Not Lost in the Hospital

Three real friends—and real doctors—James, Brodie, and Josh pull back the curtain on the hospital maze. From the ER to the ICU, they explain what’s really happening so you’ll never feel lost if you find yourself there.

Episode Transcript

(00:12):
talk about the confusion, the controlled chaos, the ups and downs, and the common questions and pain points that patients experience as they go through this journey.
We're asked questions by patients multiple times a day, and we're hoping that some education into how and why things happen will be useful to our listeners.
Regardless of where you live, our healthcare systems need improvements and revamps sometimes knowing the reality of what is happening can spark some discussions and change ideas.

(00:39):
If that does come up during the podcast, please let us know.
glad to be here.
Welcome to not another medical podcast. 9 00:01:09,316.009957749 --> 00:01:11,86.009957749 I'm James Jung, a general surgeon. 10 00:01:11,419.964503204 --> 00:01:11,869.964503204 I am Brody. 11 00:01:11,869.964503204 --> 00:01:12,409.964503204 Nolan. 12 00:01:12,439.964503204 --> 00:01:13,609.964503204 I'm an emergency doctor. 13 00:01:13,913.373594113 --> 00:01:14,598.373594113 I'm Josh Levitt. 14 00:01:14,748.373594113 --> 00:01:18,108.373594113 I'm an internal medicine physician and this is not another medical podcast. 15 00:01:18,158.373594113 --> 00:01:19,323.373594112 So thanks for tuning in. 16 00:01:19,683.373594112 --> 00:01:21,123.373594112 This is our, our first episode. 17 00:01:21,123.373594112 --> 00:01:24,663.373594112 First, first stab at this if, if you will, if we're allowed to talk about stabbing on the show. 18 00:01:25,113.373594113 --> 00:01:36,275.873594112 But I think it's only fair, you know, you're hearing from us hearing our voice the first time just Brody, what do you mean a lot of stabbing? I work in the emergency department, Not everything is about stabbing Brody. 19 00:01:37,292.373594113 --> 00:01:51,238.37359411 for Brody but I think it's, it's really fair for us to spend a bit of time just getting to know who we are, why we wanted to do this and why hopefully it'll be of interest to you guys or not, but you know, we're at least three minutes in now, so too late. 20 00:01:52,233.37359411 --> 00:01:52,563.37359411 Might as well. 21 00:01:54,309.37359411 --> 00:01:56,859.37359411 Actually James, you were kinda incremental in bringing this together. 22 00:01:56,939.37359411 --> 00:01:58,829.37359411 This kind of like your, your origin story, man. 23 00:01:58,829.37359411 --> 00:02:01,756.87359411 So what what happened? How'd we get here? Yeah. 24 00:02:01,756.87359411 --> 00:02:07,96.87359411 Thanks for recognizing whose great idea this was to bring the three of us together. 25 00:02:07,546.87359411 --> 00:02:15,856.87359411 the three of us, became really close friends starting first day of medical school, which was, I think, 17, 18 years ago. 26 00:02:16,276.87359411 --> 00:02:18,646.87359411 And we spent a lot of times together. 27 00:02:19,216.87359411 --> 00:02:23,86.87359411 You know, initially studying, you know, to be safe doctors. 28 00:02:23,416.87359411 --> 00:02:44,186.87359411 But as we got older and as we spent more time, looking after patients, advancing in our career and becoming more experienced heads and exchanging a lot of stories of our, great achievements and some of the struggles that we've had professionally, we've realized that, you know, being. 29 00:02:44,236.87359411 --> 00:03:19,806.87359411 a very caring physician is really, it's not only about knowing the facts, but it's about understanding the patient's perspective and having empathy and not just sympathy So, you know, as we got a little older I thought it would be a great idea for us to spend some time together understanding and sharing stories about, What are some of the important things that patients think about when they come in and really put ourselves in the shoes of the patients and navigate through this complex medical system that is what we're dealing with today. 30 00:03:19,856.87359411 --> 00:03:21,706.87359411 And, that's the purpose. 31 00:03:22,106.87359411 --> 00:03:24,116.87359411 And during this time we're gonna have a little bit of fun. 32 00:03:24,506.87359411 --> 00:03:28,226.87359411 I think you know, it's hard to go through all of this without humor. 33 00:03:28,226.87359411 --> 00:03:30,696.87359411 So, that's the reason that we got together. 34 00:03:30,696.87359411 --> 00:03:30,726.87359411 I. 35 00:03:31,544.37359411 --> 00:03:31,694.37359411 Yeah. 36 00:03:31,694.37359411 --> 00:03:35,714.37359411 I mean, I think if, if patients are the number one listener for this, I'd argue that. 37 00:03:36,554.37359411 --> 00:03:39,374.37359411 We're then the second most important list. 38 00:03:39,424.37359411 --> 00:03:44,194.37359411 This is probably my, one of my favorite things for doing this is just getting to FaceTime into you guys again. 39 00:03:44,794.37359411 --> 00:03:52,654.37359411 You know, we all used to be literally down the street here that Jay, Josh and I actually in the same building for an extended period of time when we were a couple years ago. 40 00:03:52,844.37359411 --> 00:03:56,504.37359411 So yeah, it's just great to, to be able to, to catch up and see you guys like this. 41 00:03:56,504.37359411 --> 00:03:58,64.37359411 So I'm, I'm mostly excited for that. 42 00:03:59,738.37359411 --> 00:04:00,188.37359411 Me too. 43 00:04:00,193.37359411 --> 00:04:01,338.37359411 And, I'll tell the listeners. 44 00:04:01,368.37359411 --> 00:04:04,638.37359411 The reason I'm here is 'cause these two were on vacation one day. 45 00:04:04,918.37359411 --> 00:04:10,78.37359411 They called me, I think it was around 10 o'clock at night when I was trying to get to bed and they said, Hey, we have a great idea. 46 00:04:10,78.37359411 --> 00:04:11,68.37359411 Let's do a podcast. 47 00:04:11,438.37359411 --> 00:04:12,188.37359411 I said, hell no. 48 00:04:12,188.37359411 --> 00:04:13,268.37359411 I don't have time for this. 49 00:04:13,388.37359411 --> 00:04:18,428.37359411 And then three weeks later, I was somehow buying a microphone on the same screen doing a podcast. 50 00:04:18,558.37359411 --> 00:04:19,908.37359411 clearly I love these guys. 51 00:04:19,908.37359411 --> 00:04:24,429.37359411 Clearly I couldn't say no to them and on, peer pressure is a is a real thing. 52 00:04:25,278.37359411 --> 00:04:26,508.37359411 Oh, it's the best. 53 00:04:26,508.37359411 --> 00:04:27,888.37359411 I love peer pressure guys. 54 00:04:28,548.37359411 --> 00:04:39,748.37359411 And yeah, on a serious note so much of our work is talking to patients in a voice that they can understand, and many healthcare practitioners are not great at that. 55 00:04:40,378.37359411 --> 00:04:40,948.37359411 So. 56 00:04:41,278.37359411 --> 00:04:47,318.37359411 We wanted a medium where we could talk to lots of patients and some of the things we talk about will be relevant to, some of them won't. 57 00:04:48,548.37359411 --> 00:04:53,408.37359411 but it's a really great chance for us to talk in just a normal day-to-day voice. 58 00:04:54,68.37359411 --> 00:05:03,68.37359411 Not get into the details of the medicine, but really talk about what the patient's going through, what they need to know, and hopefully we can answer some questions that you may have had or answer questions you didn't know yet. 59 00:05:04,816.87359411 --> 00:05:06,286.87359411 And we would love to hear from you. 60 00:05:06,316.87359411 --> 00:05:10,826.87359411 Listeners you know, our contact information is gonna be published in the note. 61 00:05:11,106.87359411 --> 00:05:17,316.87359411 So please, send us voicemails, send us emails, any kind of mail you could write it too. 62 00:05:17,756.87359411 --> 00:05:20,396.87359411 We would love to hear from you and learn from you. 63 00:05:21,243.37359411 --> 00:05:23,93.37359411 James, I'm not given my phone number out. 64 00:05:23,93.37359411 --> 00:05:24,383.37359411 You are welcome to. 65 00:05:24,469.37359411 --> 00:05:25,934.37359411 Yeah, I dunno. 66 00:05:25,934.37359411 --> 00:05:27,194.37359411 We're gonna open a PO box guys. 67 00:05:27,194.37359411 --> 00:05:28,839.37359411 It seems like a lot of, a lot of effort. 68 00:05:29,431.87359411 --> 00:05:37,51.87359411 I think this reveals your age, Josh, but you could send the voice memo through email, so you know, I'm just letting you know. 69 00:05:37,793.37359411 --> 00:05:38,933.37359411 just get this outta the way guys. 70 00:05:38,993.37359411 --> 00:05:43,823.37359411 So I'm the oldest one of the crew by about five years, and you're gonna hear a lot of jokes about that. 71 00:05:43,823.37359411 --> 00:05:48,734.37359411 And the hip surgery I had so get used to Oh, it's the hip surgery episode one. 72 00:05:49,364.37359411 --> 00:05:50,84.37359411 Spoiler alert. 73 00:05:50,213.37359411 --> 00:05:51,246.87359411 gotta throw it out Yeah. 74 00:05:51,293.37359411 --> 00:05:52,73.37359411 a patient too. 75 00:05:52,343.37359411 --> 00:05:53,483.37359411 Yeah, it's gonna happen. 76 00:05:53,963.37359411 --> 00:05:54,383.37359411 Oh man. 77 00:05:54,700.87359411 --> 00:05:55,30.87359411 Alright. 78 00:05:55,43.37359411 --> 00:05:55,253.37359411 Yeah. 79 00:05:55,930.87359411 --> 00:06:05,100.87359411 you know, I think, Josh, you picked out this topic that I think is such a great topic for, a first episode to really open up this podcast. 