warning box pops up for one of my lab values, and apparently there's no way to turn that off on the basis of "it's been like that their whole life and we know why"
HOWLING! This is the bane of my existence. Kidney patient and the never ending pissing match between endo, neph and radiology. I long for a CT w contrast with no prep and no 3 day squabbling.
I love to tell my patients in the ED that we just have one radiologist holed up in a dark room looking at scans all day that’s why it takes an hour for them to interpret their CT. I feel like I’m not that far off. They are also battling nephrologists in other dark rooms. Just salt flying everywhere.
I mean you really arent far off at all. If you think about how many scans are completed per day it does stack up, especially if the radiologist is managing multiple imaging modalities plus they have to report on imaging taken out of hours on their list and is also being constantly called by doctors wanting reports or advice. There obviously isnt just the one but they have a long long list to get through and theres a priority order too just like in ED, kids are always first on the list for example.
@@katierasburn9571 The worst part is that if you get behind, physicians (or their minions) start calling you to let you know that you are behind (oops, I mean, to ask you for their patient's results), making you more behind.
"Epic warning box", while a valid term used for a valid prompt generated by a valid program in the medical field, still sounds like it should be warning of the Nephrology and Cardiology dragons battling against each other and laying waste to the land of Cafeteria
I keep on having to remind myself that me saying I sent an "Epic message" just makes me sound like an overconfident 15-year-old boy if nobody else knows the context.
Ooh man, this hits close to home this week. I had that exact contrast-kidney damage convo with a radiologist about a close relative. I'm starting to think you can see into my brain, even without neurology. 😂
This brings back memories of an exam in med school where one section worth 15% was dedicated to nephrology(the only nephrology question in the entire exam), and the only thing they asked about was contrast induced acute kidney injury into the smallest details. Out of everything I had studied on the kidneys and related diseases before that exam, that was not something I put a lot of attention to. Still wondering why a nephrologist thought that was the most important thing to ask students at an exam lol. That exam still haunts me, I was so sure I'd failed when that question came up yet I somehow passed in the end.
@@thepapschmearmd we've had one exam where kidneys anatomy and physiology were included and one of pathology of the kidneys before the above mentioned exam. In my school we don't have exams on just one subject but rather a mix of several, for example in the exam mentioned above were also endocrinology, GI and urology included. So each field doesn't get that many questions in each exam though.
Brings me back to the horrors of medschool exams .. why do they do that! Out of the whole curriculum they choose a 0,1% part and still find every possible question to ask about it and ignore all the rest. I think it's done on purpose. Cause it doesn't even serve as a good way to test the students.. whatever.
So Epic is “the computer” I remember hearing so much about? I’ve been a paramedic long enough that all my documentation was done with paper and pen and when cell phones only had one “app”-phone. I’d encounter patients who took prescription meds but didn’t know what or why-but “don’t worry, it’s in ‘the computer”. Ah, happy memories.
Epic is electronic medical records program that their hospital used i supposed. Usually there are tons of program like these and most of them are annoying and not efficient.
@@Jen39x True enough, but they were the ones that essentially put the requirement in for EMRs and provided money for conversion to EMRs. Judy Faulkner was a very large contributor to President Obama.
As a radiologist, I’ve found the opposite to be true even more often. Surgeon/ER/hospitalist: I need a CT with contrast, but the patient has kidney issues. Radiologist: in order for me to see what you’re looking for, we’ll need contrast. What’s the GFR? Surgeon/ER/hospitalist: eGFR is 55. Radiologist: Oh, that’s no big deal. I thought you were talking about a GFR of like 16. Contrast shouldn’t be a problem. Nephrologist: STOP! NO! *Disclaimer: the better nephrologists are more like the ones in the video, and I wish most of my fellow radiologists weren’t such weenies! 😅
I would have thought the Nephrologist would appreciate the extra care and caution taken by Radiology to ensure the health and safety of his Lil' Bean Bro's.
No one likes getting the same baseless consult over and over again. I am happy to take obgyn consults from my colleagues but every time I get a vaginal bleeder and then on exam she’s bleeding from her rectum, a part of me gets just a little saltier.
@@thepapschmearmdAre people just like "Oh, she's bleeding from between her legs, and she's a woman... must be vaginal!" Like, is it that hard to determine the source of the bleeding without your help?!
This EXACT scenario happened to my child this week. Laughing loudly while sitting in the hospital and shared this gem with the doctors who also got a good laugh. Thank you for spreading joy today. Haha
"Will be there til the end of time" -- guess that's why they named it _EPIC_ !!! hahaha I'm just an old college drop out who loves your vids Dr G. Rings true with what I have osmosised over decades of patient experience with various maladies. Capstone was my covid ICU experience where I learned I could read my own chart in near-real-time via mychart on the TV screen in my room with integrated web browser. I learned so much about hospital politics that time not to mention enjoying the adventure of the crazy Kafkaesque mashup of 21st century high-tech with my own personal near-death experience. It was like having a window into each doctor's and nurse's souls contrasting what they said to me vs reading what they were really thinking all along.
