Archives for July 2003

A Beautiful Sunrise

can mean only one thing if I’m seeing it: night shift.

It was nice, but not enough to make me a Morning Person.

The A10 gets more combat power

heh. Perfect.

Night Shift Study

Scary truths about the graveyard shift Circadian Technologies (a ‘consultancy’) has found some things about night shifts:

Graveyard-shift workers make five times as many serious mistakes and are 20 percent more likely to suffer severe accidents.

Those on the overnight shift also have a significantly higher incidence of costly diseases and disorders, costing employers billions.

…divorce rates are as high as 60 percent among all-night workers, and why they have 150 percent more stress-related gastrointestinal disorders.

The medically related:

On July 1, the Accreditation Council for Graduate Medical Education, the national body that oversees medical residents, mandated paring back residents? brutal 100-hour workweeks to 80 hours, and reducing their 30-plus hour patient-care shifts to a maximum of 24.

I’ve been told, and have no reason to doubt, that a disproportionate number of medical mistakes happen at about 0400.

I’ll keep all this in mind while I’m working the night shift this month.

Challenge to Residency Training Thrown Out – Judge Dismisses Daniel v. ABEM Lawsuit

A federal judge upheld an earlier recommendation that a 13-year-old antitrust lawsuit challenging the requirements for emergency physician certification be dismissed.

Gregory F. Daniel, MD, later joined by more than 100 other physicians who are not residency trained in emergency medicine, sued the American Board of Emergency Medicine (ABEM) in 1990, claiming that their practice experience should allow them to take the certification exam, and that ABEM is conspiring to restrain trade and exclude non-certified emergency physicians from practice.

On June 20, US District Judge Richard Arcara granted the defendants? motion to dismiss the case and entered a final judgment in favor of ABEM.

The plaintiffs can still appeal with the Second Circuit Court of Appeals, and must file a notice of intent to do so by the end of July. Representatives for the plaintiffs could not be reached for comment.

ABEM, which was formed in the 1970s, administers a certifying exam in emergency medicine where physicians, once deemed eligible, may become ABEM certified in emergency medicine as a specialist if they pass the written and oral examinations. Many physicians attained certification though the so-called ?practice track,? which required 7,000 hours and 60 months practice in emergency medicine, among other criteria. The practice track closed in 1988 when formal residency training in emergency medicine became a required prerequisite for eligibility to take the ABEM exam.

Residency training can by the only real path to certification. All specialties started with a ‘practice track’ because it was a brand new specialty, docs with vision tried it out, and it their specialty made sense and was accepted enough that then formal training was set up to produce more of the specialists.

This suit was a bad idea to start with, and hasn’t gotten any better with time.

USS Ronald Reagan – USS Ronald Reagan commissioned – Jul. 12, 2003
When I signed up for the Navy, Reagan was President, we were building a 600 ship Navy, and the Evil Empire was the Threat. When I went on Active Duty, Clinton was President, the Evil Empire was no more. I’ll spare you the whining about serving in a military ‘led’ by Clinton.

The USS Ronald Reagan will sail the seas for 50 years. I can’t think of a better tribute to a great president.

Update: a better tribute would be to spell his name right, which I just fixed. Thanks, Aunt Sue!

Fort Worth Fastest Growing City in US

Census: Fort Worth Grows Fastest In Texas, Austin Sees Population Decline

Fort Worth’s 2.6 percent population growth rate between 2001 and 2002 was the highest among Texas’ 10 largest cities, according to estimates made public Thursday by the Census Bureau. Cowtown expanded to nearly 568,000 people, about 10,000 shy of El Paso, which grew by 1.1 percent. If those paces continue, Fort Worth will supplant El Paso at No. 5 by next summer.

And, as one who has lived in both cities, Fort Worth is better in every single respect.

Other surprises:

More than 11,000 people moved out of Dallas between 2001 and 2002 despite its net increase of about 5,600. Texas state demographer Steve Murdock noted that San Antonio, which gained about 23,000 to reach 1.17 million last summer, by now should be on the verge of passing Dallas (1.21 million) as the state’s second-largest city.

Best quote? It’s about Austin:

Austin, which grew at a brisk 4.1 percent annually during its tech-driven heyday, was the only major Texas city to lose population as it shrank by about 1,100 between 2001 and 2002.