80 00:06:05,440.87359411 --> 00:06:09,980.87359411 tell us a little more, Josh about, why you thought this topic was important and why you chose this. 81 00:06:11,32.37359411 --> 00:06:17,947.37359411 I mean, I kinda mentioned it before and Brody probably sees us just as much, if not more than both of us as an Emerge doc. 82 00:06:18,47.37359411 --> 00:06:25,427.37359411 There are so many steps in the medical system once you get into the hospital and we're really gonna focus on hospital. 83 00:06:25,427.37359411 --> 00:06:28,287.37359411 All of us work in hospital for the most part. 84 00:06:29,327.37359411 --> 00:06:37,187.37359411 through my work as a physician through some of my leadership positions where I sit on committees that help with flow, kind of moving patients through the hospital and things like that. 85 00:06:37,892.37359411 --> 00:06:40,532.37359411 Like patients have no clue what is going on. 86 00:06:40,772.37359411 --> 00:06:48,782.37359411 And unfortunately, and we'll talk about it a little more, communication breaks down constantly in hospital, despite everyone's best efforts. 87 00:06:48,842.37359411 --> 00:06:52,22.37359411 And there's a couple things as we talk about this that I really want to point out. 88 00:06:52,122.37359411 --> 00:07:00,792.37359411 I think number one is that healthcare practitioners, for the most part are doing the best they can in their work, hospital or otherwise. 89 00:07:01,508.37359411 --> 00:07:02,258.37359411 Totally agree with that. 90 00:07:02,332.37359411 --> 00:07:06,52.37359411 every job has people who are bad at their jobs or lazy, and that's fair. 91 00:07:06,52.37359411 --> 00:07:09,472.37359411 But I think the majority of our colleagues are doing the best they can. 92 00:07:10,282.37359411 --> 00:07:20,362.37359411 I also wanna say the majority of patients are sympathetic, empathetic, caring, and understand that things will not run smoothly as maybe we want. 93 00:07:20,422.37359411 --> 00:07:25,642.37359411 And I do have to thank every patient I've worked with 'cause the majority are super understanding in a really tough system. 94 00:07:26,323.37359411 --> 00:07:26,743.37359411 Totally. 95 00:07:26,893.37359411 --> 00:07:30,163.37359411 And I, I'd add to that too, it's, they're often usually for in pain. 96 00:07:30,253.37359411 --> 00:07:31,123.37359411 They're uncomfortable. 97 00:07:31,153.37359411 --> 00:07:33,793.37359411 Like they're, they're coming to the hospital not 'cause they're feeling great for the most time. 98 00:07:33,793.37359411 --> 00:07:40,423.37359411 So on top of that, yeah, having some degree of understanding when you're already probably having one of the worst days of your life is also quite exceptional. 99 00:07:40,473.37359411 --> 00:07:40,683.37359411 Yep. 100 00:07:40,983.37359411 --> 00:07:41,313.37359411 Thank you. 101 00:07:41,313.37359411 --> 00:07:42,213.37359411 That, that's a great point. 102 00:07:42,663.37359411 --> 00:07:47,43.37359411 And then logistically, just so you guys know, so Brody and I work in Ontario, Canada. 103 00:07:47,973.37359411 --> 00:07:49,23.37359411 works in the United States. 104 00:07:49,23.37359411 --> 00:07:50,823.37359411 So the, we're gonna talk about the hospital system. 105 00:07:50,823.37359411 --> 00:07:56,853.37359411 There's going to be discrepancies, but these themes are going to carry through most hospital visits probably around the world if I was a guessing person. 106 00:07:58,53.37359411 --> 00:08:03,369.37359411 So why, why don't we get into it a little bit, guys? You cool with it? Let's what we're here for. 107 00:08:03,933.37359411 --> 00:08:04,173.37359411 Yep. 108 00:08:05,203.37359411 --> 00:08:08,23.37359411 We need more witty banter. 109 00:08:08,766.87359411 --> 00:08:16,538.37359411 I, can I decline to proceed? you are welcome to, and that's James is out, podcast left. 110 00:08:17,219.37359411 --> 00:08:21,389.37359411 once again, this is our first and last episode of not another medical podcast. 111 00:08:21,811.87359411 --> 00:08:24,179.37359411 God, We've made it 12 minutes. 112 00:08:24,179.37359411 --> 00:08:24,989.37359411 Boy, it's well done. 113 00:08:25,208.37359411 --> 00:08:26,11.87359411 We yes. 114 00:08:26,138.37359411 --> 00:08:27,278.37359411 Alright, let's move forward. 115 00:08:27,728.37359411 --> 00:08:36,213.37359411 So listen, the journey through the medical system, let's just say we do need to go to the hospital and it's, the emergency room is the big first beast. 116 00:08:36,363.37359411 --> 00:08:45,883.37359411 I would say, but Brody, knowing that you work a lot in pre-hospital kind of paramedics and things like that, I don't know if there's anything you wanna say before we even get into the Yeah, for sure. 117 00:08:45,883.37359411 --> 00:08:47,903.37359411 It, it's a good thought to think about, right? I mean yeah. 118 00:08:47,903.37359411 --> 00:08:53,753.37359411 Often we think about your hospital care being once you arrive at the hospital, obviously, but you're right, A lot of patients, especially if they're sick or unwell. 119 00:08:53,903.37359411 --> 00:08:55,943.37359411 Will first come in with an ambulance. 120 00:08:55,973.37359411 --> 00:08:59,173.37359411 You know, you're feeling unwell, you're having chest pain, you're having difficulty breathing. 121 00:08:59,183.37359411 --> 00:09:03,863.37359411 You think you're having a stroke calling 9 1 1 or whatever your local number would be. 122 00:09:03,863.37359411 --> 00:09:07,163.37359411 And, getting an ambulance and paramedics dispatched to you and there's all sorts of different. 123 00:09:07,523.37359411 --> 00:09:11,353.37359411 Levels of care that they can do and, and medications they can provide. 124 00:09:11,383.37359411 --> 00:09:13,903.37359411 And sometimes even actually decide which hospital you go to. 125 00:09:14,253.37359411 --> 00:09:22,923.37359411 So for example, in Ontario we have bypass criteria if someone is having a massive heart attack or a stroke or if they're a trauma patient, like if they're severely injured. 126 00:09:23,343.37359411 --> 00:09:31,53.37359411 So even, yeah, just that initial contact with the paramedics before you go to a hospital might actually dictate where you get brought to It's a really good point, Josh. 127 00:09:31,153.37359411 --> 00:09:37,243.37359411 And then, yeah, then you know, the, the emerge is certainly the the, the front doors of the hospital for most, most places. 128 00:09:38,178.37359411 --> 00:09:45,168.37359411 It is, and it's just walking in there is just overwhelming, especially if you go kind of during the busy time. 129 00:09:45,168.37359411 --> 00:09:59,183.37359411 So, Brody, why don't you just kind of break it down to what happens when you walk into an emerge? Like what are the steps that are gonna take? What are the big maybe pain points or delays that patients may understand why they're happening? Break it down for us. 130 00:09:59,339.37359411 --> 00:09:59,999.37359411 Yeah, for sure. 131 00:10:00,4.37359411 --> 00:10:08,194.37359411 and again, I'll do the caveat that I'll mostly be speaking about kinda the experience at our hospital and knowing that there's different methods that different hospitals might take on, on that kinda initial approach. 132 00:10:08,194.37359411 --> 00:10:10,894.37359411 But for the most part, when you walk in, you're gonna go to a place called triage. 133 00:10:10,994.37359411 --> 00:10:12,554.37359411 And often that's staffed by nurses. 134 00:10:12,944.37359411 --> 00:10:14,714.37359411 They'll go in and you have to some degree of registration. 135 00:10:14,714.37359411 --> 00:10:17,534.37359411 Because of course, you know, to be a patient, we need to have your information. 136 00:10:17,534.37359411 --> 00:10:20,924.37359411 We need to get your, your health card, your insurance information. 137 00:10:20,994.37359411 --> 00:10:24,54.37359411 If you've been to the hospital before, we'll have to link that with your other medical records. 138 00:10:24,54.37359411 --> 00:10:36,364.37359411 So we need to right off the bat off just kind of ask who are you, give us some information about yourself just so we can start to do the process of making a patient record for you if you haven't been there, to link it to your other patient record if you have been there previously. 139 00:10:36,714.37359411 --> 00:10:39,549.37359411 able to, able to talk If you, Yes. 140 00:10:39,561.87359411 --> 00:10:39,891.87359411 it's true. 141 00:10:40,101.87359411 --> 00:10:43,401.87359411 If you can't speak, you get to kind of bypass the line, which we'll get to that in a little bit. 142 00:10:44,511.87359411 --> 00:10:44,801.87359411 Yeah. 143 00:10:45,209.37359411 --> 00:10:50,939.37359411 But yeah, it's often you'll see one of the triage nurses first and they kind of do a bit of like a rudimentary history and some initial vital signs. 144 00:10:50,939.37359411 --> 00:11:05,914.37359411 You know, what's your heart rate, your blood pressure, your temperature? Do you have a fever? What's your oxygen levels? Really, it's all kind of probabilities, like, how sick are you or do we think you are? Or how quickly do we think you need to be tended to kind of based on this one time snapshot for what you look like right now. 145 00:11:06,364.37359411 --> 00:11:08,44.37359411 And that's kind of usually it. 146 00:11:08,74.37359411 --> 00:11:10,804.37359411 After that, you get registered and then you end up waiting. 