Orthopedic Surgeon Excited To Complete Fellowship in Left Pinky.

St Louis, MO --  Dr. James Bender is proud to call St. Louis home after 12 grueling years of training to become just one of five orthopedic surgeons nationwide super super subspecialized in the left pinky finger.  Redding Orthopedics, the largest multispecialty orthopedic practice in Missouri, hired Dr. Bender last month to be the group's go-to-guy for left pinky pathology.   He joins other highly specialized orthopedists in the group, including one spine surgeon who will only operate on L3 and a wrist surgeon who will only tackle injuries of the right Positions* bone

To become a super, super subspecialist, Dr. Bender had to complete four years of medical school, a five year orthopedic residency, a one year hand fellowship, a one year bilateral pinky fellowship and a one year left pinky fellowship.  After 12 years of clinical training, he joins just  four other distinguished colleagues on the  American Academy of Left Pinky Orthopedic Surgeons.

"I thought about doing another one year fellowship on the distal phalange of the left pinky but I was finally ready to make a difference in people's lives between 8 a.m. and 4:30 p.m. on Mondays, Tuesdays and Wednesdays that don't fall on a holiday," said Dr Bender,who was later shocked to learn he would still have to take general ortho call for his group at four different hospitals.

"I intentionally super, super subspecialized myself into outpatient orthopedics, but my group made made me take all general ortho and trauma call day and night for the next two years,  I don't even remember the bones of the hip anymore."

Hospitalists and ER doctors were livid at Redding Orthopedics.  "That group has been pulling this crap for years.  Whenever we call Dr. Bender, he says 'I don't do anything but the left pinky' and hangs up,  So we end up calling the hospitalist and tell them there's an admit for delirium that happens to have a broken hip,"  said Dr Phil Fedder, an ER doctor who's greatest achievement so far has been to work an entire day without being cynical.

Very few hospital staff have ever met Dr. Bender . "I thought for sure I'd get to meet him last week when I had a man with hairline fracture of his right pinky come in by ambulance, but Dr. Bender made sure to let me know he only operates on the left pinky," said Dr Fedder.

* Mnemonic for wrist bones:  Some Lovers Try Positions They Can't Handle.





Mayo Clinic Sued By Hellmann's Maker For False Advertising.

Rochester, MN --  Mayo Clinic was sued Monday by a Unilever, the maker of  Hellmann's mayonnaise, claiming the hospital's actual brick and mortar is not made of egg and oil, an FDA requirement since 1957 for any product that wants to call itself mayonnaise.   The lawsuit comes less than a week after the multinational behemoth  sued Just Mayo -- a small San Francisco start-up with a vegan alternative to mayonnaise -- for using mayo in their name despite not having the required egg and oil mixture.

Mayo Clinic sued for false advertising
Unilever, which claims consumers equate mayo to mayonnaise,  is asking Mayo Clinic to add a required egg and oil mixture to all structural components of their campus buildings worldwide or change their name to Not Mayo Clinic.

"The Food and Drug Administration (FDA) has very specific requirements for any product calling itself mayonnaise.  We are simply asking Mayo Clinic to comply with the law," said Hans Grubble, Head of Unilever's Cease and Desist Orders Division.

Mayo Clinic CEO Dr. John Noseworthy responded to the lawsuit with an offer for free medical care for Unilever representatives involved with the lawsuit.  "Anyone who thinks Mayo clinic is Mayonnaise clinic needs to be evaluated.  We are offering a free head-to-toe neurological exam for the entire Unilever management team with the best neurologists in the world," said Dr. Noseworthy, who ironically prefers the smell of mustard over mayo for his sandwiches.

Patient advocacy groups applauded Unilever's action as a step in the right direction for truth in advertisement.  One internet website forum claims to have thousands of comments from disgruntled Mayo Clinic patients who say they were not offered real mayonnaise while hospitalized for their unusual symptom complex that always turns out to be psychiatric in nature.

"I could tell my turkey sandwich did not have real mayonnaise when I didn't get severe throat swelling and rash after eating it," said one Mayo Clinic patient who posted her list of 42 other allergies, including the color red and bright lights, on the forum page as proof of her rare affinity for strange allergies.

