New Blogroll Addition

Mr. Hassle’s Long Underpants
Steered by RangelMD, I have read and enjoyed the site of an EM resident, “Doc Shazam”. I cannot believe a resident has the time or energy to blog, but I salute her for it.

Have a look!

Another field amputation

CNN.com – Trapped miner cuts off own arm – Jun. 28, 2003

In a case evoking memories of American climber Aron Ralston, who earlier this year hacked off his arm after getting trapped under a boulder in a remote Utah canyon, the man severed his arm with a short-bladed craft knife, New South Wales state police said in a statement Sunday.

Here’s the twist:

Another worker discovered the injured miner and raised an alarm, but he insisted on severing his arm below the elbow rather than waiting for rescue, police said.

So, even though it was remote, he knew help could be summoned, but he cut his arm off anyway.

Hmmmmm. Not a camping buddy.

Family Trip

The last few days we were travelling in the Great State of Texas. Our trip started with a drive to San Antonio, where we went to Sea World. My opinion: Disney has absolutely nothing to fear. The Shamu show was terrific, and the other large animal shows and exibits were really well done, and highly entertaining. The rest is a modestly dull amusement park, at top prices. Now we’ve been, and I don’t plan on going back.

Yesterday, we toured the Alamo (Texan Mecca), then we drove to Austin and toured the Capitol, which is very impressive. It was a big Texas day, and we enjoyed it.

So, we’re back home, and had a really good time.

Opera7 and Synaptics Scrolling

NonTroppoWiki:Opera7Tips
This applies to people who run the Opera web browser (7.11 currently) and use a Synaptics Touchpad (on your laptop). If you don’t have both, skip this.

I love the scrolling function of the Synaptics Touchpad, and I like the Opera web browser (I’ve said so before). However, they don’t natively get along, without a fix.

The fix is the addition of four lines of code to the synaptics .ini file:

How to get Scrolling working with Synaptics TouchPads
Open the SynTPEnh.ini file and add this:
[Opera7]
WT = “*Opera*”
SF = 0x10000000
SF |= 0x00004000
above the section that says:
[Opera Browser]
WT = “*Opera 5*”
SF = 0x10000000
SF |= 0x00000002
SF |= 0x00000004
SF |= 0x00000008
SF |= 0x00000400
SF |= 0x00000120
SF |= 0x00001000
Save the changes and reboot. Or else simply end the process SynTPEnh.exe and run it again.


I must now add the disclaimer: this is just unsupported code (though it works for me): if your toaster barks or your screen looks like the Matrix and won’t stop, don’t call me. This is for information only.

More on Medicine Looking Good

discussing: DB’s Medical Rants: More on the fiscal crisis

A (the only) comment (since deleted: left an invalid email address) in my prior post said to go and read MedRants, so I did.

I stand by my original statement: for a Professional Choice, medicine (big tent) looks good as compared to accounting, etc. You have to Be There to Do It, and that makes most medicine (excepting Radiology, who have made it a point to disconnect themselves from their hospitals and medical staffs) a non-overseas-exportable choice for a profession.

Yes, Primary Care reimbursement stinks. Surprise. Everyone, med school applicants included, is aware of that going into school. (Why someone would choose a primary care specialty with a huge school debt is beyond me. Perhaps some schools should ask themselves why they preach Primary Care while charging 25K/yr tuition).

Yes, there is a primary care access problem. I often refer my ED patients to specialists for their outpatient workups because I have no generalists interested in the job.

And, let’s be honest. When patients come to my ED 30 minutes after leaving their doc’s office, it’s for a ‘second opinion’, and the put-downs about their primary care docs are astonishing. I know, “…that ER doc was clueless” is stock after an ED visit, but most patients (like you, gentle reader) would rather have a specialist than a generalist.

There, I said it, it’s out in the open. It’s all (mostly) about perception. We will collectively rant and wail about the dearth of generalists, but when you need diabetes management, it’s “call the endocrinologist”.

Medicine has problems. So do people. I don’t think those are disconnected statements.

How Google Works

How Google Technology Really Works

(humorous)

Oops. Archive alert.

Those who know me know I love to tinker with technology, and this website is no different. Today, I decided to tinker with the archives. I screwed them up so badly they disappeared.

I got them to reappear, but they all got renumbered in the process (sorry), so if you had a particular article linked, its number may have (and probably did) change.

I won’t do it any more. Probabaly.

AMA gives best reason to ban cloning

ScrappleFace: AMA Reverses Decision on Cloning: It’s Unethical

The American Medical Association endorsed human cloning Tuesday morning, but later in the day reversed the decision upon discovering that malpractice attorneys could be cloned.