147 00:11:11,304.37359411 --> 00:11:17,864.37359411 And this is where, a lot of emergency departments have different zones, so they might have a higher acuity zone or a major zone. 148 00:11:18,134.37359411 --> 00:11:20,624.37359411 Then they sometimes have an ambulatory or a minor zone. 149 00:11:20,834.37359411 --> 00:11:28,149.37359411 But usually after triage process, there's a little bit of waiting to figure out where you're gonna go and which area we think you'd be best suited to be treated for. 150 00:11:29,109.37359411 --> 00:11:31,94.37359411 Yeah, I could provide some key statistics. 151 00:11:31,124.37359411 --> 00:11:44,444.37359411 in 2022, which is the most recent data that I was able to access, there were approximately 155 million visits to the emergency room in the United States, and that's roughly about 47 visits per hundred people. 152 00:11:44,444.37359411 --> 00:11:47,984.37359411 So, the chances of, somebody visiting the emergency room. 153 00:11:48,434.37359411 --> 00:11:48,914.37359411 is high. 154 00:11:48,921.87359411 --> 00:11:49,341.87359411 Mm-hmm. 155 00:11:49,614.37359411 --> 00:12:12,244.37359411 and the other thing that, I wanted to say is after the patients are triaged, we talked about the waiting, and unfortunately that's part of it because the resources are limited and, I think the wait times will be different in the United States versus Canada, but the statistics that I have on average it's about 163 minutes of stay in the emergency room in 2023. 156 00:12:12,244.37359411 --> 00:12:13,924.37359411 That's the national median time. 157 00:12:13,924.37359411 --> 00:12:18,496.87359411 So that's the middle, which, for you guys, that's like a really good That's a pretty good name. 158 00:12:18,844.37359411 --> 00:12:20,366.87359411 Yeah, which is really Can't beat that. 159 00:12:20,504.37359411 --> 00:12:22,94.37359411 Ontario, where you guys work. 160 00:12:22,424.37359411 --> 00:12:24,314.37359411 Where in December, 2023. 161 00:12:24,314.37359411 --> 00:12:28,634.37359411 This was published by McLean's, which is one of their national magazines. 162 00:12:28,664.37359411 --> 00:12:31,244.37359411 The average wait time was about 22 hours. 163 00:12:31,544.37359411 --> 00:12:32,677.87359411 A being admitted. 164 00:12:32,894.37359411 --> 00:12:33,194.37359411 sorry. 165 00:12:33,194.37359411 --> 00:12:38,575.37359411 A magazine is one of those book things, right? That, that Well, Josh, Josh, like, I It's a podcast with pictures, Josh. 166 00:12:38,722.87359411 --> 00:12:39,862.87359411 this more than anyone here. 167 00:12:40,734.37359411 --> 00:12:44,4.37359411 I open up my local newspaper and see what the wait time is. 168 00:12:45,89.5007329 --> 00:12:47,939.5007329 And it's a good time to kind of pivot to talk about that triage that we do. 169 00:12:47,969.5007329 --> 00:12:52,979.5007329 'Cause again, you know, the emergency department doesn't, you know, work in a fashion of, you get seen the order which you register. 170 00:12:52,979.5007329 --> 00:12:54,479.5007329 And I think a lot of people understand that now. 171 00:12:54,479.5007329 --> 00:13:00,809.5007329 And actually James was with your numbers and of people just kind of had experience with that, which can certainly be a frustrating part at that at some point as well. 172 00:13:00,809.5007329 --> 00:13:18,509.5007329 But, by default, you know, the system has to be there to work for those that are the sickest, right? So those that aren't breathing, those that have abnormal vital signs, those that, need, time critical intervention to like really minutes matter, right? And, and those, the patients that you know, do get to kind of prioritize and triage first. 173 00:13:18,879.5007329 --> 00:13:22,737.0007329 give us some of the examples of, what those highest priorities Totally. 174 00:13:22,737.0007329 --> 00:13:23,7.0007329 Yeah. 175 00:13:23,69.5007329 --> 00:13:23,999.5007329 for the listeners. 176 00:13:23,999.5007329 --> 00:13:28,537.0007329 Like what are some of the, you know, that you're Yeah, for sure. 177 00:13:28,537.0007329 --> 00:13:36,937.0007329 So in Canada we use something called the CA, which is the Canadian triage and acuity system, which is just, again, a scoring system that the nurses can apply quickly with their vital signs. 178 00:13:36,937.0007329 --> 00:13:48,447.0007329 But, you know, really at a high level, you're thinking of, you know, does this patient have major trauma like bleeding? Are they having a stroke, any kind of neurological deficits? And then you kinda look at, their vital signs. 179 00:13:48,447.0007329 --> 00:13:55,977.0007329 do they have, a super fast heart rate? Do they have a super low blood pressure? Are their oxygen levels low? And those are kind of the mainstay treatments at that point. 180 00:13:56,307.0007329 --> 00:14:03,997.0007329 A little bit further down, the triaging, if someone has chest pain, we'll do an ECG really early on to look for, signs of a massive heart attack that you'd see in signs of an ECG. 181 00:14:04,27.0007329 --> 00:14:05,47.0007329 But those are really the things. 182 00:14:05,47.0007329 --> 00:14:10,967.0007329 So it's, you know, if, if someone is, they're not speaking or they're not, able to follow commands and unstable vital signs. 183 00:14:10,967.0007329 --> 00:14:13,27.0007329 So those are ones that kind of get bumped up the higher level. 184 00:14:13,27.0007329 --> 00:14:21,747.0007329 And often they'll kind of again, get rushed in or brought by paramedics and we'll, in the really bad cases, bring 'em to our resuscitation bay or a trauma bay to kind of bring the whole team together. 185 00:14:22,896.0007329 --> 00:14:26,496.0007329 and just for listeners, we're not advocating that any of these things happen to you. 186 00:14:26,606.0007329 --> 00:14:29,507.0007329 Just so you get in faster, Yeah, yeah, yeah. 187 00:14:29,507.0007329 --> 00:14:37,217.0007329 There's also the notion often that we see too, that sometimes people think that by coming in, by paramedics, that you kinda get to bypass the line as well, at least certainly for our shop in Ontario. 188 00:14:37,217.0007329 --> 00:14:42,827.0007329 That's not true either, you know? and unfortunately once you hit the door, it's triage for all that that dictates kind of where you go. 189 00:14:43,826.0007329 --> 00:14:52,16.0007329 And, this is like having been a patient myself, both personally with my kids, like this is frustrating as hell and I think we could say hell on this podcast. 190 00:14:52,66.0007329 --> 00:14:52,786.0007329 We will see way worse. 191 00:14:53,20.0007329 --> 00:14:53,530.0007329 Yeah, we'll see. 192 00:14:53,530.0007329 --> 00:14:53,830.0007329 Way worse. 193 00:14:55,0.0007329 --> 00:15:02,800.0007329 because you, you may come in with whatever you come in with, but if 30 people who are sicker come in after you, you're probably waiting lot longer. 194 00:15:02,800.0007329 --> 00:15:07,540.0007329 And this, unfortunately, this is unpredictable and working in a system is unpredictable. 195 00:15:07,540.0007329 --> 00:15:09,160.0007329 Leads to a lot of, a lot of waiting. 196 00:15:09,460.0007329 --> 00:15:12,460.0007329 So we're gonna talk about waiting a lot, I think. 197 00:15:13,81.0007329 --> 00:15:13,201.0007329 Yeah. 198 00:15:13,360.0007329 --> 00:15:14,941.83406623 So why Hey, hey Brody. 199 00:15:15,1.83406623 --> 00:15:21,481.83406623 You've worked in, all different days of the week in emergency room, all different time shifts of the shifts that are available. 200 00:15:22,981.83406623 --> 00:15:28,126.0007329 There's no evidence in this, but kind of your anecdotes, like, what is the best time, Oh man. 201 00:15:28,126.0007329 --> 00:15:32,116.0007329 Do you, you want the, the trick, like if you, obviously, if. 202 00:15:32,336.0007329 --> 00:15:34,106.0007329 You know, you are very unwell. 203 00:15:34,106.0007329 --> 00:15:35,696.0007329 You should go immediately. 204 00:15:35,855.0007329 --> 00:15:36,75.0007329 Or. 205 00:15:36,243.5007329 --> 00:15:36,953.5007329 And it, Yeah. 206 00:15:37,583.5007329 --> 00:15:41,93.5007329 But you know, sometimes you have something that like, you know, maybe could wait a bit. 207 00:15:41,273.5007329 --> 00:15:42,893.5007329 you sprain your ankle, it's sore. 208 00:15:43,103.5007329 --> 00:15:45,113.5007329 You maybe wanna go get an x-ray. 209 00:15:45,153.5007329 --> 00:15:47,943.5007329 I had a fever for a couple days, not feeling well. 210 00:15:47,943.5007329 --> 00:15:49,113.5007329 But you don't need to go right away. 211 00:15:49,163.5007329 --> 00:15:51,203.5007329 As a whole, Mondays usually be the worst day. 212 00:15:51,663.5007329 --> 00:15:57,123.5007329 typically as the day goes on, we kind of, we kind of joke sometimes about like the bus shows up or at around like 10 or 11. 213 00:15:57,123.5007329 --> 00:16:01,53.5007329 So like, usually after 11 or 12, that's where a lot more people start to register and it makes sense. 214 00:16:01,53.5007329 --> 00:16:03,543.5007329 More people are awake, they're up, they're doing stuff again. 215 00:16:03,543.5007329 --> 00:16:15,493.5007329 A lot of emerge is sometimes injuries or now you're, you know, you're haven't heard from someone that maybe you spoke to last night and you're checking in on them and that, you know, leads to a wellness check and you're finding people you know, after they haven't heard from overnight. 216 00:16:15,493.5007329 --> 00:16:15,733.5007329 So. 217 00:16:16,488.5007329 --> 00:16:20,118.5007329 The best time to go would be early in the morning. 218 00:16:20,388.5007329 --> 00:16:29,88.5007329 Usually around like a seven to eight to 9:00 AM would probably be the, the, the lowest chance of having to wait a long time, at least at our shop. 219 00:16:29,238.5007329 --> 00:16:32,618.5007329 But again, unsolicited advice no guarantees on any of that. 220 00:16:32,686.0007329 --> 00:16:47,156.0007329 I, I, I think that's good to know, you know? think it's also good to know to avoid going to the emergency room after a particularly rowdy like Red Sox game in Boston or, Yeah, anytime after a long holiday, Halloween. 