Dr. Noseworthy defended Mayo Clinic's use of fake mayo as a patient safety issue.  "We understand patients may believe they are getting real mayo in their sandwiches when they come here because of our name, but we have studied the issue for years. Our patients have a much higher rate listing life threatening allergies to mayo and our fake mayo policy is a Joint Commission mandate implemented after a rash of  real mayo related pseudoseizures and 'just in case intubations' we experienced in the 1990's.





Rural Doctor Fired for Not Waving Back to Local Residents in Public.

Abigail, KS --  Brown Community Hospital fired their only Family Medicine physician on Wednesday after town residents complained he never reciprocated the two finger greeting in public. With great fanfare, Dr. Riley Jones had just been hired two months prior after the critical access hospital failed to sign a local physician for the previous three years.

"The CEO welcomed me into in his office with a two-finger-hat-tilt-head-bob-wave and then told me to clean out my desk," said Dr. Jones, who was shocked a hospital would fire the only doctor within 60 miles for failing to wave back in public.

According to hospital officials, Dr. Jones was contractually required to initiate a wave or to wave back to town members as a sign of community respect.

"On numerous occasions, we asked the doctor to participate in our class on How to Improve Patient Satisfaction through Public Hand Waving, but he never complied.  His repeated lack of respect for community standards left us no choice but to let him go," said CEO Benny Brainard, known for his right-hand-index-finger-circular-lift-off-the steering-wheel-wave when leaving the hospital in his 2001 Buick Regal.

"I've never been to a small town before.  In Kansas City, waving at strangers will get you shot," said Dr. Jones, who has already found another job in a lucrative cash only Kansas City botox clinic for three times the money.

Several years ago, Medicare started paying hospitals based on patient satisfaction scores. Since then, hospitals have placed increasing pressure on physicians to keep patients happy at all costs.  A 2013 Gallup survey found rural hospitals could increase their patient satisfaction scores by 28% if physicians facilitated or reciprocated  a friendly wave to community residents in public.

 Dr. Jones was the target of animosity even before he saw his first patient.   "He didn't even acknowledge me when I drove past him at church," said, Annabelle Vedlaceck, one of several elderly ladies who started organizing the doctor's recall just days after his arrival.  "I think it's rude not to get  the finger from your doctor," said Annabelle, as she greeted the hospital's on-call night nurse, passing by on a bicycle, with a two-finger-chin-bob-left-eye-squint-wave.

Finishing first in his medical school class and saving  the life of two local residents after just a week on the job was not enough to overcome dissatisfaction with his lack of hospitality.  Multiple town residents met with hospital officials at Bill's Cafe in September to demand Dr. Jones be fired or they would boycott the hospital and travel 60 miles out of their way to Green Community Hospital, where their doctor always gives a friendly left-handed-two-finger-brow-touching acknowledgement to the lay folk.

Outsiders may question the utility of firing the town's only doctor they've had in years for presumed rudeness, but local residents disagree.  "The one-finger wave is such a basic part of our community, we just can't let it slide," said John Banner, a farmer who lost all but a single waving finger in a combine accident at the age of 12.

"Getting a one-finger-wave from my doctor is the best medicine I could ever ask for."



Top 10 List of Social Admits Defined!

What is a social admit to the hospital?   A social admission is generally accepted by healthcare professionals to be a patient with no acute medical needs that is brought into a hospital because no safe discharge arrangements could be made at the time they presented.

Most social admits involve elderly patients who present to an emergency room with weakness, have a thorough negative workup and are too weak to go home but have no where else to go. They might have a non surgical fracture limiting their mobility or a family refusing to take them home.

Most social admissions occur after-hours when community services are unavailable to assist with a safe discharge.  Most patients are admitted through the ER by a Hospitalist to observation status, which often causes the patient to be readmitted a month later with a stroke or a heart attack when they get a bill for thousands of dollars in uncovered Medicare services.

Most of the time, a social admit can be safely discharged within the next 48 hours, which happens to be the time Medicare will pay for observation status.  Occasionally, a weekend or a holiday throws a wrench in the plan and hospitals become default nursing homes until discharge can be arranged.