Dear god, I never wanted to see that Epic login screen again since I was laid off and they closed the PT dept at my hospital! My sympathies to all who still deal with this human-crushing entity!
Let patients add&edit their own meds list! For your sanity, I hope no one else starts offering suggestions, but OMG it is nearly impossible to get a meds list anywhere near accurate if you see multiple doctors - especially when they aren't on the same systems. 🤐🤐🤐
I love this. Never before the fear of contrast induced kidney injury has so much medical investigation been stopped for so little evidence. In my hospital you can't order scans with contrast without writing the creatinine on the chart.
Sometimes when i see orders back and forth between nephro and cardiologists now , your scripts are running in my background. This humor makes things light. Relieves stress :-). Thank you
Had a patient with CKD who got a left heart cath that found he a 90% occlusion. Instead of doing the PCI (or calling nephrology) they stopped the procedure because they “weren’t sure if it’s okay to give more contrast”. Two days later they took the patient back for the PCI and it was a new radiologist who refused the procedure because his creatinine bumped 10%. Real life cardiology vs radiology attending right happened right on the floor.
Thank God the Nephrologist didn’t hear the med student basically calling it contrast induced nephropathy, otherwise a whole lecture of 45 mins would have been given to correct him; and calling it contrast associated nephropathy
"Fun" contrast story, and not sure if I was onto the right thing still but I'll mention it anyway: was in dermatology clinic as a med student, in came a patient (retired engineer) that was covered in an red, itchy rash that no body could diagnose or treat, biopsies showed nothing significant for both garden variety and less common diagnoses. The skin reaction had started when he received IV contrast for a procedure and it never sent away. I was chatting with him and asked, half jokingly, if he'd been hanging around Chernobyl at all (being British background in Australia I didn't expect he would have). You can't imagine my surprise then when he said "actually I have, no one told us how bad it was at the time, but I was involved in the clean up effort." He'd also sadly had fertility issues. I've had a few clinicians in Aus brush off a DX of radiation sickness/rash, but in the absence of anything else, with that history, plus the scientific research/treatments carried out in the Baltic states post Chernobyl, it's not an impossible diagnosis. It makes me wonder if we should actually ask this is a question for contrast screening for certain patients 😅 If I'm wrong I'm sure infectious diseases would be proud of the history taking, at least 😂
This is medicine for you in a nutshell. The numerous pop-ups from Epic where Doctors spend an inordinate amount of time, not taking care of the patient. So glad I am in my late 50s and will be able to retire, hopefully the next 7-8 years. Bureaucracy, tons of paperwork, and ridiculous EMR requirements taking the fun out of medicine.
My husband, who is a nephrologist, has at least one weekly fight with cardiology/radiology over this. May this skit spread awareness so that his life becomes easier lol
Don't forget to draw the macula densa! (I was once praised, lauded and pointed out as an outstanding clever student during prac for finding the macula densa on a kidney section; I happened to have moved the microsocope eyepiece as I desperately tried to make sense of what I was looking at, and the pointer randomly landed on it. I had no idea what it was - I had to go and look it up after class. And this was BI (Before Internet), so I had to find it in an actual book.) Is nephrology shaking his salt cannister as a warning a case of parallel evolution, analogous to the way a rattlesnake uses its tail?
As a former CT technologist, this brought flashbacks. If only I had a dollar for every time I had to call a radiologist about a low GFR, because the ER doc didn't believe contrast can cause further kidney damage in someone with CKD. So glad those days are over. And I also got sleepy when the lights were too bright. To this day, I turn down the lights when I walk in a room :)
Former epic employee! If something has an epic warning box, that is 100% on your health system for not wanting to remove it. We absolutely can remove it quite easily, but it's up to your health system, not Epic. Blame your admin bros
Yeah, a lot of people in the comments here are attributing to Epic what their hospital decided to configure. It's not perfect software by any means, but most of their frustration is coming from their own organization's managment and IT
Even back in nursing school a decade ago we were taught to check the GFR if a test was being ordered with contrast. Now being a dialysis patient myself, I'm so asking about this the next time our nephro rolls through the clinic.
I used to work for a totally-not-related company called Epic, and I was never sure whether the looks I got at the hospital when asked for my employer name was recognition, horror, despair, or rage... 😄
Spot on! I’m in internal medicine and we constantly get consults from surgery expecting us to “reverse” CKD so they can scan a patient like we’re some kind of magicians
Just saw you hit the mill; man, what a ride. Still remember this all started out with a fake channel of an impersonator of moderate size and a challenge to “reach the same number”. And now look where you are 🎉❤
It's true. Epic gives you warnings whenever you give iodine contrast. It always says some weird stuff like 50 mL's of contrast is like 150% of appropriate consumption, or that acute kidney disease will be severely exacerbated for patients on metformin. Doctors keep ordering contrast studies anyway 😂
Haha nailed it. As the radiology reg, I just love saying "well you can give it if you want, but you'll have to get renal involved...". We dont really believe it, they don't believe it, but it goes straight into the category of "not my problem" and I saunter off back into the darkness. Don't even get me started on Gad 😂