221 00:16:47,483.5007329 --> 00:16:49,946.0007329 event, man? Or St. 222 00:16:50,93.5007329 --> 00:16:50,573.5007329 Halloween. 223 00:16:50,573.5007329 --> 00:16:51,53.5007329 New Year's. 224 00:16:51,53.5007329 --> 00:16:51,263.5007329 St. 225 00:16:51,263.5007329 --> 00:16:51,803.5007329 Patrick's. 226 00:16:52,106.0007329 --> 00:16:52,406.0007329 Yeah. 227 00:16:53,87.5007329 --> 00:16:56,147.5007329 Championship parades for sports teams, Yeah, yeah. 228 00:16:56,331.5007329 --> 00:16:57,111.5007329 this is all good stuff. 229 00:16:57,111.5007329 --> 00:16:57,891.5007329 I'm taking notes here. 230 00:16:57,941.5007329 --> 00:16:58,241.5007329 Yeah. 231 00:16:58,305.5007329 --> 00:17:00,95.5007329 don't we Get through the triage. 232 00:17:00,405.5007329 --> 00:17:02,175.5007329 we've had our medical issue. 233 00:17:02,205.5007329 --> 00:17:11,995.5007329 We've, slowly getting into the emergency room, what, what's happening in the background, what are the docs and nurses doing in the main emergency room? While all these patients are being triaged and put on some kind of list, I assume. 234 00:17:12,646.5007329 --> 00:17:14,326.5007329 Yeah, kind of juggling all of that stuff. 235 00:17:14,356.5007329 --> 00:17:24,386.5007329 I mean,, a lot of hospitals have medical directives for the nurses, which allow them to do things like blood work and ECGs, sometimes even order chest x-rays or different imaging on patients before the doctor sees you. 236 00:17:24,416.5007329 --> 00:17:27,626.5007329 Some hospitals actually put a doctor right at triage, so as soon as they see you, they can. 237 00:17:27,626.5007329 --> 00:17:40,821.5007329 And take a bit more of a history and order those blood tests and imaging The challenge is those things take time, right? Like we take your blood and it, it goes to a laboratory in the hospital and then they, do tests on it and just, it takes time to do all of those things. 238 00:17:40,861.5007329 --> 00:17:43,231.5007329 And that often takes like an hour and a half. 239 00:17:43,641.5007329 --> 00:17:45,321.5007329 For most of the blood work just to come back. 240 00:17:45,631.5007329 --> 00:17:50,631.5007329 And sometimes there's also a bit of weight for, for imaging especially if it's more advanced imaging. 241 00:17:50,631.5007329 --> 00:17:52,851.5007329 So things like CT scans often take a long time. 242 00:17:52,851.5007329 --> 00:17:59,121.5007329 Ultrasounds can take a long time, but that's all the stuff that's kind of cooking in, in the background kind of while, while you're waiting. 243 00:17:59,451.5007329 --> 00:18:05,431.5007329 And then, you know, to to that point you know, because the emerges is, unpredictable, you know, all the nurses and doctors. 244 00:18:05,481.5007329 --> 00:18:06,891.5007329 They're also balancing all the other patients. 245 00:18:06,891.5007329 --> 00:18:08,751.5007329 And also then there are other tests coming back. 246 00:18:08,751.5007329 --> 00:18:14,631.5007329 So it's not just seeing the new ones, but following up on the people when their tests and their imaging are back and being, okay, I need to go back and see them. 247 00:18:14,631.5007329 --> 00:18:15,471.5007329 I need to discharge 'em. 248 00:18:15,471.5007329 --> 00:18:18,651.5007329 But sometimes you get pulled and a thousand different directions at this time. 249 00:18:18,681.5007329 --> 00:18:21,351.5007329 'cause now all of a sudden there's an EC, G in your face of like, Hey, can you look. 250 00:18:21,361.5007329 --> 00:18:23,11.5007329 This, Hey, this person's blood work is back. 251 00:18:23,11.5007329 --> 00:18:23,941.5007329 This one's X-rays back. 252 00:18:23,941.5007329 --> 00:18:25,471.5007329 This one needs more pain medication. 253 00:18:25,471.5007329 --> 00:18:28,81.5007329 So there's a lot of stuff kind of going in the background. 254 00:18:28,111.5007329 --> 00:18:35,131.5007329 But that being said, if you're worried, if you're uncomfortable, if you're pain, that's also a reason to speak and to let us know so we can try to address some of that. 255 00:18:35,500.9610466 --> 00:18:40,270.9610466 So, you see the doc and they said, okay, like you need a CT scan. 256 00:18:40,300.9610466 --> 00:18:43,60.9610466 Right? Which increasingly is more utilized these days. 257 00:18:43,420.9610466 --> 00:18:51,710.9610466 And some statistics here, there was a study of above 56,000 emergency visits Approximately half of them require some form of imaging. 258 00:18:52,40.9610466 --> 00:18:56,850.9610466 So from the patient's perspective, what does it mean? when the doctor says, you need a CT scan. 259 00:18:57,43.4610466 --> 00:18:57,778.4610466 Oh man, it. 260 00:18:57,780.9610466 --> 00:19:06,593.4610466 a machine come to you and then, take a little picture of you or what happens for the patient? Can we I think that CT scans certainly at our hospital is one of the big bottlenecks that we have. 261 00:19:06,653.4610466 --> 00:19:09,243.4610466 'Cause a lot of people are going for imaging. 262 00:19:09,293.4610466 --> 00:19:17,673.4610466 And I think we're doing more CT scans because people are, it's more medically complex, you know, and I think our testing is kind of pushing us to this way to try to get more. 263 00:19:18,143.4610466 --> 00:19:24,203.4610466 Accurate diagnosis and information, which just means that we often need to get more, like, better imaging for, for some of those things. 264 00:19:24,593.4610466 --> 00:19:31,823.4610466 And so usually for me, again, talking to my shop, like if someone's going for a CT scan, I say, you're gonna be here for a few hours just for that. 265 00:19:31,873.4610466 --> 00:19:37,353.4610466 Obviously that probably doesn't apply to other hospitals and centers, but for the most part, there's a delay to get the CT scan. 266 00:19:37,743.4610466 --> 00:19:42,903.4610466 You then often have to, leave your room, so there's some degree of waiting for a porter or someone to bring you there. 267 00:19:43,203.4610466 --> 00:19:47,733.4610466 The CT scan itself usually only takes like five to 10 minutes for the most part. 268 00:19:47,793.4610466 --> 00:19:49,863.4610466 It's not like you're in there for a long time. 269 00:19:49,913.4610466 --> 00:19:56,3.4610466 But then to take some time for the images that be put together, you then need a radiologist to, to have a look and to read it and put a report back. 270 00:19:56,303.4610466 --> 00:20:00,343.4610466 And again, those are all the things that are going on in the background that take time for us to figure out what's going on. 271 00:20:00,425.9610466 --> 00:20:05,305.9610466 a and also for the CT scan, while we're talking about that, some of the studies require contrast. 272 00:20:05,355.9610466 --> 00:20:10,415.9610466 these are, agents that, pop out the images so that we can understand the images better. 273 00:20:10,465.9610466 --> 00:20:13,735.9610466 some of the contrast are through iv, like intravenous. 274 00:20:14,65.9610466 --> 00:20:16,65.9610466 Some of them are through oral. 275 00:20:16,65.9610466 --> 00:20:22,278.4610466 So you drink a contrast, tastes like chalky water that nobody Yeah, it's gross. 276 00:20:22,512.4610466 --> 00:20:26,172.4610466 why haven't we got a better flavor? Like even the dentist gives us better flavors for Flo. 277 00:20:26,242.4610466 --> 00:20:33,892.4610466 I agree with you Josh, though, I think this is probably gonna be the theme of, some of what we talk about, but the customer service in medicine has not been really topnotch. 278 00:20:33,922.4610466 --> 00:20:34,222.4610466 Right. 279 00:20:34,283.9610466 --> 00:20:35,362.4610466 This is, So. 280 00:20:35,373.9610466 --> 00:20:36,63.9610466 Well said. 281 00:20:36,333.9610466 --> 00:20:36,603.9610466 Yeah. 282 00:20:36,612.4610466 --> 00:20:37,62.4610466 Yeah. 283 00:20:37,492.4610466 --> 00:20:41,482.4610466 so there's, you know, contrast that you have to drink and, you know, you have to time it. 284 00:20:41,692.4610466 --> 00:20:49,962.4610466 Sometimes you have to get contrast through rectum if there are particular reasons why you want to understand that area a little better if you had colorectal surgeries and things like that. 285 00:20:50,962.4610466 --> 00:20:55,282.4610466 And then IV contrasts have to be tied, so all of those things could take time. 286 00:20:55,312.4610466 --> 00:20:59,692.4610466 I think there's variations on how long it takes for people to get a CT scan. 287 00:20:59,692.4610466 --> 00:21:02,422.4610466 Certainly longer in Canada versus here in the United States. 288 00:21:02,702.4610466 --> 00:21:05,782.4610466 But it's not something that you could just snap your finger and get it done. 289 00:21:05,782.4610466 --> 00:21:08,752.4610466 You know, it takes time to get these things, but these are very. 290 00:21:09,47.4610466 --> 00:21:12,137.4610466 Cts are increasingly becoming important. 291 00:21:12,137.4610466 --> 00:21:17,449.9610466 Over the last 10 years, there's been about 150% increase in use of CT scan That's impressive. 292 00:21:17,537.4610466 --> 00:21:17,687.4610466 room. 293 00:21:18,19.9610466 --> 00:21:24,49.9610466 So what I'm hearing here, and I know this, I just kinda wanna break it back to the patient's views. 294 00:21:24,49.9610466 --> 00:21:25,999.9610466 So we're sitting in the emerge. 295 00:21:26,209.9610466 --> 00:21:28,969.9610466 We've had blood taken, we've had a doctor. 