CEREBROSPINALECTOMYThe system did not break. It is working exactly as designed. Which number made your jaw tighten? (If it's none of them, you haven't been here long enough.) ED: "He has been boarding nineteen hours." Me: "Boarding where?" ED: "Hall B." Me: "Hall B is a corridor." ED: "It has a bed number now." Insurance: "Denied. Not medically necessary." Me: "It's a seizure workup." Insurance: "Has the patient tried lifestyle modification?" Me: "For seizures." Insurance: "Yes." The script. Somewhere there is a flowchart, and the flowchart has never met a seizure. Survey: "This is completely anonymous." Survey: "Department?" Survey: "Role?" Survey: "Years in practice?" Me: "There are two of us." The anonymous wellness survey would like three identifying details, purely for context. The EMR: "Please reconcile the medication list." Me: "Where did this list come from?" The EMR: "You." Me: "I copied it from you." The EMR: "Please reconcile the medication list."
EXPLAINED (ACCURACY-CHECKED)
(1) Emergency department boarding — holding admitted patients in the ED after the decision to admit — is associated with worse outcomes and is driven by inpatient capacity constraints rather than by clinical decision-making. (2) No clinical claim about epilepsy management. Satirizes generic utilization-review scripting; makes no assertion that lifestyle modification is or is not a treatment for seizures, and gives no advice to any patient. (3) No clinical claim. Describes the common design flaw of workplace 'anonymous' surveys that collect enough demographic fields to identify small departments. (4) Medication reconciliation is a required safety process; copy-forward propagation of unverified medication lists between notes and encounters is a well-documented source of persistent chart error.
https://cerebrospinalectomy.com/jokes/ed-he-has-been-boarding-nineteen-hours/