Human Factors and Meds

Black Triangle: If medicines were planes

…It is instructive to compare the pharmaceutical industry with the aviation industry. Boeing have been designing planes for years. They do not design them merely to be able to be able to overcome the force of gravity in order to lift a plane from the ground, keep it aloft and land it again.

Interesting article about how the pharma industry resists changes we know would help.

Medblogs Grand Rounds 8

DB’s Medical Rants ? Grand Rounds 8

“Some Dude”: Public Health Menace

I work in an Emergency Department, and have noticed that there is one common denominator in the majority of the assaulted patients I treat: they were all assaulted by “Some Dude“. (Also, they were all assaulted for “…no reason…”, but that’s the topic of another rant). This is true no matter where I work, the time of day or day of the week.

“Some Dude” has in the last two weeks shot my patients, sucker-punched, struck with bottles, beaten them with fists and a golf club (or perhaps the entire set), and pushed my patients down stairs.

Additionally, “Some Dude” has ‘slipped drugs’ into the drinks of, transmitted sexual diseases to, and stolen the medications of my patients.

I have no idea how “Some Dude” is everywhere at once. I suspect he’s an evil superhero, though in the current times I cannot completely exclude an AlQuaeda conspiracy.

I advocate a vigorous police and public-health effort to locate and confine “Some Dude” due to the clear and present danger he represents to the health and welfare of our republic.

Traumatic Carotid Aneurysm

A Chance to Cut is a Chance to Cure has an excellent post with a CT and several angios of a patient who sustained a GSW to the head, with the formation of a traumatic aneurysm, then an arteriovenous fistula, who then underwent an intervention to thrombose (clot) the av fistula. Really excellent care, with pictures! What more could we want?

Smart but Slow, or Med School Gets Dumbed Down

Author Virginia Postrel recently pointed out (in Forbes (not free), and on her website) ongoing efforts to get special accomodations for students with the ‘disability’ that they aren’t good test takers, and whether what applies to students in grade schools should carry over into this nations’ professional schools:

Over the past decade students with learning disabilities have gotten used to having extra time on tests and, in some cases, separate rooms to reduce distraction. In many cases that makes sense. Giving a dyslexic third grader extra time on a standardized test makes it more likely that his answers will show what he knows rather than how fast he reads.

But a sensible accommodation for little kids can create a misleading double standard for adults. How much you know isn’t the only thing that matters in school–especially when you’re training for a demanding professional job. What patient wants a genius doctor who can’t focus in a distracting environment, reads so slowly that she can’t keep up with medical journals or tends to misspell drug names on prescriptions?

There are, of course, excellent physicians with learning disabilities. But they succeeded the hard way, without special accommodations. They demonstrated that they could work around their problems.

I would agree with that. Not all docs are geniuses; in fact, probably most are of above average intelligence, but not genius-range. They got through school and residency by working really hard and applying themselves, not necessarily through stupefying brilliance.
[Read more...]

Veterans’ Day

From Cox & Forkum
Happy Veterans' Day

Happy Birthday, USMC

Happy Birthday, Marines!
Iwo Jima

Medblogs Grand Rounds 7, Here!

Welcome to Medblogs Grand Rounds, a weekly rotating compendium of posts by the medically minded. Here you’ll find writings from many different perspectives about medicine, patients, and thoughts about the medical parts of comic books (really).

Thus far the hosts have had somewhat varying organizations for the submitted posts, and I will continue that trend, by posting a little snippet, to whet the appetite for more.

We begin with the most topical topic, that of Mrs. Elizabeth Edwards, wife of Senator and presidential candidate John Edwards, being diagnosed with breast cancer (from CNN). Via Kevin MD, a review of the most common type of breast cancer:

Prognosis for women with early stage disease would vary according to tumor size and spread. The 5-year survival rates for lymph nodes negative, 1-3 positive, and >4 positive are as follows:

And follow with three remote-from-the-bedside opinions about the cause of Yasser Arafat‘s non-fatal, reversible, but maybe-a-little-fatal affliction. All three (Dr. Rangel, MedPundit and CodeBlueBlog) agree the underlying cause is liver insufficiency/failure, though CodeBlueBlog has a hypothesis as to why he took a sudden turn for the worse, just as he was making Monty Python noises about “getting better”:

I think the final diagnosis is going to be Hepatitis and iatrogenicide.