296 00:21:29,419.9610466 --> 00:21:32,929.9610466 We of talk to us about our symptoms, do a physical exam. 297 00:21:32,929.9610466 --> 00:21:34,999.9610466 We've had a nurse do a whole bunch of stuff. 298 00:21:35,419.9610466 --> 00:21:44,449.9610466 We maybe even had some medication and then we're just waiting and we're waiting for an unknown amount of time because we don't know how many people are waiting for the CT scan. 299 00:21:44,719.9610466 --> 00:21:48,169.9610466 We don't know how long it's gonna take for the radiologist to read those results. 300 00:21:49,99.9610466 --> 00:21:52,334.9610466 Why is no one coming and talking to me, the patient about. 301 00:21:53,269.9610466 --> 00:22:05,205.9610466 long things are gonna be, or why the delays, because I know everyone sitting around me is asking the same question, like, when am I gonna see someone? Why is this taking so long? Why is no one talking to me? Yeah, I think we can do a better job on that. 302 00:22:05,255.9610466 --> 00:22:10,385.9610466 honestly, the challenge is we are so limited from a human. 303 00:22:10,880.9610466 --> 00:22:14,990.9610466 Healthcare resource perspective, we just don't have the people to go around to do it. 304 00:22:14,990.9610466 --> 00:22:18,920.9610466 if you kind of bird's eye, just, just sit in, in the emergent watch. 305 00:22:18,920.9610466 --> 00:22:20,960.9610466 Everyone's kind of just running around. 306 00:22:20,960.9610466 --> 00:22:23,720.9610466 it's very much like chaos, but organized chaos to a degree hopefully. 307 00:22:23,970.9610466 --> 00:22:31,160.9610466 But we're not set up well for having the time necessarily to circle back as much as we should, which I think is certainly a disservice to the patients. 308 00:22:31,240.9610466 --> 00:22:34,930.9610466 And I'm sure that there is a way for us to do things better. 309 00:22:34,980.9610466 --> 00:22:40,230.9610466 But I think it's, we're also stuck with kind of those realisms of what the system is like right now. 310 00:22:40,530.9610466 --> 00:22:40,820.9610466 Yeah. 311 00:22:41,94.4610466 --> 00:22:41,384.4610466 Yeah. 312 00:22:41,841.1277133 --> 00:22:42,111.1277133 Sorry. 313 00:22:42,161.1277133 --> 00:22:58,666.1277133 I mean, I think certainly the limited, expert resources, I think, you know, giving, you know, talking about diagnosis, when you're unwell, right? This could be a variety of things, right? Like something like, oh, you have a skin cut, is. 314 00:22:59,361.1277133 --> 00:23:01,971.1277133 Easy for everybody to see that that is it. 315 00:23:02,1.1277133 --> 00:23:05,721.1277133 And then, you know, it's not something that you're gonna be very upset about. 316 00:23:05,721.1277133 --> 00:23:18,31.1277133 you know that there's a cut there, but if you have a new diagnosis of cancer, or you have, they found that you're critically unwell, your loved one is critically unwell, potentially terminal condition. 317 00:23:18,216.1277133 --> 00:23:27,931.1277133 You know, that's not something you want to delegate to, most responsible physician, like, you want the most senior physician to talk to the patients about that. 318 00:23:27,931.1277133 --> 00:23:28,201.1277133 Right. 319 00:23:28,571.1277133 --> 00:23:36,951.1277133 in my mind I'm thinking like, oh, can we do, and a lot of people say like, oh, can we delegate to AI chat bot to talk about that? No. 320 00:23:36,951.1277133 --> 00:23:43,771.1277133 these are kind of things where you want, like, I'm sure the chat bots provide some sort of, very. 321 00:23:44,101.1277133 --> 00:23:56,441.1277133 Good description of things in as empathic way as possible, but you want to be able to talk to a human being, who could hold your head when talking about these things and who could empathize with you and, have that human touch. 322 00:23:56,441.1277133 --> 00:24:02,241.1277133 So I think, you want to wait for that human, emerge doc to talk to you in these situations. 323 00:24:03,477.6277133 --> 00:24:08,972.6277133 And I'll say May, maybe as the three of us solve the healthcare system right now. 324 00:24:09,28.6277133 --> 00:24:09,318.6277133 Yeah. 325 00:24:10,72.6277133 --> 00:24:13,192.6277133 Maybe there is this role for like AI is going to be an in-between. 326 00:24:13,192.6277133 --> 00:24:19,42.6277133 While you're waiting, maybe some AI magic happens that actually keeps you up to date on things and where things are at as best it can. 327 00:24:19,222.6277133 --> 00:24:20,992.6277133 So there's some really cool stuff that might come from that. 328 00:24:21,278.6277133 --> 00:24:27,268.6277133 I am seeing more and more that patients have access to all their medical records, which is perfect, right? it's so helpful on so many levels. 329 00:24:27,368.6277133 --> 00:24:32,468.6277133 And what I found interesting is more recently, sometimes they'll actually get the results before I've had the chance to look at it. 330 00:24:32,728.6277133 --> 00:24:35,8.6277133 Which is great because then they're informed and they have all of that. 331 00:24:35,168.6277133 --> 00:24:35,978.6277133 But then sometimes they're like. 332 00:24:36,338.6277133 --> 00:24:37,268.6277133 Hey, my results are back. 333 00:24:37,268.6277133 --> 00:24:43,838.6277133 Why has it taken you so long to come back and to see? But it's so great to see the access that people have to their care. 334 00:24:43,838.6277133 --> 00:24:49,98.6277133 And I think they're a lot more informed about what's going on and what we're, doing in the background Which is, a good step forward. 335 00:24:49,812.6277133 --> 00:24:50,52.6277133 Yeah. 336 00:24:50,352.6277133 --> 00:24:54,462.6277133 So I think right now it's pretty important to say that as healthcare professionals. 337 00:24:54,837.6277133 --> 00:24:58,527.6277133 The majority of us understand how stressful it is for patients sitting in the rooms. 338 00:24:58,527.6277133 --> 00:25:08,787.6277133 And we are remarkably empathetic to the degree we can be, but all the stresses and the under resources is that a word? It is now. 339 00:25:09,846.6277133 --> 00:25:15,56.6277133 The lack of resources, honestly, it prevents us from coming and talking to you as much as we need to. 340 00:25:15,56.6277133 --> 00:25:19,346.6277133 And I'm not just talking doctors, I'm talking nurses, I'm talking physiotherapists, everyone who works in there. 341 00:25:20,576.6277133 --> 00:25:22,466.6277133 It is something we have to do better, like you said, Brody. 342 00:25:22,916.6277133 --> 00:25:26,556.6277133 So let's just push through the system a little bit so we've got some test results back. 343 00:25:26,916.6277133 --> 00:25:30,516.6277133 Maybe someone's gonna be discharged and we'll just put that on the back burner for a second. 344 00:25:32,16.6277133 --> 00:25:34,536.6277133 One of the next things that can bring you into the hospital is. 345 00:25:35,871.6277133 --> 00:25:37,101.6277133 needs a specialist. 346 00:25:37,531.6277133 --> 00:25:51,901.6277133 A specialist meaning that something's come up in a test or the story where the primary emergency doctor work is done, they need a specialist to come and talk to the patient and decide what to do next. 347 00:25:51,961.6277133 --> 00:26:01,376.6277133 Does the patient need to be admitted and where to go from here? So James, you and I are kind of the, the specialists or called consultants in some cases. 348 00:26:01,686.6277133 --> 00:26:07,116.6277133 But James, like, what, what happens there? Brody calls you and says, James, I need, I need a surgical consult. 349 00:26:07,116.6277133 --> 00:26:34,411.6277133 What, what happens on your side of things? So in our healthcare emergency room, as you said is the primary care for emergency situations, and then patients require, specialty consultations like surgery or what, so then, we will hear from the emergency physicians about what the conditions are, and we will do our own review of the patient's conditions and we'll see the patients now. 350 00:26:35,11.6277133 --> 00:26:48,644.1277133 You know so the important thing is when do we see them, right? So they're, Like, yeah, patients have been already waiting for, to be seen by pri, first layer of, doctors and then now there's a second layer of doctors, right? and sometimes a bunch of trainees in between. 351 00:26:49,923.1277133 --> 00:26:52,713.1277133 Guys, this is the really weird visual layers of doctors. 352 00:26:53,163.1277133 --> 00:26:54,333.1277133 I don't want to go there, but I. 353 00:26:55,164.1277133 --> 00:26:57,24.1277133 It's like a club sandwich of medical people. 354 00:27:00,806.6277133 --> 00:27:06,176.6277133 So the outer layer of the sandwich is, the white bread is. 355 00:27:06,539.1277133 --> 00:27:08,9.1277133 the, that's right. 356 00:27:09,129.1277133 --> 00:27:15,99.1277133 the, in, in general surgery, which is one of the most common, you know specialties to be consulted. 357 00:27:15,409.1277133 --> 00:27:18,259.1277133 We understand that we are consulted frequently. 358 00:27:18,509.1277133 --> 00:27:25,169.1277133 So we have established usually a lot of the hospitals do this, but you know, where I work, we have a acute care surgery where. 359 00:27:25,904.1277133 --> 00:27:36,614.1277133 know, they're really focused on taking care of patients who are coming to the emergency room and taking care of those patients who are admitted to their services after surgery or surgical care. 360 00:27:36,894.1277133 --> 00:27:41,254.1277133 So, but that's usually from, you know the daytime. 361 00:27:41,504.1277133 --> 00:27:45,64.1277133 And after 6:00 PM then, somebody has to be available. 