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     Interestingly, when Doug Nelson wrote his article on "Humor in the Pediatric Emergency Department," (which he compiled from a number of notebooks that were kept in the ED at St. Chris detailing interesting or humorous encounters,) there were some letters to the editor written to Pediatrics reflecting disappointment/disgust that anyone would dare laugh at our patients.

     I was always impressed with his original response to the criticism.  I don't have a copy anymore.  But, if memory serves me correctly, it can be summed up as a heartfelt, "Lighten up."

     P.S.  My favorite addition to the St. Chris notebooks was a response from a teenager who was asked if any diseases ran in the family.  His response---"Yes...chlamydia."
 
> Date: Thu, 27 Aug 2009 11:52:02 -0500
> From: [log in to unmask]
> Subject: Re: Odd visits
> To: [log in to unmask]
> 
> I agree with Fergus, Dr. Soprano, ( odd that name is the one who comes
> forward with the "love your fellow man, kumbyyaa" philosophy isn't it?) take
> the stick out and lighten up. these stories are humerus and I enjoy hearing
> them. Beats the heck out of reading stories about tragedies.
> 
> Marty
> 
> 
> On Wed, Aug 26, 2009 at 7:46 PM, Andrew J Bowman
> <[log in to unmask]>wrote:
> 
> > No names or identifiers
> > And they are funny
> >
> > Typed by my index finger and sent from my iPhone.
> >
> > Andrew J Bowman
> > Acute Care Nurse Practitioner
> > Trauma Nurse Specialist
> > Paramedic
> >
> > Witham Health Services
> > Emergency Department
> > Lebanon, Indiana
> > 765-485-8500 Work
> > 765-426-4189 Cell
> > 765-485-8509 Fax
> >
> > Clarian Arnett Hospital
> > Emergency Department
> > Lafayette, Indiana
> > 765-838-5100 Work
> >
> > Keeney Ambulance & Transport Service (KATS)
> > Staff Educator
> > Lafayette, Indiana
> >
> > On Aug 26, 2009, at 20:32, Joyce Soprano <[log in to unmask]>
> > wrote:
> >
> > Are we done yet, folks? I am sure these parents and patients would be
> >> pretty sad to hear how they are being mocked in such an open forum. I think
> >> we can put an end to this string of emails.
> >>
> >>
> >> --
> >> Joyce Soprano, MD
> >> Associate Professor of Pediatrics
> >> Associate Fellowship Director
> >> Pediatric Emergency Medicine
> >> University of Utah School of Medicine
> >> (801) 587-7448 office
> >> (801) 587-7455 fax
> >>
> >> Interoffice/Hospital Mail: Ped Emerg Med-Williams Bldg. 295 Chipeta
> >> Standard Mail: PO Box 581289, Salt Lake City, UT 84158
> >>
> >>
> >>
> >>
> >>
> >> On 8/26/09 5:37 PM, "Coop" <[log in to unmask]> wrote:
> >>
> >> Ok what do you do with the chief complaint in a 3 year old "my child has
> >> never been himself"?
> >>
> >>
> >>
> >> Robert J. Cooper, MD, FAAP
> >> Orlando Medical Director
> >> After Hours Pediatrics
> >> [log in to unmask]
> >>
> >>
> >>
> >>
> >> ________________________________
> >> From: "Brown, Julie C." <[log in to unmask]>
> >> To: [log in to unmask]
> >> Sent: Wednesday, August 26, 2009 6:33:52 PM
> >> Subject: Re: Odd visits
> >>
> >> Sometimes I can find a symptom:
> >>
> >> 780.91 Fussy infant (baby)
> >> 780.92 Excessive crying of infant (baby)
> >> 780.95 Excessive crying of child, adolescent, or adult
> >> 780.7 Malaise and fatigue
> >> 780.99 Other general symptoms
> >> 792 Nonspecific abnormal findings in other body substances
> >> 799.3 Debility, unspecified
> >> 782.9 Other symptoms involving skin and integumentary tissues
> >>
> >> Plus I might add these V-codes
> >>
> >> V29 Observation and evaluation of newborns for suspected condition not
> >> found
> >> V29.9 Observation for unspecified suspected condition
> >> V71 Observation and evaluation for suspected conditions not found
> >> V71.9 Observation for unspecified suspected condition
> >>
> >> This may be a helpful section of the ICD codes:
> >> SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS (780-799)
> >> This section includes symptoms, signs, abnormal results of laboratory or
> >> other investigative procedures, and ill-defined conditions regarding
> >> which no diagnosis classifiable elsewhere is recorded.
> >> Signs and symptoms that point rather definitely to a given diagnosis are
> >> assigned to some category in the preceding part of the classification.
> >> In general, categories 780-796 include the more ill-defined conditions
> >> and symptoms that point with perhaps equal suspicion to two or more
> >> diseases or to two or more systems of the body, and without the
> >> necessary study of the case to make a final diagnosis. Practically all
> >> categories in this group could be designated as "not otherwise
> >> specified," or as "unknown etiology," or as "transient." The Alphabetic
> >> Index should be consulted to determine which symptoms and signs are to