On rare occasion, social admits stay weeks, sometimes months, in a hospital because no long term care facility will accept them.  Some patients, and their families in particular, have burned all the bridges in their community nursing homes and patients have no where to go.  Occasionally patients are too dangerous for nursing home care and state psychiatric wards refuse to accept them because of other chronic medical needs they can't provide for.

Every now and then hospital medical teams ask adult protective services to start revocation proceedings to strip powers of attorney rights from families of patients they feel are neglected from failure to place into long term care.

What is the longest hospital stay ever?   That's a good question readers could shed some light on. Feel free to leave a comment with the longest hospital stay you've ever heard of.  This AHRQ graph presented here shows the two most common longest hospital stays are pediatric related with premature birth and infant respiratory distress syndrome.  However, neither comes  close social admit lore.  Some patients have reportedly spent months or years in a hospital waiting for discharge.

Readers have previously shed some light on the definition of a social admit (admit to the hospital to arrange for a nursing home placement) and the social admit marathon (when the admission and arrangement for placement happens twice a month for 3 years).  Make sure to update your vocabulary with all the funny medical slang.

What does the Top 10 List of Social Admits look like?  The Happy Hospitalist Facebook asked readers to help define The Social Admit and they didn't disappoint.   Here is the list of the top 10 social admits based on comment likes.
  1. Nobody, and I mean nobody,  wants to do incontinent grandma's colonoscopy bowel prep at home.
  2. I once worked for a cardiologist who was asked to admit an older physician's mom because her home was being painted.
  3. Family took mom off hospice and brought her in for the holidays so they could go out of town for Christmas and New Years.
  4. The family has been caring for grandma at home for a number of years but have suddenly decided on a Friday night at around 9 pm that they can no longer handle it.
  5. Once had a dead patient left in a wheelchair by family.
  6. "My mom hasn't been acting themselves (they are 80+yrs old) I think something is wrong" followed by "If you need to get ahold of us here is our cell number we will be down in the Caribbean for an already planned vacation" as they run out of the hospital leaving a smoke trail.
  7. Wife admitted with pneumonia.  She brought in alcoholic spouse because he was "unsafe at home without me."  He was admitted after wandering around the ER's seclusion area.  They had rooms down the hall from each other, but the man didn't want to allow her to see him because he was mad at her for bringing him in. Nicest drunk I've ever cared for.
  8. Patient was admitted for possible spider bite on arm. Patient only needed high doses of intravenous pain medication and cable TV because WWE was on.  Patient and family didn't have cable at home and the hospital was within walking distance for everyone.
  9. Caregiver no-showed and we couldn't get a SNF admit.  You know you can find a "UTI" or "pneumonia" on pretty much anyone!  Solid goto diagnosis for those social admits.
  10. I have had many a patient show up in the ER with suitcase in hand because they are just going to be admitted no matter what.