362 00:27:45,64.1277133 --> 00:27:51,344.1277133 So it's usually one or two surgeons who take the calls, depending on how big your hospitals are. 363 00:27:51,714.1277133 --> 00:27:57,159.1277133 And they're responsible for all the emergencies, that require surgical care subsequently. 364 00:27:57,169.1277133 --> 00:28:03,559.1277133 some of those times, these surgeons may be operating on patients who already require surgical care. 365 00:28:03,809.1277133 --> 00:28:03,989.1277133 You know, if. 366 00:28:05,414.1277133 --> 00:28:16,184.1277133 happen to be not operating and do not have urgent issues, they'll come and see the patients and perform the assessments and make decisions on what to do. 367 00:28:16,184.1277133 --> 00:28:23,394.1277133 So whether it's, discharging the patient home, if it's deemed safe or bringing in the patients for admissions. 368 00:28:23,754.1277133 --> 00:28:26,844.1277133 And I assume it's very similar for you Josh in internal medicine. 369 00:28:28,410.6277133 --> 00:28:31,620.6277133 Very much so, and it's, Brody calls me for a consult. 370 00:28:31,700.6277133 --> 00:28:35,105.6277133 Oftentimes the majority of patients that I see as an internal medicine Dr. 371 00:28:35,105.6277133 --> 00:28:37,720.6277133 James, I'm not sure about you will get admitted. 372 00:28:37,770.6277133 --> 00:28:40,230.6277133 Not all of them and, and hopefully just. 373 00:28:40,310.6277133 --> 00:28:44,300.6277133 A good emerge doc will prepare them for, Hey, you're going to see this specialist. 374 00:28:44,480.6277133 --> 00:29:04,330.6277133 This might end up in an admission you might be waiting longer because the theme of the day is waiting, and I'm gonna be triaging just like we have in every step of this, where you may be the next patient on my list, I may have 10 patients that I have to see, and I'm going to start usually seeing the sickest one first. 375 00:29:04,690.6277133 --> 00:29:06,340.6277133 Now just from the patient side. 376 00:29:07,120.6277133 --> 00:29:09,970.6277133 Brody consults, one of us, Brody's still involved. 377 00:29:10,160.6277133 --> 00:29:16,1.6277133 and you're still, Brody, correct me if I'm wrong, you're still gonna be looking after the patient until one of us formally takes Yeah. 378 00:29:16,61.6277133 --> 00:29:21,221.6277133 Especially for the, if the Emerge, I mean the Emerge team spirit, we're always there to kind of help out, make sure you're paying control. 379 00:29:21,641.6277133 --> 00:29:23,531.6277133 Yeah, so, we do try to work as a team. 380 00:29:23,581.6277133 --> 00:29:27,931.6277133 one of us are gonna get to you, we're going to ask a whole bunch of the same questions again. 381 00:29:27,931.6277133 --> 00:29:29,431.6277133 And we are sorry about that. 382 00:29:29,671.6277133 --> 00:29:31,81.6277133 We're gonna review tests. 383 00:29:31,531.6277133 --> 00:29:35,941.6277133 You might even get a different view from one of us than what the emergency room doctor has. 384 00:29:35,941.6277133 --> 00:29:41,41.6277133 And that's not that necessarily anyone's right or wrong, it's just we have different specialties and different views. 385 00:29:42,71.6277133 --> 00:29:46,421.6277133 These specialists have more time to review than the Emerge doc does. 386 00:29:46,421.6277133 --> 00:29:53,351.6277133 So we may just have gathered a bit more information 'cause the Emerge doc, at the end of the day, treat people sick or not sick. 387 00:29:53,561.6277133 --> 00:30:05,271.6277133 And what happens next? Go home or admit to or refer to specialist where the specialist has to decide truly, okay, here's a bit longer of a plan, whether it's going home with a plan or being admitted for a plan. 388 00:30:05,481.6277133 --> 00:30:06,801.6277133 So at the end of the day, again. 389 00:30:07,556.6277133 --> 00:30:08,276.6277133 We're triaging. 390 00:30:08,276.6277133 --> 00:30:11,156.6277133 We're seeing people as fast as we can, but that could be a delay of one hour. 391 00:30:11,156.6277133 --> 00:30:13,516.6277133 That could be a delay of a lot of hours. 392 00:30:13,584.5097994 --> 00:30:19,739.5097994 Yeah, so, some of the, statistics here, CDC had published this, every year, but about. 393 00:30:19,864.5097994 --> 00:30:24,664.5097994 13% of visits to the emergency room resulted in hospitalization or admission. 394 00:30:24,664.5097994 --> 00:30:29,884.5097994 So when people say you're admitted, you know, that means you're spending time in the hospital overnight. 395 00:30:31,84.5097994 --> 00:30:35,164.5097994 the older you are, the more likelihood of your emergency room visit. 396 00:30:35,484.5097994 --> 00:30:36,864.5097994 Translating into admission. 397 00:30:36,904.5097994 --> 00:30:43,624.5097994 If you're between age 60 to 69, it's about 19% of emerge visits, ages nineties and over. 398 00:30:43,624.5097994 --> 00:30:46,504.5097994 It's about 33% chance of being admitted to the emergency room. 399 00:30:46,504.5097994 --> 00:30:54,114.5097994 It just shows you about severity of illness or existing, conditions that you already have that leads to the sickness that you may feel. 400 00:30:54,866.0097994 --> 00:30:55,86.0097994 Hey. 401 00:30:55,134.5097994 --> 00:31:05,635.5097994 let's say you're admitted, right? And what happens? So does that mean that now you're gonna go to the bed on the ward, or do you get to wait be, wouldn't it be More. 402 00:31:05,660.5097994 --> 00:31:08,180.5097994 if we just did this, like 180 be like, no, you get a bed immediately. 403 00:31:08,180.5097994 --> 00:31:08,660.5097994 Of course you do. 404 00:31:08,660.5097994 --> 00:31:10,610.5097994 Why would you wait? That is not gonna happen. 405 00:31:10,700.5097994 --> 00:31:12,230.5097994 I'm just gonna go back and say one thing. 406 00:31:12,540.5097994 --> 00:31:14,670.5097994 The 13% admission I didn't actually know that. 407 00:31:14,720.5097994 --> 00:31:15,50.5097994 Mm-hmm. 408 00:31:15,74.5097994 --> 00:31:16,364.5097994 as high as I thought it might be. 409 00:31:16,694.5097994 --> 00:31:21,239.5097994 If you are being consulted by a specialist, I think though the percentage of people who are. 410 00:31:22,49.5097994 --> 00:31:24,119.5097994 consulted will have a very high admission rate. 411 00:31:24,119.5097994 --> 00:31:28,619.5097994 Like people who are consulted to an internist, probably 80 plus percent of those people are going to be admitted. 412 00:31:29,39.5097994 --> 00:31:30,839.5097994 based on how good the Emerge stocks are. 413 00:31:32,256.0097994 --> 00:31:33,216.0097994 Careful James. 414 00:31:33,246.0097994 --> 00:31:34,26.0097994 Careful James. 415 00:31:34,380.0097994 --> 00:31:34,500.0097994 yeah. 416 00:31:34,550.0097994 --> 00:31:39,110.0097994 Although I am getting butterflies thinking about the times when I was actually calling you guys on the phone. 417 00:31:39,160.0097994 --> 00:31:40,540.0097994 Those were much easier conversations. 418 00:31:40,540.0097994 --> 00:31:41,140.0097994 I enjoyed those. 419 00:31:41,199.0097994 --> 00:31:44,439.0097994 Brody age used to work together in a, in a former life. 420 00:31:45,559.0097994 --> 00:31:48,379.0097994 So yeah, once you get admitted, no, you are waiting. 421 00:31:48,379.0097994 --> 00:31:51,169.0097994 And honestly, you could be waiting a long time. 422 00:31:51,229.0097994 --> 00:31:58,519.0097994 And this is where I, I don't know about the states, but hallway medicine has become very, very prominent in Canada, and hallway medicine is very literal. 423 00:31:58,519.0097994 --> 00:32:00,649.0097994 It means you are stuck in a hallway bed. 424 00:32:01,309.0097994 --> 00:32:06,19.0097994 And there are a whole bunch of reasons for this, there are so many patients. 425 00:32:06,109.0097994 --> 00:32:15,949.0097994 There is so little room in hospitals, and there are so few hospitals for the population we have that we literally have to create beds in hallways just to house patients. 426 00:32:16,669.0097994 --> 00:32:20,839.0097994 So when you get admitted, you may be stuck in that hospital bed because that's the closest thing we have. 427 00:32:21,499.0097994 --> 00:32:26,299.0097994 That hospital bed is often in the emergency room, so it does kind of make the emergency room a bit busier. 428 00:32:27,349.0097994 --> 00:32:30,349.0097994 We will always be trying to get you to a ward bed. 429 00:32:30,449.0097994 --> 00:32:33,839.0097994 Which is the ward being whether you're on a surgical ward or otherwise, or medical ward. 430 00:32:34,149.0097994 --> 00:32:36,9.0097994 But that's also gonna depend on what you're there for. 431 00:32:36,9.0097994 --> 00:32:45,339.0097994 So if you're there with something like a lung infection, a pneumonia, you're gonna need special isolation or precautions, and only certain beds are able that. 432 00:32:45,339.0097994 --> 00:32:46,869.0097994 So that's gonna limit which beds you go. 433 00:32:47,869.0097994 --> 00:32:50,239.0097994 certain diseases need what's called telemetry, where we have a. 434 00:32:51,169.0097994 --> 00:32:54,319.0097994 Kind of ongoing heart monitor on you at all times. 435 00:32:54,499.0097994 --> 00:32:56,569.0097994 And only certain wards or certain beds can handle that. 436 00:32:56,569.0097994 --> 00:33:00,769.0097994 So if you go in with one of those things, you're probably waiting longer for a bed than the next person. 437 00:33:00,795.6764661 --> 00:33:06,825.6764661 There are certain wards that if the general surgery ward doesn't have any beds, you may be stuck in the emergent until James finally discharges the patient. 