> >> be allocated here and which to more specific sections of the
> >> classification; the residual subcategories numbered .9 are provided for
> >> other relevant symptoms which cannot be allocated elsewhere in the
> >> classification.
> >> The conditions and signs or symptoms included in categories 780-796
> >> consist of: (a) cases for which no more specific diagnosis can be made
> >> even after all facts bearing on the case have been investigated; (b)
> >> signs or symptoms existing at the time of initial encounter that proved
> >> to be transient and whose causes could not be determined; (c)
> >> provisional diagnoses in a patient who failed to return for further
> >> investigation or care; (d) cases referred elsewhere for investigation or
> >> treatment before the diagnosis was made; (e) cases in which a more
> >> precise diagnosis was not available for any other reason; (f) certain
> >> symptoms which represent important problems in medical care and which it
> >> might be desired to classify in addition to a known cause.
> >> SYMPTOMS (780-789)
> >> NONSPECIFIC ABNORMAL FINDINGS (790-796)
> >> ILL-DEFINED AND UNKNOWN CAUSES OF MORBIDITY AND MORTALITY (797-799)
> >>
> >> Sometimes I feel truly stuck, and will give the diagnosis they came in
> >> suspecting, plus the V-code for concern for condition not found.
> >>
> >> For the 'omphalitis' patient, how about:
> >>
> >> 782.9 Other symptoms involving skin and integumentary tissues
> >> plus
> >> V29.9 Observation for unspecified suspected condition
> >>
> >>
> >>
> >> Julie Brown, MD, MPH
> >> Assistant Professor, Pediatric Emergency Medicine
> >> Mailstop B5520
> >> Seattle Children's Hospital
> >> Seattle, Washington, USA
> >> (206) 987 4016
> >>
> >>
> >> -----Original Message-----
> >> From: don zweig [mailto:[log in to unmask]]
> >> Sent: Wednesday, August 26, 2009 3:05 PM
> >> To: Brown, Julie C.
> >> Cc: [log in to unmask]
> >> Subject: Re: Odd visits
> >>
> >> What do you usually put on normal exam type cases so one may get
> >> paid? is normal exam paid by insurance?
> >>
> >> don
> >> On Aug 26, 2009, at 2:30 PM, Brown, Julie C. wrote:
> >>
> >> I can't help but add to the list:
> >>>
> >>> 1. The baby rushed back by a nurse for omphalitis and mottled
> >>> skin. I
> >>> washed off the gentian violet around the umbi stump, which was healing
> >>> normally, and noted the normal if slightly reticulated skin with brisk
> >>> capillary refill. The tough part was what to give as a diagnosis for
> >>> this beautiful perfectly healthy newborn.
> >>>
> >>> 2. The 3-year-old with a small splinter brought in for streaking
> >>> redness. The resident told me she felt it was cellulitis with
> >>> lymphangitic spread and suggested antibiotics. On exam, it was such a
> >>> linear streak leading away from the splinter, I asked if I could try
> >>> to
> >>> wipe it off, even though Dad had already tried. It came off with
> >>> alcohol, after which Dad remembered that the child's preschool had
> >>> served popsicles that day. At least I could diagnose and remove the
> >>> splinter.
> >>>
> >>>
> >>> Julie Brown
> >>> CONFIDENTIALITY NOTICE: This e-mail message, including any
> >>> attachments, is for the sole use of the intended recipient(s) and
> >>> may contain confidential and privileged information protected by
> >>> law. Any unauthorized review, use, disclosure or distribution is
> >>> prohibited. If you are not the intended recipient, please contact
> >>> the sender by reply e-mail and destroy all copies of the original
> >>> message.
> >>>
> >>> For more information, send mail to [log in to unmask] with
> >>> the message: info PED-EM-L
> >>> The URL for the PED-EM-L Web Page is:
> >>> http://listserv.brown.edu/ped-em-l.html
> >>>
> >>
> >>
> >> CONFIDENTIALITY NOTICE: This e-mail message, including any attachments,
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> >>
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> >>
> >>
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> >>
> >>
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> >>
> >
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> >
> 
> 
> 
> -- 
> Marty
> Martin Herman, M.D.
> Pediatric Emergency Specialists, P.C.
> Lebonheur Children's Medical Center
> Memphis Tn 38103
> 901 405 1407 ( office)
> 901 219 9202 ( cell)
> 901 287 5986 ( ED office)
> 901 287 6226 ( ED fax)
> 
> Help fight blindness. Support the Memphis VisionWalk 2009. Go to
> www.visionwalk.org.
> find the Memphis TN chapter and follow the prompts to make a donation to my
> team " watch out for that Pole!", or form a team of your own or, simply make
> a donation.
> Thanks!
> Marty and Lynette, Vision Walk Event CHairs for 2009..
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
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