Archives for October 2004

Medical Draft II

Talk about timely, here comes another statement:


Texas “Party of Medicine” Candidates

The Party of MedicineIf you live and vote in Texas, this is for you. I don’t blog about politics very much, as others do it better and I’m just not that interested. I do follow politics, have my views, and don’t think anybody gives a hoot, so I keep them to myself.

However, this doesn’t mean I’m apolitical, especially where my profession in concerned. The photo is a thumbnail from (here’s the original .pdf file), the lobbying arm of the Texas Medical Association, and this is their slate of endorsed candidates. They call it the “Party of Medicine”, and as you can see this list features democrats and republicans both.

I don’t know a single one of the people on this list, but given the TMA’s track record for separating friend from foe in politics, these candidates are the ones most friendly to medicine.

Me, I’m going to print it out when I go to vote, as there’s no way I’ll remember all the endorsed names. It might work for you, too. Just an idea.

Medical Draft: or, Kool-Aid and You.

In an interesting entry, Graham wishes to alert us to the risk of a possible Medical Skills Draft, via the International Herald Tribune, and the weblogs Blatant Truth and DailyKos (there’re some sites I never thought I’d link). Spend a few minutes reading any of these three and you’ll be left, like me, with the feeling that these are way left-of-center sources of information.

I do not for a minute doubt that our government has plans on the shelf for a medical draft. Planning is one of the things we expect, nee, demand our government do (think of the outrage if there isn’t a plan for relief after every single weather-related disaster). Also, having been in the service, I know that we have plans to invade a couple of countries, and have no doubt that we have a plan, in one form or another, to invade every other country and the moon, and that we have a plan to draft left handed beekeepers should a national need arise.

Planning is a long way from execution. I have a plan to retire, but I’m a long way from pulling it off.

(I recall being told that, at the end of the Berry Plan (a Medical Draft during the Vietnam War), the feds made a deal with the AMA that, if the AMA would keep track of who all the docs are and where they are, the feds wouldn’t require docs to register with the Selective Service. That’s why I never wonder why the AMA always knows where to send my ‘please join’ notices, no matter how many times I move. It could also just be an old doc’s tale. Dunno.)

Medical drafts have happened in our nations’ history, young and midcareered docs and nurses faced a choice, and the overwhelming majority chose honorable service to their country. They were not required to kill for their country, they were needed for their medical skills and training, to provide aid and comfort to the sick and injured, both friend and foe. They served with honor, some reluctantly and some wholeheartedly, but they served when called.

I had the great good fortune to have served with one of these draftees, in the twilight of his career. He’d gotten out after Vietnam and had a terrific vascular surgery practice, then missed the service near retirement and returned, I think just to lead me. He was my Division Surgeon, and his citation for the Navy Cross appears in the extended entry. One hell of a role model.

Not to belabor a point, but every single person who has spoken with authority from the current administration has said, uncategorically, that there will be no draft. No little hidden, ‘but ifs’, etc. They can Just Say No. But, you know, they’re politicians. Like the Democratic politicians who sponsored the only bill calling for a draft. A bill defeated so soundly its own Democratic author didn’t vote for it.

So, for completeness’ sake, let’s think of this from a supply and demand standpoint. This nation has several fully-staffed Military Medical Centers, filled with excellent docs in all stages of training, and nurses (ditto), and there’s no shortage of people vyying for those positions. Several of those facilities have seen their served active duty populations deploy overseas, and though they continue to care for the returned wounded, dependents and retirees in their areas, their committed forces are elsewhere. Were they needed (i.e., a shortage of medical specialists in theatre), they’d be deployed there. I’ve been paying attention, and no such shortage has happened. This current war on terror has created a terrible number of killed and wounded, yet it’s nowhere near the number seen during several single months of fighting in Vietnam. I am NOT minimizing the impact of injury on any single servicemember or their loved ones. I am saddened by every one, and appreciate their sacrifice, but this country is not being overwhelmed by casualties, and has no shortage of medical practioners to tend to the battle fallen.

To finish: No draft. Not going to happen, not for riflemen and certainly not for medical professionals. I find it more than a little depressing that ‘draft fear’ is apparently rampant in the Left, and that scare tactics about drafting (add affected group here) is a powerful (presumable) motivator to vote against GWBush. It must poll terribly well, or it wouldn’t be pushed like this, and to every potential interest group, in this case medical professionals. There’s plenty of reasons to vote against the incumbent president without making up scary things that go bump in the night, and it’s doubly depressing that the idea of service to ones’ country is seen as a catastrophic affliction to be avoided at all costs. The original JFK’s “ask not…” is now a source of bemusement to the Left, not a call to serve ones’ country.

Don’t get all your ideas or information from one side, and stay the hell away from the kool-aid. It’ll give you a funny moustache, and can kill you if you get it from the wrong people.

Update: Comments by MedPundit, Bloodletting, Cut to Cure, and code:theWebSocket.
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Fellow, American College of Emergency Physicians

Today I became a Fellow in the main professional college of my medical specialty, Emergency Medicine, ACEP.

It doesn’t come with more pay, or better parking, or anything like that. It’s just a recognition of the time, the training, and the practice commitment of being an Emergency Physician.

Medblogs Grand Rounds 4

Welcome to and to this week’s Grand Rounds, a selection of the choicest cuts from the medical blogosphere. Every week, one member blog takes on the responsibility of compiling and hosting the submitted posts.

Go, read, be entertained.

