One of the more nebulous concepts I've learned this year is the interplay between correctional facilities, law enforcement, psychiatry, and medicine. The patients that have experience with the first two likely have a prickly relationship with the latter. The rule with the last three is that they will give you the benefit of the doubt if you're nice and don't heavily abuse any one part of the system. Of course biases exist, as studies (and experience) have shown over and over again. If your community's criminal or indigent population are socioeconomically distinct from the people taking care if them, they fare worse in the system.
Yesterday my medical team got a patient that had been spurned by the other three parts of the network. He was put in jail for drug charges, treated for opioid dependency with methadone while in jail and then released without any attempt to taper the medication or set him up with a rehab facility. In an attempt to get a fix, he immediately did IV heroin for several days while living on the street. Realizing he needed help, he came to our psychiatric ER looking for help detoxing. He was released a few hours later because there weren't enough beds to admit him for detox. He was given a MetroCard and directions to rehab shelters with instructions to go to an ER if he started showing any of the dangerous symptoms of detox.
Six minutes later he checked into our medical ER. At this point he complains of some vague detox symptoms and, oddly enough, pain in his finger. Over a month ago in prison, he had cut his hand. The wound had never healed and now was deep into the joint. Sadly, he probably should have been just bandaged up and sent on his way if one ER doctor hadn't heard a heart murmur when listening to the guy's chest. We never heard the murmur again, but it was enough to get him a bed for the night as we worked-up an unlikely, but potentially serious diagnosis of ok infective endocarditis.
I find it interesting and terrifying that these entities that are meant to help people can be so temperamental. One moment, a patient is our charge to be defended by the system when the next they are a burden to be pushed to the next sap that has to take them. People who need psychiatric treatment are arrested, in jail they are kept from the psychiatric and medical treatment they need, then they are released without any hope of recovering or surviving on their own and end up either in an ER or on the way back to jail. Don't get me wrong; sometimes the system does work. But in my very short experience in medicine, I've already seen it fail more times than should be allowed.
The benevolent connection between all four of the previously mentioned groups (corrections, police, psych and med) is social work. These are the only people that seem to bridge the gaps in this societal support system. They are also frequently the only people who help the patients navigate the time between the four services.
YesterdayIL: The frog-leg test is a way to test for asterixis (flapping movements indicative of a brain infection) when the patient is unconscious.
TIL: For a P wave to be a P wave it must come from the SA node.
Cardiac pain is midline and lasts 2-20 minutes NOT seconds or hours.
Heart pain can cause a patient to tense their chest muscles to the point where they are sore. This is good to remember because a reproducible pain usually rules out heart problems, but the muscle sprain can be reproducible even after the heart pain has subsided.
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