Here is the rest of the social admit list compiled by Facebook readers.  If you haven't joined, make sure to like the page and never miss another status update again.  You won't find this kind of important information anywhere else!
  • The family is going out of town for a state Basketball tournament and couldn't take grandma.
  • Long term dementia patient but the family swears there are new mental status changes, increased confusion.  Come on.  And the million dollar work up begins.
  • Altered mental status in Alzheimer's patient on a holiday weekend.
  • I had a patient admitted for "dementia".  When I called the hospitalist to notify him of her admission and arrival to the floor he asked what she was admitted for. I said "dementia." He said, "Is that even a diagnosis for admission?" I said listen, "She has dementia and the husband takes care of her but he was admitted for pneumonia and the family doesn't know what to do with her so they wanted to check her in too." So, apparently dementia is in fact an admission diagnosis.
  • When my great-grandmother had each of her (nine) kids, she stayed in the hospital with the newest baby for 6 weeks in a private room with her own private duty nurse. It's like the complete inverse of social admits now... Instead of being pawned off by a family not willing/able to provide care she was getting away from being the caregiver, and they just paid for it with no middle entity like you did back then. Back to today, my favorite is the social failure-to-discharge: when you discharge a patient yet they're still on your list the next day, and the next, and the next, just because of social/placement issues.
  • The VA.
  • Bringing grandma in so family could evacuate for hurricane.
  • My favorite is the demented John Doe dropped off at the ER entrance with no admission reason but no ID or contact info either. Thanks family.
  • "Confusion" at 3 a.m. after taking sleeping pills, from the Alzheimers/Dementia unit.  Baseline neuro: confusion.
  • Patient flown in from remote Alaska location for "skin infection" but discovered to be homeless, broke, and has a blister from 5 days of walking around without changing his socks or shoes after he spent time up to his knees in mud.
  • Family didn't want to take grandma on vacation with them.  Decided 90 year old grandma needed admission for ETOH detox.
  • Bringing grandma in so family could go on a cruise.
  • Grandma is demented and family was remodeling the house, thus rendering it an unsafe environment for her.
  • And don't leave out the extended stays! Grandma is ready to discharge Friday but the family can't pick her up until Monday because they're "out of town."
  • Friday night ER visit: loving son drops off demented mom for confusion but can't be reached until Monday because coincidentally he is out of town for a wedding and demands her discharge Monday morning at 0800.
  • 300+lb middle-aged female that "can't" walk (i.e. wont walk) and has urinary retention, has "servants" that help her in the home but family refused to take her back home with a foley leg bag despite extensive teaching of both patient and family.
  • How about admission for possible seizures because it was the middle of winter, snowing and the person was homeless.
  • Family brought grandma in because "it was time for that free nursing home" but demand the really nice one 'cause only the best when it's free!
  • Patient arrives from another country yesterday to stay with family but family quickly realizes they can't care for them. Patient receives dialysis but treatment hasn't been arranged and patient's insurance doesn't carry to the U.S!
  • Nursing home drop offs for weekends and holidays for "altered mental status" that have been going on for a week.
  • I was working at LA County Main admitting one night when a guy came in because he had been evicted at 11 o'clock at night. He knew there was a social worker there at night.
  • It's Saturday night and family wants to party, so they drop off the patient in the ED with a suitcase full of clothes and say they'll pick her up on Monday.
  • Currently trying to deal with a chronic lunger who wants to stay because they turned off her electricity. Still has enough cash to buy cigarettes though. Oh yeah, I do have to feed her too. Glad to see my tax money going to a good cause.
  • Most of the referrals to acute rehab are for social reasons. We are not your grandma's babysitters. * sigh*
  • When I worked during Hurricane Katrina, we had multiple admits from home because the family didn't want to take their loved ones with them, or they were on home oxygen. Extreme case, but true. Needless to say, our wall oxygen didn't work, we had no running water or electricity, and they were medivac'd out to God knows where.
  • Wealthy family in a small town has family come to visit.  Elderly aunt has a personal care giver with her but dear aunty is admitted to hospital for "HOSPITALITY" level of care! Out to family gatherings during the day but was brought back by 7 pm, put to bed by care giver who then went back to enjoy socializing with the family... the hospital tied up a 2 bed room in a critical access hospital for $10/night! We pottied her, changed her bed etc & were told to cater to her. We had to remind ourselves frequently that if you have the right name & position in the community you can get this service. No one else EVER got "HOSPITALITY " care.
  • Chicago. Old couple admitted because their heater broke last winter.
  • Had an ER patient brought by ambulance from another hospital ER because the wait was too long.
  • Daughter just can't do the dressing changes anymore (had home health for six days a week for a little foot wound) she had to do the dressing once a week (or could have let it go one day)
  • Constipated severely demented 98 year old whose wife couldn't get him to take laxatives (and would probably have broken both their hips getting to the bathroom if he had taken them).
  • Parents bring in child on medicaid for running fever all week on Friday night to ER. Leave and come back to take home Sunday afternoon. Can't call it neglect because they left in care of responsible people! Parents get free babysitter for weekend.
  • Brother and sister admitted for varicella because the family had plans to go to a water park for the weekend.
  • Because family planned a vacation and forgot to find someone to watch grandma.
  • Kicked out of assisted living home because of behaviors on continusou oxygen and 22% lung function with severe COPD.  Social worker drops him off at ER for "SOB".  No where to discharge to! Spent a week admitted walking halls and flirting, room service while someone found him a place to go!!
  • I thought you were referring to the patient using the phone the entire time with a room filled with company and relatives calling for an update q15m (every last one of them drunk and hungry). After all, the patient does need the sliver removed. My duh. I had to read the other posts. Gotcha.
  • 89 year-old grandma with Alzheimer's brought in by local fire rescue. She was found wandering in her night gown. Police got her address off of a ID necklace she was wearing. When they got to her house they found her husband dead. During the middle of the night he had passed from a massive MI and no one was around to take care of her.
  • Husband has been taking care of wife at home, who has advanced multiple sclerosis for 10+ years. Apparently no followup, no therapy, no home care. Decides on Monday that since he's having back surgery on Thursday, he can't care for her. (Sad thing is, she went skilled and will probably never go back home. She's 56.) Sad social admit, because she had no acute illness, but so preventable.
  • Why is it always grandma and never grandpa
    • Editor:  Good point!
"Ask your hospitalist today if mom is too old to hyperventilate and they'll work the system to get her free entry into the Nursing Home Marathon paid for by Medicare"