For what it’s worth, I think he had an intracranial hemorrhage (stroke) due to his announced thrombocytopenia (low platelets). We will probably never know.

Next up are a pair of reviews about a thought-provoking New York Times article about two interns, by Jonathan Wilde of Catallarchy

Lifestyle considerations do not necessarily lead to undedicated doctors. There are incentives in both directions.

and Bard Parker of Cut to Cure:

Medicine has always attracted a wide spectrum of individuals, from the lazy and disaffected to the deeply committed. Even draconian scheduling policies may not change basic personality traits, or the kind of doctors that interns grow up to be.

Obesity and its flip side are both debilitating. From Interested Participant, we hear that

According to the United Nations World Food Program, virtually every country on the entire continent of Africa is malnourished…(m)eanwhile, in Sun City, South Africa, the First African Obesity Conference recently concluded with the determination that obesity is “completely out of control.”

and find that starvation is linked to behavioral problems, per Mental Notes‘ Dr. James Baker:

If you let a toddler become malnourished, you increase his chances of behavior problems throughout childhood, according to this research in the American Journal of Psychiatry.

Politics raises its unusually medical head, with medical post-election commentary from Dr. Rangel which is a rich linkfest of its own, and from Matthew Holt’s The Health Care Blog:

I don’t think that we are going to see any serious expansion of Medicaid to cover the working poor, and the defeat of Prop 72 in California augurs poorly for any expansion of employment based insurance.

Keeping an open mind it important, per Dr. Centor of DB’s Medical Rants

Physicians err when they do not think. We must keep an open mind. I like to recall Peter Falk?s Columbo routine – you know the one where he is leaving the room, pauses and turns, and says, ?You know, something is bothering me ??

especially when your transgendered patient requests a mammogram

As I began to conclude a rather disjointed visit, she looked at me with concern. ?Shouldn?t I be getting a mammogram, doctor??

from The Examining Room of Dr. Charles.

Cancer is the unifying theme of the next four posts. The Cheerful Oncologist wishes to share about some of the less worthy in medicine

Although it sounds as hideous as it is strange, I have worked with several doctors who have such a nihilistic attitude toward the treatment of cancer that they harbor prejudice and ill will against their own patients fighting the disease.

while Dr. Emer of Paralell Universes has some science to back up a cheerful attitude, followed by his anecdotal evidence

In practice, I have always observed that there is a world of difference between an OPTIMISTIC sick patient and a GLOOMY sick patient. The optimistic patient has always recovered more favorably and faster than his depressed counterpart.

a finding echoed by Hospice Blog, that patients on hospice live longer

…these things boil down to one common point. Hospice patients live longer because they have someone who caring for them. Simple, but true.

and the story of an individual with a bad cancer and an excellent attitude, from Geena at CodeBlog

Yet he still wants to get out of bed. He goes from bed to chair several times a day and has even managed to manage his own wires for himself. Unfortunately, every time he exerts the amount of energy necessary to move from bed to chair, it takes him quite a long time to catch his breath again.

And now, for something completely different: A review of the recently released comic book Strange issue #2, focusing on the medical aspects of the comic, from Family Practitioner Scott at Polite Dissent

Strange #2 was much better than the first issue. The story and art were improved (though not as good as Lee and Ditko?s original), and the medical aspect was better thought out. My only major medical gripes were a couple of typos due to poor editing. There were some smaller nit-picks too, of course.

Lastly, a Fool Physician and his Money are soon parted, via Symtym

I’m always intrigued by the propensity of “professionals” to be so easily pandered and duped. No doubt x?lan offered a special decoder ring and had a secret handshake for all those “special” meetings ?