438 00:33:06,825.6764661 --> 00:33:07,995.6764661 'cause we know he's slow. 439 00:33:08,115.6764661 --> 00:33:10,935.6764661 And James, please start discharging patients 'cause we need those beds. 440 00:33:11,655.6764661 --> 00:33:12,975.6764661 Lots of reasons you'll be stuck. 441 00:33:13,35.6764661 --> 00:33:16,575.6764661 But again, communication probably won't be ideal as you'd like it to be. 442 00:33:16,666.6764661 --> 00:33:18,980.6764661 So, Again, I think that, most negative person here. 443 00:33:18,980.6764661 --> 00:33:19,220.6764661 Guys. 444 00:33:19,220.6764661 --> 00:33:19,820.6764661 Help me out. 445 00:33:20,356.6764661 --> 00:33:21,196.6764661 yeah, this is a bit of a downer. 446 00:33:21,249.1764661 --> 00:33:23,566.6764661 I mean, you know, I to healthcare. 447 00:33:23,596.6764661 --> 00:33:24,376.6764661 You are waiting. 448 00:33:25,899.1764661 --> 00:33:38,949.1764661 well, so, right? Certainly, it's about, resources, right? So,, it's about how many beds and what workforce, we're talking about physicians, nurses, physician assistants and, so forth. 449 00:33:39,319.1764661 --> 00:33:44,839.1764661 Who could provide, the appropriate amount of help for the number of beds that are available. 450 00:33:45,239.1764661 --> 00:33:49,669.1764661 And, it's about finding appropriate level of beds, like, you talked about, Josh. 451 00:33:49,699.1764661 --> 00:34:01,959.1764661 Maybe can you touch a little bit about,, what's the difference between Just the regular bed versus step down or, or observation status versus the intensive care unit. 452 00:34:02,39.1764661 --> 00:34:02,819.1764661 Yeah, for sure. 453 00:34:02,999.1764661 --> 00:34:11,909.1764661 And just to be a little more positive, as much as this, all this waiting is happening, even though it doesn't feel like it, people do know what's going on in the background. 454 00:34:11,909.1764661 --> 00:34:13,679.1764661 People are constantly looking at tests. 455 00:34:13,679.1764661 --> 00:34:19,919.1764661 we're constantly triaging, and if something big is going on or a test comes back with something scary, we're going to be on it quickly. 456 00:34:20,89.1764661 --> 00:34:21,439.1764661 Yeah, it's, it's, it's a good point. 457 00:34:21,591.6764661 --> 00:34:22,11.6764661 late. 458 00:34:22,41.6764661 --> 00:34:24,584.1764661 Josh, I think you made everyone sad Yeah, exactly. 459 00:34:24,858.1764661 --> 00:34:25,188.1764661 Yeah. 460 00:34:25,238.1764661 --> 00:34:27,98.1764661 It's funny because I'm usually the positive guy. 461 00:34:28,599.1764661 --> 00:34:28,749.1764661 Yeah. 462 00:34:28,749.1764661 --> 00:34:31,565.1764661 And Josh will refill all of your antidepressants for you by the end of the episode. 463 00:34:32,463.1764661 --> 00:34:37,301.6764661 Yeah, yeah, so tell us about the beds, Josh Enough with the sad stories. 464 00:34:37,683.1764661 --> 00:34:38,73.1764661 Yeah. 465 00:34:38,133.1764661 --> 00:34:40,23.1764661 How sick you are determines where you go. 466 00:34:41,143.1764661 --> 00:34:43,303.1764661 We have a certain number of intensive care unit beds. 467 00:34:43,303.1764661 --> 00:34:45,463.1764661 Those are for the sick, sickest people in the hospital. 468 00:34:45,753.1764661 --> 00:34:51,493.1764661 Those are often people who need quote unquote life support machines, like tubes in the lungs to help them breathe. 469 00:34:51,803.1764661 --> 00:34:57,413.1764661 Those are people who need lots of specialized medications that you need specialized nurses and doctors to give. 470 00:34:57,803.1764661 --> 00:34:58,913.1764661 So those are the sickest people. 471 00:34:58,913.1764661 --> 00:35:02,53.1764661 It's they're, they're usually smaller units. 472 00:35:02,618.1764661 --> 00:35:05,858.1764661 And more and more as, as people get sicker, we need more of that. 473 00:35:06,278.1764661 --> 00:35:09,338.1764661 And there are these things called step down beds, which are kind of the in between. 474 00:35:09,338.1764661 --> 00:35:13,358.1764661 You're sick, but you don't quite need the intensive care unit level of care. 475 00:35:14,18.1764661 --> 00:35:15,698.1764661 You still do need some specialized drugs. 476 00:35:15,698.1764661 --> 00:35:18,908.1764661 You need a bit more monitoring than just a usual ward bed. 477 00:35:19,488.1764661 --> 00:35:21,168.1764661 So not all hospitals have step down units. 478 00:35:21,168.1764661 --> 00:35:22,488.1764661 This is kind of dependent on where you are. 479 00:35:22,758.1764661 --> 00:35:24,798.1764661 Then there's the usual ward beds, which is. 480 00:35:25,233.1764661 --> 00:35:30,903.1764661 You're there, you're obviously there for a good reason, but getting vital signs every four hours, for example, is the norm. 481 00:35:30,903.1764661 --> 00:35:31,683.1764661 And that's fine. 482 00:35:31,923.1764661 --> 00:35:34,923.1764661 The medications everyone are is comfortable giving there. 483 00:35:35,163.1764661 --> 00:35:36,603.1764661 So it's really level of sickness. 484 00:35:36,603.1764661 --> 00:35:38,163.1764661 And again, it's a triage process. 485 00:35:38,403.1764661 --> 00:35:39,938.1764661 It's, a common theme that we're still talking about. 486 00:35:40,781.6764661 --> 00:35:51,35.1764661 is also the ratio providers to the bed or patient, Good that determines this, right? In intensive care unit is like almost one-to-one or, you know whereas step downs maybe one. 487 00:35:51,950.1764661 --> 00:36:11,565.1764661 To two patients, maybe, something like that, right? And then general, you know, beds are usually, you know, one nurse will take care of four or five patients, sometimes more overnight, right? You are absolutely right and as resources allow, yeah, like one to four is a great number, but sometimes it's one to six, one to seven, depending on Mm-hmm. 488 00:36:11,606.6764661 --> 00:36:12,686.6764661 of patients and things like that. 489 00:36:12,686.6764661 --> 00:36:14,46.6764661 So really variable. 490 00:36:14,526.6764661 --> 00:36:17,826.6764661 And as you get further away from that higher acuity, sicker patients. 491 00:36:17,856.6764661 --> 00:36:21,696.6764661 The is going to be less and less just so you know what to expect. 492 00:36:21,696.6764661 --> 00:36:24,816.6764661 When you're on the wards, often you only see the doctor once a day. 493 00:36:25,135.1764661 --> 00:36:25,555.1764661 Mm-hmm. 494 00:36:25,566.6764661 --> 00:36:30,96.6764661 nurses regularly, but communication will probably not be as often as you want it. 495 00:36:30,655.1764661 --> 00:36:31,75.1764661 Mm-hmm. 496 00:36:31,266.6764661 --> 00:36:33,516.6764661 is working in the background and things are happening. 497 00:36:34,215.1764661 --> 00:36:34,635.1764661 Mm-hmm. 498 00:36:34,807.6764661 --> 00:36:36,652.6764661 So you need to come to the hospital. 499 00:36:36,862.6764661 --> 00:36:42,16.6764661 What do you think are some of the, the top takeaways for listeners? Good. 500 00:36:42,66.6764661 --> 00:36:42,186.6764661 I. 501 00:36:42,425.6764661 --> 00:36:42,965.6764661 good question. 502 00:36:42,965.6764661 --> 00:36:45,125.6764661 So, number one, bring some activities. 503 00:36:45,365.6764661 --> 00:36:49,541.6764661 And, and I am joking here, but I'm not I like that. 504 00:36:49,781.6764661 --> 00:36:53,291.6764661 And a charger for if those activities are battery dependent. 505 00:36:53,519.1764661 --> 00:36:57,209.1764661 only if you can participate in other activities other than being sick. 506 00:36:58,115.6764661 --> 00:36:59,855.6764661 Oh no, but Brody brings up a really good point. 507 00:36:59,915.6764661 --> 00:37:00,635.6764661 Bring a charger. 508 00:37:00,635.6764661 --> 00:37:03,5.6764661 'cause nobody can ever find a charger in a hospital. 509 00:37:03,469.1764661 --> 00:37:03,759.1764661 Yeah. 510 00:37:03,810.6764661 --> 00:37:04,975.6764661 If, if you're breaking your phone. 511 00:37:05,365.6764661 --> 00:37:09,925.6764661 So I, I think the big takeaways are you are going to see a lot of waiting. 512 00:37:09,925.6764661 --> 00:37:15,985.6764661 You are going to see communication less than ideal, or at least less than than you want as a patient. 513 00:37:16,885.6764661 --> 00:37:21,325.6764661 everyone in the background is working as best they can with the resources they have. 514 00:37:22,15.6764661 --> 00:37:23,845.6764661 they're going to be there when you're sick. 515 00:37:24,475.6764661 --> 00:37:27,355.6764661 So as much as you're waiting, it is a tough time. 516 00:37:27,355.6764661 --> 00:37:32,965.6764661 In your day, week life, people are there for you. 517 00:37:34,285.6764661 --> 00:37:36,175.6764661 If you need to speak up, you speak up. 518 00:37:36,205.6764661 --> 00:37:39,715.6764661 Don't feel embarrassed about going to the nursing station and asking what's going on. 519 00:37:39,775.6764661 --> 00:37:42,55.6764661 Don't feel weird about flagging someone down. 520 00:37:42,55.6764661 --> 00:37:45,955.6764661 You don't know because often you're not gonna see a nurse that you know or something. 521 00:37:45,985.6764661 --> 00:37:49,75.6764661 So just speak up is a really big point that I think we mentioned. 522 00:37:49,555.6764661 --> 00:37:52,621.6764661 What else am I missing here, guys? Yeah, I think that's great. 523 00:37:52,621.6764661 --> 00:38:00,211.6764661 You know, the, thinking about coming back to, you've spoken a couple times, there's really hospital works based on triage, right? And a lot of the triage that we do. 524 00:38:00,211.6764661 --> 00:38:02,881.6764661 You is given the information we have at that exact point. 525 00:38:03,271.6764661 --> 00:38:04,741.6764661 And things change. 