Austin is still a place where people want to live, says downtown-area real estate broker Kevin Burns. It seems to help, though, if they don’t need a job.


Anger Management – Plant shooter took anger management classes – Jul. 10, 2003

Which tells us all we need to know about Anger Management classes.

Anger management classes are a “time out” penalty for adults. When I was on active duty, I knew several people who elected to go to anger management rather than some other punishment. My evaluation then, as now, it that it’s a valuable tool to tell someone you’re paying attention to them, but that it’s otherwise a big time waste (like ‘ethics’ classes, but that’s a different rant).

Rapid West Nile Test: my work just tripled – FDA approves rapid West Nile virus test – Jul. 9, 2003 and my life just got harder.

West Nile virus is transmitted by mosquitoes, and in most people causes no symptoms or a very very mild viral illness; a very few go on to develop the most dangerous of these infections, meningitis. The biggest risk factor, past mosquito bite, is age greater than 50.

Roughly everyone on the planet is going to be bitten by mosquitoes this summer, and there are a terrific number of people who are going to worry incessantly about their bug bites. They’re going to come, or be sent, to the ED.

Last year, we were able to tell people (truthfully) that there wasn’t a decent, reliable test, and that the only people we were testing for this usually always self-limited viral illness were saved for those being admitted to the hospital for meningitis.

Now, we’re going to be innundated with people who are worried they ‘may have the virus’ and ‘want the test’.

Talk all you want about education, when people come to the ED they want The Test, and it doesn’t matter if it’s a blood test or an MRI in the middle of the night. This is going to cause a lot of extra ED visits, at least in the short run, until the public gets used to the endemic nature of West Nile. (Then, look for a test on the store shelves).

Oh, and bring back DDT, and this will be a non-issue.

West Nile from the CDC.

The LP

Today, I had a Physician Assistant Student (PAS) in the ED. I like to teach, and I do it infrequently enough that it’s fun. Today’s topic: the Lumbar Puncture.

The PAS hadn’t seen an LP before, so we talked about it before the procedure, after a nice long talk with the patient about risks, benefits and alternatives.

This was the best, easiest, smoothest LP I have done in about 2 years, of course. The only other option, given the audience, was abject failure and humilitation, which was thankfully avoided. The patient had very little discomfort (see below), and tolerated it exceptionally well.

Afterward, everyone who had been in the room (the ED tech, the scribe, the PAS and I) were actually laughing (very very professionally) at how easily it went, and how completely unrepresentative of a usual experience the whole thing was. It was a completely unrepresentative introduction to the procedure, and everyone involved pointed that out.

If I were to make a movie about ‘how to perform an LP’ this is the one I wish I had on tape.
(Discomfort is a doctor term for pain that other people feel).

Pitot Tube Uses

I asked my brother, who designs high-end open wheel race cars for a living, why the F1 cars have pitot tubes. His answer was interesting, but not as interesting as the photo included to show other uses of said pitot tubes!

Photo copyright by my brother, FireBalls

The Declaration of Independence

ScrappleFace: Declaration of Independence

What today celebrates.

Enjoy our liberties, and please remember why we have them


On Vacation

This is a WWII poster, from a terrific site, which I have forgotten. My brain is on vacation, too.

Update: it’s just one poster from a terrific collection maintained at the Northwestern University Library.

Satellite Latency Explained

ping timeThis represents 10 sequential pings of of the named sites, in milliseconds. Yes, that’s 2 seconds for a return trip.

Now, that’s not a lot of time waiting for a long download, but explains why first-person shooter games don’t work.

tool from

New Qfever Issue!

There’s a new issue of Q Fever! It’s rare enough to take notice, and funny enough to read.


PS: all this crap is in their description: – MEDICAL HUMOR, medical satire, medical news, healthcare humor, doctor humor, nursing humor, nurse, humor, physician, stethescope, stethoscope, stethoscopes, stethescopes, medical parody, parodies

The Real Me

my alter-egoMy older daughter was in the Disney Store the other day, and said that when she saw this, she thought of me.

Those who know me will confirm, Grumpy is the real me, much more than Doc.