Ask your hospitalist today if mom is too old to hyperventilate and they'll work the system to get her a free entry into the Nursing Home Marathon paid for by Medicare ecard humor photo.


"Did you know 'too angry for discharge' and 'patient refuses to leave the ER' are now Medicare approved reasons for inpatient admission?"


Did you know 'too angry for discharge' and 'patient refuses to leave the ER' are now Medicare approved reasons for inpatient admission doctor ecard humor photo.


"Prepare yourself! Holiday admits are coming!"

Prepare Yourself.  Holiday Admits are Coming medical humor meme photo.




Hospital Bans Unauthorized Nurse Bathroom Breaks

Albuquerque, NM -- Pine View Hospital on Friday started banning unauthorized nurse bathroom breaks, cutting cost in anticipation of reduced payments next year.  Officials believe the move will allow 32 projected nurse retirement positions to go unfilled and save the hospital several million dollars.

"Thirty-five years ago, I remember taking at least 8-10 bathroom breaks a day.  Now, I'm lucky if I get one,"  said Sandy Berrymore, an outpatient surgery nurse who made sure to tell everyone around her she was just 78 days away from retirement.

Starting last week, Pine View Hospital started authorizing nurse bathroom breaks with a daily first-come, first served sign up sheet posted outside the staff bathroom area at change-of-shift, to encourage nurses to get their business done before their shift starts.

Hospital officials say they were prepared for long lines starting several hours before clock in.  "We installed two additional porta-potties near the staff break room on each floor to make the process as least disruptive as possible," said CEO Jake Fedmore, who was given an 8% raise next year for this creative idea.

Less than a week since the new policy began, nurse productivity has increased by 30% and two million dollars in costs savings are projected annually.

"I can't believe how much money I'm saving my hospital by foregoing my bathroom breaks,"  said new nursing graduate Theresa Beddle, who was trained to take one for the team whenever a challenge arises.

The policy does provide medical exemptions if a notarized physician explanation is provided.  "I had a charge nurse barge into the bathroom yesterday telling me I was not authorized to poo, until I showed her my doctor's note," said Jenny Allingsworth, a nurse who's doctor authorized 10 breaks a day.

To help prepare nurses for their new expectation, Pine View Hospital is encouraging nurses to view their free online classes, including Methods to Hold Your Bladder after CPR,  How to Work 12 Hours without Drinking and Mind over Bladder.

Based on the overwhelmingly positive economic impact in just the first week, CEO Jake Fedmore plans to take the policy to the next level with a more aggressive algorithm (Figure 1) next year.  "I'm anticipating at least a 15% raise next year with this awesome idea."

"Nurse Bathroom Break Protocol"

Nurse Bathroom Break Protocol Algorithm Humor
Figure 1:  Nurse Bathroom Break Protocol


This funny nurse algorithm is available for purchase on t-shirts, mugs, and holiday ornaments and other gifts from The Happy Hospitalist Zazzle store.  Huge discounts (up to 60% and more) are available for Veterans Day Sale using discount code VETERANDAY14.