MebdBlogs Reminder

A friendly reminder:
We are very excited to be hosting upcoming Grand Rounds of the medical blogosphere. Grand Rounds IV submissions are due by 9 PM PST on Monday, October 18. Please email your recommendations to

More Flu

An excellent primer on deckplate things to do to prevent, and what to do if you think you have, the flu. I’m linking it as I like this nice bit of perspective:

Political vaccination (
Let me also say that this is a situation where perception becomes reality. People who would otherwise not even seek out a flu shot, balking at the fifteen dollar cost, now are in hysterics trying to get vaccinated, forking over hundreds of dollars, and putting their lives at risk to do so. Because everyone now wants a vaccine that they normally wouldn’t the demand has increased. Since the supply is effectively frozen, the shortage is much more felt. So, the shortage is self-reinforcing.

Me, I’m going to go and wash my hands.

MDI’s and Emptyness II

On the 15th I blogged about research showing that Metered Dose Inhalers (MDI’s) are commonly misunderstood, and that there is no easy way to figure out if they’re empty.

This took me completely by surprise, as I thought the ‘float test’ was an accurate way to tell if medication remained, but the article said it wasn’t, the only way to be safe was to count down the number of doses expected to be in the container, and discard it when empty.

SO, I got a little time to go check on it today, and from the MDConsult drug reference, under “Information for Patients”:

…Discard the canister after 200 sprays have been used or 3 months after removal from the moisture-protective foil pouch, whichever comes first. Never immerse the canister into water to determine how full the canister is (“float test”).

and boy do I feel silly, as I thought the float test worked.

(The float test came about over one of the big frustrations of MDI’s: they have more propellant than medication, and thus will keep right on spraying medically useless propellant into the patients’ lungs instead of meds and propellant).

There’s a cautionary tale here: I was taught the float test as a pup, and it’s not unreasonable to think it would work. It makes intuitive sense and when I’ve had a patient bring in an obviously empty inhaler and floated it, the demonstration ‘worked’. Medicine has several of these ‘things everybody knows’ that are wrong.

So: no more float tests, and tell the patient taking albuterol (salbutamol for the non-US part of the world) to count backward from 200 doses (and remember!), then throw the canister away, and get a refill.

How I feel about the Flu Shot Shortage

I agree with her thoughts. I also will be offering many more flu meds this year, but you should read it.

And, her insights come with some entertainment! Feet First

The shortage has spawned one good joke that I heard: before the third debate, Bush and Kerry flipped a coin. The winner got a flu shot.


Refreshed from his latest blogging hiatus, Rick has a couple of posts about how making yourself feel good by talking trash about others looks: from the wrong end. Worth reading.

MDI’s and Emptyness

Metered Dose Inhalers (MDI) are a true lifesaver to many, and a terrifically convenient way to deliver other medications. One of the big drawbacks to them is that there’s no really accurate way to tell if the MDI is out of medication but is just spewing out propellant. I thought I knew the answer, and it turns out I was wrong (rats).

Yahoo! News – Parents May Not Know When Asthma Inhaler Is Empty

According to experts, the only reliable way to judge whether a canister is empty is to subtract the number of doses used from the total available number listed by the manufacturer.

The new findings support this advice, according to Rubin and his colleagues, who also debunked another way some parents in the study used to define “empty”: seeing whether the medication canister floats in water. If it sinks, some parents believed, there is still medication left. If it floats, it’s empty.

Not only was this method ineffective when the researchers tested it, but it also allowed water into the canisters’ valve opening 27 percent of the time, making the practice “potentially dangerous,” they note.

Keeping track of doses by counting can be difficult and prone to error, the authors acknowledge. However, they add, until effective built-in dose counters are added to metered-dose inhalers, counting doses the old-fashioned way remains “the only accurate method” for judging when a canister is empty.

I have always thought the ‘floating upright vs. on its side’ test was accurate, but apparently not.

Somebody could retire on this idea: a foolproof way to count doses delivered, or medication remaining in an inhaler.

also posted at LingualNerve

Friday Night Lights Movie

My youngest and I went to see Friday Night Lights (FNL) a couple of days ago, and I have to eat my words. As a commenter to Sleepless in Midland, when the film crew came to Odessa I said something like “…they didn’t come all this way to make us look good…”, my belief fueld by a) the original, not very flattering book on which the movie was based, and b) the director is the cousin of the books’ author.

I was wrong. They made Odessa, and Odessans, look like Odessans, no better and certainly no worse. (I grew up in Odessa, went to Odessa Permian, and know of which I speak).

The movie is an excellent story of small-town but big-time High School football, and as such could have been about nearly any program, but Permian made an excellent subject with their outstanding winning record and painfully devoted fan base. (Mojo!)

Just go and see it, or see it when it comes out on DVD. You’ll be glad you did.

Symtym has a nice site redesign, by Moxie. It’s very pretty, and he’s the best on West-Coast hospital goings-on, from a Macro viewpoint.

Go take a peek.

Medical Joke

An older gentleman had an appointment to see the urologist who shared an office with several other doctors.

The waiting room was filled with patients. As he approached the receptionist’s desk he noticed that the receptionist was a large, unfriendly woman who looked like a Sumo wrestler. He gave her his name.

In a very loud voice, the receptionist said,


All the patients in the waiting room snapped their heads around to look at the very embarrassed man.

He recovered quickly, and in an equally loud voice replied,


Great Moments in Plaintiff Attorney Advertising

One you have to see to believe…

Overlawyered: Willie Gary marketing tactics
There is, perhaps, a niche of personal injury clients for whom an ostentatious display of personal wealth and a video with the theme from “Rocky” and a Michael Buffer impersonator narrator will be especially persuasive. If so, attorney Willie Gary (Jan. 7, Dec. 23) has that market sewn up (streaming Windows Media)…

I wonder: if a neurosurgeon did this, would you be more or less likely to choose him?

also posted at LingualNerve