H E A L T H L A W Beware the BFRF! ■ JOHN SHUFELDT, MD, JD, MBA, FACEP R emember the scene in Ghostbusters when Gozer (the Gozar- ian) asks Ray Stantz if he is a “god?” Stantz, compulsively honest, says, “No.” Gozer says, “Then die,” as he tries to blow them off the roof of the building. After recovering, Peter Venkman yells at Stantz, “If someone asks if you are a god, you say YES!” The question Gozer asked Stantz was a red flag—one of those moments when you want to consider your options be- fore blindly plunging in and sealing your fate. I have the privilege of working with an extraordinary person of unmatched enthusiasm, integrity, intelligence, and beauty. She is the president of NextCare, the chairperson of the Arizona Foundation for Women, and a devoted wife and mother. All in all, she is the “complete package.” Among her many other ac- complishments, she coined the phrase, “BFRF.” A “BFRF” is a big “f-ing” red flag. She is way too classy to ever say the “f-word,” so it is left up to your imagination what word to substitute. Over the years, I have kept a list of things that should make the hair on the back of your neck stand up, although I did not know what to call the collection until “BFRF” entered my vo- cabulary. Much of the list has to do with medicine, some items have to do with activities of daily living, and a couple have not found a home. So, the following is a list of “BFRFs” I collected over the years; feel free to use them as your own. They have certainly saved me a few times when I was about to get blown off the roof. Some may even keep you out of court or help you be a better practitioner. 1. When a patient tells you, “I think I am going to die,” be- lieve him. 2. Never discharge a patient with abnormal vital signs un- less you understand and have documented the reason for the abnormality. John Shufeldt is the founder of the Shufeldt Law Firm, as well as the chief executive officer of NextCare, Inc., and sits on the Editorial Board of JUCM. He may be contacted at JJS@shufeldtlaw.com. w w w. j u c m . c o m 3. Never try to do a back flip after consuming alcohol. 4. Never barefoot ski (water or snow) if you are not an expert. 5. If a patient has a foreign object in their rectum, it really is important to establish the true etiology of the inser- tion. Don’t fall for the, “It was a million to one shot, doc” story. 6. Do not hire someone who is rude to your receptionist or assistant. 7. Do not hire someone who won’t shake your hand be- cause they are a “germophobe.” 8. Don’t date (or marry) someone who is rude to waiters or waitresses. 9. Don’t hire, date, or marry anyone who is a “hater.” 10. If a patient wants someone to stay in the room with them for the exam, procedure, etc., let them. 11. When a patient starts dry heaving, physically turn their head away from you (and toward your least productive staff member). 12. “Two beers” is always more than two beers. Unless of course, they are 44-ounce cans. 13. Never eat food that has been sitting in the nursing break room. You will die either from the food or by the hand of the nurse who brought the food. 14. Never kill a bee by slapping it on your own skin. 15. Hanging upside down while drinking a margarita is a sign that you are drunk, stupid, or both (from experience). 16. If an employee tells you they are doing their best when obviously they are well below the mark, believe them— and then fire them. 17. Never discharge a patient who acutely cannot ambulate (unless of course they have a fractured leg). 18. You can’t teach kindness or compassion; if a caregiver does not demonstrate those characteristics, they should be working in the food service or the janitorial industry. 19. When your gut tells you something, believe it. 20.When a patient says “stop” during a procedure, stop the procedure. 21. Never use a cautery on a patient after using topical anesthetic spray. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | M a r c h 2 0 0 9 33