Hehe

Suddenly Medicine Looks Better

From Fortune:

The scariest blue-collar parallel, however, is only just beginning to be felt in the white-collar world: overseas competition. Like automakers that moved production from Michigan to Mexico or textile firms that abandoned the Southeast for the Far East, service firms are now shifting jobs to cheaper locales like India and the Philippines. It’s not just call centers anymore. Indian radiologists now analyze CT scans and chest X-rays for American patients in an office park in Bangalore, not far from where Ernst & Young has 200 accountants processing U.S. tax returns. E&Y’s tax prep center in India is only 18 months old, but the company already has plans to double its size. Corporate America is quickly learning that a cubicle can be replicated overseas as easily as a shop floor can.

None of this bodes well for the jobless white-collar workers who are hoping that a more robust recovery will bring the next paycheck. The numbers of those who are searching are staggering. Of the nine million Americans out of a job, 17.4% are managers or specialty workers, according to a study of Labor Department data by Hofstra University economist Irwin Kellner. During the 1990-91 recession only 10% of that group was unemployed. Even after the much deeper recession of the early 1980s, just under 8% of unemployed workers were white collar. Sure, there are more white-collar workers today, but joblessness among them has risen faster than their share of the overall job market.

There has been considerable concern amongst the chattering classes about the declining numbers (and perhaps ‘quality’) of medschool applicants over the last two decades. The usual reasons cited are more opportunities for the profession-bound, and the relative unattractiveness of Medicine as compared with, well, any other well-compensated profession.

The above article snippet points out that if your job can be done somewhere else, cheaper, it’s gone. This isn’t news to the UAW, or textile workers, but the First World doesn’t have a monopoly on intellect or education. Notably, radiology was mentioned as a profession being outsourced (to India, in this case), and tele-radiology has been touted for years as the wave of the Xray lifestyle future (though this cautionary tale will not be heeded by most radiologists, I’m sure, who will continue to isolate and insulate themselves from the patients and physicians they serve). (I wonder about the malpractice aspects of radiology read from outside the US).

So, perhaps the lesson here is, choose a profession that cannot be done remotely, or from a chair, one where you have to be there to get it done. Medicine (with a few specialty-specific exceptions) is that profession.

via InstaPundit

Update: and, if you’re going to leave comments, then you need to leave a real email address.

Wha? 10 felonies and nobody goes to jail?

How in the world can a company plead gulity to 10 felonies and nobody do time?
Firm Silent as Patients Died (washingtonpost.com)

From the article:

A major maker of medical devices pleaded guilty yesterday to covering up thousands of incidents in which its product malfunctioned as it was being inserted in patients’ bodies. Twelve patients died, and dozens needed emergency surgery.

EndoVascular Technologies Inc. of Menlo Park, Calif., a subsidiary of Guidant Corp., agreed to pay $92.4 million to settle federal civil and criminal charges and pleaded guilty to 10 felonies, including selling a “misbranded” medical device and making a false statement to the Food and Drug Administration.

Under federal law, the Guidant subsidiary was required to notify the FDA of serious malfunctions involving its product, a fabric graft inserted through incisions in the groin to reinforce weak spots or bulges in the aorta, a major artery. About one-third of the devices shipped by the manufacturer malfunctioned before the product was recalled and corrected two years ago, prosecutor Matthew J. Jacobs said.

The company reported 172 of those malfunctions but failed to disclose 2,628 others, court papers said. The device sometimes became stuck while being implanted, the plea agreement said. And during some failures, company sales representatives coached doctors in the operating room through untested, unapproved procedures to break part of the device and extract it from the patient’s body, potentially averting the need to notify the FDA, the government added.

After a patient died during one such attempted extraction, seven employees sent an anonymous letter to the company and the FDA, court papers said. That triggered an internal investigation that led to a recall of the product in early 2001 and to the federal investigation.

In court documents unsealed yesterday in San Francisco, the government did not charge any individual employee or say who participated in the misconduct, but it said the criminal investigation is continuing.

the reassuring part (if you lived, you’re OK):
The FDA said that the problems related only to the system for implanting the device, not to its performance once implanted.

The device, known as the Ancure Endograft System, was designed for treatment of abdominal aortic aneurysms, potentially fatal weaknesses in the artery that carries blood from the heart.

OK, so that’s a long quote, but I was just rivited to this article. The good news is that employees couldn’t stomach deaths at the hands of their medical device, but they didn’t tell the FDA.

I’m a doc, and I use medical devices all the time (though none are ‘cutting edge'; mine have been around for years, and are well proven). I would be furious, ragingly furious, if a company sold me a device they knew had problems and didn’t report. This goes to the heart of the doctor patient relationship, first do no harm.