526 00:38:04,741.6764661 --> 00:38:07,771.6764661 We know patients just with illness, they can get sicker over time. 527 00:38:07,771.6764661 --> 00:38:08,401.6764661 Things can change. 528 00:38:08,431.6764661 --> 00:38:12,211.6764661 If all of a sudden your pain is a lot worse, you know, vital signs are changing. 529 00:38:12,301.6764661 --> 00:38:15,281.6764661 These are all things that, the team will follow and should be aware of. 530 00:38:15,281.6764661 --> 00:38:17,501.6764661 And that might kind of change a bit of that trajectory too. 531 00:38:17,561.6764661 --> 00:38:25,181.6764661 So to that point, if you are in a position to be able to advocate for yourself or advocate for your family if you're there those are great ways to. 532 00:38:25,431.6764661 --> 00:38:29,851.6764661 to help ensure that, you're getting the care that you need and the timeliness that you were able to provide. 533 00:38:30,55.8431327 --> 00:38:37,585.8431327 Let's talk about some, you know so these are kind of the core things that we talked about for treatment, you know, and flow of, you know, your care. 534 00:38:37,975.8431327 --> 00:38:44,155.8431327 But, you know, hospital is such a big place and there other things, you know, do you guys have any,. 535 00:38:44,205.8431327 --> 00:38:53,175.8431327 Spots like cafeteria or, or little hidden spots or, you know, my favorite is find the cleanest washroom in the, in the hospital. 536 00:38:53,175.8431327 --> 00:38:55,110.8431327 You know, some of those like, you know. 537 00:38:55,167.3431327 --> 00:38:55,447.3431327 James. 538 00:38:55,467.3431327 --> 00:38:57,567.3431327 Please do not tell us what happens after that. 539 00:38:57,657.3431327 --> 00:38:58,87.3431327 Thank you. 540 00:38:58,961.6764661 --> 00:39:06,988.3431327 Yeah, I'm super lucky that there are so many, like coffee shops, restaurants, all walking distance that you're probably best if you're able to leave to go get food. 541 00:39:07,268.3431327 --> 00:39:08,978.3431327 for me it's anywhere with natural light. 542 00:39:09,8.3431327 --> 00:39:11,139.3431327 Like if you could find an atrium or something I. 543 00:39:11,168.3431327 --> 00:39:15,968.3431327 that just to breathe for a few minutes, whether you're a patient or healthcare practitioner, do it. 544 00:39:17,283.3431327 --> 00:39:24,375.8431327 Back in the old days when we were training, people used to smoke up in the atrium, or anywhere with the open I don't know if we were training that long ago. 545 00:39:24,639.8431327 --> 00:39:24,849.8431327 Yeah, dude. 546 00:39:25,125.8431327 --> 00:39:26,854.8431327 Did we go to the same hospitals? here. 547 00:39:26,933.3431327 --> 00:39:36,215.8431327 Dude, I, I, I remember like, I, I remember people are like, you know, anyways, smoking cigarettes or smoking meth? 'cause yes, I, there would be a benefit. 548 00:39:36,863.3431327 --> 00:39:39,313.3431327 yeah, we've definitely seen both in our old place. 549 00:39:39,413.3431327 --> 00:39:51,303.3431327 Anything else that, we as patients would need to know going into a hospital before we wrap this up? I am just gonna say everybody on both sides try to be kind to each other. 550 00:39:51,753.3431327 --> 00:39:53,433.3431327 It is a high stress environment. 551 00:39:53,673.3431327 --> 00:39:55,173.3431327 People are working the best they can. 552 00:39:55,203.3431327 --> 00:39:59,413.3431327 So both sides, healthcare practitioners and patients work together as best we can. 553 00:39:59,443.3431327 --> 00:40:01,773.3431327 'cause you don't want fighting in a place that's already tough to be in. 554 00:40:02,711.8431327 --> 00:40:04,511.8431327 Yeah, I totally agree with that. 555 00:40:05,651.8431327 --> 00:40:30,331.8431327 one thing that I would say here, you know, this is a, overly simplistic characterization of kind of the average patient's flow, right? So, if you are a patient who are in critical illness, like somebody who needs emergency surgery, somebody who came in with, a trauma, like, high speed motor vehicle accidents and things like that, we expedite the care for these patients. 556 00:40:30,361.8431327 --> 00:40:41,11.8431327 And if you're wondering, why the doctor hasn't come to see you for your cold, it's because they're taking care of, patients who have gunshot wound or patient who have, heart attack or stroke. 557 00:40:41,61.8431327 --> 00:40:43,975.3431327 Or, you know, we, I Of course. 558 00:40:44,101.8431327 --> 00:40:44,701.8431327 in the atrium. 559 00:40:50,620.3431327 --> 00:40:51,910.3431327 Yeah, back when I was trading. 560 00:40:52,0.3431327 --> 00:40:52,540.3431327 That was fun. 561 00:40:53,750.3431327 --> 00:41:04,700.3431327 we do understand and share the frustration that patients are undergoing, in time of stressful, episodes where you are unwell, and you come to the hospitals to get better. 562 00:41:05,30.3431327 --> 00:41:09,670.3431327 And sometimes you feel like, you kind of healed yourself by just waiting like 20 hours. 563 00:41:09,920.3431327 --> 00:41:13,40.3431327 That shouldn't be, the way, patients have to feel. 564 00:41:13,435.3431327 --> 00:41:17,395.3431327 Unfortunately, these things do happen, which is not okay. 565 00:41:17,785.3431327 --> 00:41:25,785.3431327 But as Josh alluded to, please know that vast majority of clinicians are working around the clock to provide the best care. 566 00:41:25,845.3431327 --> 00:41:26,265.3431327 they can. 567 00:41:27,52.8431327 --> 00:41:27,352.8431327 Yeah. 568 00:41:27,357.8431327 --> 00:41:36,497.8431327 and I think might just end with, you know, medicine is an art and I know like we talk about this all the time, but the point of that though is it's also a bit of a game of probabilities. 569 00:41:37,832.8431327 --> 00:41:43,472.8431327 And I say this thinking about patients that maybe you're being discharged home and you've come in, you've had chest pain, you're worried about it. 570 00:41:43,772.8431327 --> 00:41:46,202.8431327 And then the doctors say, well, it's not a heart attack. 571 00:41:46,202.8431327 --> 00:41:47,792.8431327 It's not a blood clot in the lungs. 572 00:41:47,842.8431327 --> 00:41:48,922.8431327 It's not a pneumonia. 573 00:41:49,292.8431327 --> 00:41:51,182.8431327 And you ask, well, what is it? And it's, I don't know. 574 00:41:51,242.8431327 --> 00:41:56,882.8431327 And I'd say, you know, the majority of patients that I'm sending home from the emerge, I don't know what's going on. 575 00:41:57,332.8431327 --> 00:42:05,882.8431327 But we use these tests, this, you know, blood work, your X-rays, your CT scans, your ECGs really is different kind of points to try to see. 576 00:42:05,932.8431327 --> 00:42:17,172.8431327 do we think that, this is within the, the, the range of normal or abnormal? And things can change over time, right? So if you're in a place that you get discharged home and then symptoms change. 577 00:42:17,307.8431327 --> 00:42:24,897.8431327 we always want you to come back, We know that's just the way that diseases work sometimes, right? Like things either get better on their own or they don't. 578 00:42:25,317.8431327 --> 00:42:29,387.8431327 And if things aren't getting better, right? That's, it's the time to kind of go back in a see assessment. 579 00:42:29,447.8431327 --> 00:42:35,217.8431327 So sometimes, you know, it's, it's trying to deliver those assurances that I don't think I see anything big or scary going on today. 580 00:42:35,217.8431327 --> 00:42:39,567.8431327 And I think that it's safe to go home, but there's always that caveat that if things change, we're always open. 581 00:42:39,567.8431327 --> 00:42:40,527.8431327 We always want to come back. 582 00:42:41,17.8431327 --> 00:42:42,127.8431327 Well, at least the emerge is always open. 583 00:42:42,157.8431327 --> 00:42:42,727.8431327 James isn't. 584 00:42:44,287.8431327 --> 00:42:45,7.8431327 He's always in nature. 585 00:42:45,117.0097994 --> 00:42:47,412.0097994 Yeah, I've been smoking pollen these days. 586 00:42:48,72.0097994 --> 00:42:48,822.0097994 my goodness. 587 00:42:49,499.5097994 --> 00:42:49,789.5097994 Yeah. 588 00:42:49,863.5097994 --> 00:42:51,282.0097994 One to two The pollen. 589 00:42:51,312.0097994 --> 00:42:53,202.0097994 The pollen allergy is real. 590 00:42:54,677.0097994 --> 00:42:55,912.0097994 In the southeast where I am. 591 00:42:55,963.5097994 --> 00:42:57,973.5097994 We just had a snowstorm, so we're not there yet. 592 00:42:58,379.5097994 --> 00:42:58,579.5097994 Yeah. 593 00:42:58,699.5097994 --> 00:42:58,979.5097994 I know. 594 00:42:59,413.5097994 --> 00:43:01,753.5097994 I think, why don't we why don't we leave it there. 595 00:43:01,753.5097994 --> 00:43:04,333.5097994 It's been a super fun first podcast. 596 00:43:04,543.5097994 --> 00:43:06,253.5097994 I feel like we should probably do some more. 597 00:43:07,522.0097994 --> 00:43:08,602.0097994 Yeah, I agree. 598 00:43:09,319.5097994 --> 00:43:09,829.5097994 Sign me up. 599 00:43:09,883.5097994 --> 00:43:14,693.5097994 on that, why don't we just thank our listeners for tuning into not another medical podcast, and we'll definitely see you next time. 600 00:43:16,19.5097994 --> 00:43:16,259.5097994 Great. 601 00:43:16,469.5097994 --> 00:43:17,39.5097994 Thanks guys. 602 00:43:17,102.0097994 --> 00:43:19,742.0097994 and please send us a, send us an email voicemail. 603 00:43:20,687.0097994 --> 00:43:23,519.5097994 Or even a Snail mail, we want to hear and see it all. 604 00:43:23,519.5097994 --> 00:43:29,429.5097994 Yeah, as always, we'll leave James' phone number and sin number in the show notes. 605 00:43:29,429.5097994 --> 00:43:29,939.5097994 Thanks everybody. 606 00:43:31,103.5097994 --> 00:43:31,883.5097994 Bye guys.