A tiny caveat: the world needs such a treatment for aneurysms, which have a high mortality and morbidity rate. With some things I, harm can be done, falling into the you have to be alive to be inconvenienced category (from Dr. Peacock, Dept. of Surgery, TTUHSC:ElPaso; thanks!).

This is a cautionary tale, and I’d be willing to bet those involved in the whistleblower letter are mortified by the death(s) and concerned for their liberty, but someone deliberately covered this up and deserves to pay.

via The Business Word

Star Telegram Irony Impaired

In my previous post, I mentioned, and linked to, an article in the Fort Worth Star Telegram about Governor Perry coming to our city to sign the bill into law (at least ceremoniously).

problem right; solution leftThe article made me laugh, but for a different reason. The sidebars of the Star Telegram have rotating ads (reload their page to see them change), but here’s what I saw the very first time I pulled up the article!

If that doesn’t make you chuckle, you’re either dead, or a malpractice attorney.

The Gov came to town today

Star Telegram | 06/11/2003 | Perry signs bill capping malpractice awards in Fort Worth ceremony

And he brought some good news:

The bill, passed by the Republican-controlled House and Senate in Austin, places a $250,000 maximum cap in malpractice lawsuits for “non-economic damages,” mainly for pain and suffering.

Under the law, a single hospital or clinic would be subjected to a maximum $250,000 payout, and the cap would be a total of $500,000 if there were more than one medical institution involved.

Past judgments in medical malpractice lawsuits in Texas have at times totaled millions of dollars, which doctors say have caused the cost of their liablity insurance to increase at an unrealistic rate.

“This bill will keep doctors practicing medicine … (and) our hospitals and clinics will remain open,” Perry said before ceremoniously signing the bill in the lobby at Harris Methodist Fort Worth hospital.

None of us really expect our malpractice to go down, we just really really want it not to keep going up exponentially.

Patient’s don’t ‘Say Ahhhh'; TV to blame

I have found, over the past several years, that patients (in general) don’t know how to say “aaaah” during the ENT exam.

It goes like this:

me: Open your mouth widely and say ‘aahhhhh’
pt: opens mouth widely, makes no noise whatever
me: say ‘aahhhh’
pt: nothing
me: (bumping stretcher) say ‘aahhhhh’
pt: ‘aahhhh’

I don’t know when we stopped teaching how to say aahh. I learned in the doctors’ office from about 2jillion cases of tonsillitis, but I have an idea who’s to blame: TV.

Old doctor show: Marcus Welby, MD; you got a friendly exam by a nice grey-haired doc, and at some point ‘aaah’ came in.

Today’s doctor show: Intubation, central lines, chest tubes, cracked chests or crack babies. No aaah.

OK, that’s a little simplistic, but I’m a simplistic guy.

My Favorite Gen. Franks Quote

General Tommy Franks, recently interviewed in his hometown:

“And it’s going to be great for some kids down the road to pick up a book here in Midland and read how a President and a General that were whippin’ butt in a couple of wars were both from the same town, as was the First Lady.”

That town? Midland, Texas.

via MyWestTexas

Fidelis for Marines, not the Marriage

CNN.com – Feds: Grenade attack on Marine was ‘love triangle’ crime – Jun. 6, 2003

James Glass, 37, suffered shrapnel wounds when Framness allegedly lured him into a guard shack on May 14 and detonated the explosive device, according to the indictment unsealed in U.S. District Court in Phoenix Thursday.

Authorities allege the two hoped the plot would be seen as terrorism in the aftermath of the Iraq war.

An opening for the murder came in January 2003 when the two Marines were dispatched to Camp Snake Pit at Ali Al Salem Air Base in Kuwait as part of Operation Iraqi Freedom, the indictment states.

The plan was to kill him “in a way that would appear to be through the course of his official duties or through the actions of a terrorist,” the indictment states.

Wendy Glass reportedly told Framness that “she didn’t want to know how he would do it, but that she didn’t want ‘Houston’ to suffer.”

On May 14, authorities say, Wendy Glass first called Framness and awakened him. Then she called her husband to do the same. Framness then went with James Glass to a guard station where they sat for awhile before he left and asked Glass to remain.

Once outside, Framness tossed a live grenade into the shack.

James Glass was hospitalized and had to have several surgeries to remove shrapnel to his neck, legs and back. He has since recovered from his wounds.

It’ll be a dull trial, but an interesting TV movie. There’s also a morality tale in there, but if you can’t find it yourself you’re not going to get it.