Just a rule of thumb, the word pyramid when used with “funding” or “financial” is never a good thing! (as in Pyramidal Funding Systems)

MedRants is hosting next week, and get your submissions in early! Many thanks to Nick at Blogborygmi for getting the whole thing started!

Kevin Costner, meet Steve McQueen

Thanks to Tivo I hardly watch commercials any more, but I see them during football games. Yesterday I sat through one, completely transfixed. Allow me to explain.

The setup is a farmer who builds a race course in his cornfield (“if you build it…”), and he parks his brand new Ford Mustang on the Start/Finish line. Out of the corn steps Steve McQueen, probably the best known Ford driver I can think of, both for Bullitt (driving a Mustang) and in Le Mans, (driving a Ford GT40, now in release as a reproduction).

The farmer recognizes Steve, flips him the keys, and the legend starts to lap the course. Many shots of McQueen in the car, seen in the rear-view mirror, etc, an astonishing technological tour-de-force. I’ll be honest, it made me want to go buy a Mustang, and I’ve never owned a Ford in my life.

I am somewhat uncomfortable with icons of the past being raised from the dead to sell me things, though I’ll admit it’s situational. I really didn’t like it when John Wayne was resurrected to sell beer, but I’m more comfortable with McQueens’ ghost pushing cars, and this was one very entertaining car ad.

There’s some group of ad execs right now trying to get the estates of Marilyn Monroe to let her sell Ambien, Bogie to push Camels, Jack Benny and the Dollar Store, etc.

For how they did the commercial, here’s some links.

Update: McQueen actually drove a Porche 917 in LeMans, not a Ford GT40. GruntDoc regrets the error, and thanks reader Roger for the correction.

email fixed

I was just notified that my email box was full, and that people are getting messages returned. I sincerely apologise, and it’s now fixed.

Please resend any bounced emails.

ED Observation

If they ever cure stupidity and outlaw alcohol, I’ll be out of a job.

In fact, this entire nation might need about 10 ED docs then. Maybe I could get one of those jobs.

Drop in foreign grad students raises alarm

CNN.com – Drop in foreign grad students raises alarm – Nov 5, 2004

(AP) — A new survey indicates the number of foreign graduate students enrolling for the first time at American universities is down 6 percent this year — the third straight decline after a decade of growth. Educators worry the trend is eroding America’s position as the world’s leader in higher education.

Phooey, they’re worried they’re going to have to teach their own labs and grade their own papers.

Flood Averted!

The water heater (known here in Texas as a hot water heater) was apparently original with the house, making it a little past 20 years old.

The rust blossoms on the sheet metal were only on the lower third, but still, we were concerned. So, even before it started leaking, we started thinking of replacing it.

Today, our favorite plumbers brought the replacement, and the changeout was nearly painless, at least for me. There was a re-soldering to be done, and I now have a cool ball valve instead of a gate valve, so that’s good.

To show that replacement was the right thing, the old heater started leaking as soon as it was moved, so, right on time. Given my history of home floods, it was interesting to see one not happen.

Maybe we’ll replace this one in less than 20 years.

Xélan Clients: Call Your Tax Attorney

symtym has an excellent review of the collapse of a financial investment company called Xélan, which markets itself to physycians.

A brief quote:

WASHINGTON — A judge ordered more than $500 million in investment accounts frozen as the Justice Department probes charges of tax avoidance involving a company that markets tax-savings plans to doctors.

The Internal Revenue Service estimates that some 4,000 doctors are involved in what it called a fraudulent tax-reduction scheme, and they could owe as much as $420 million in taxes plus interest and penalties, Justice Department officials said. That works out to more than $100,000 per taxpayer.

Like nearly every doctor, I have gotten dozens of very slick solicitations from Xélan in the mail asking me to ‘come to a seminar, and learn how to save money’, etc. I know a doc or two who use their services, and hope they’re in the clear on this.

As a general rule, I am very leery of ‘sounds too goo to be true’, especially when it comes to tax avoidance schemes. Now I know why.

Go and read symtym’s entry, it’s very well done.

Down Under Humor

Feet First

The questions below are about Australia, are from potential visitors.

They were posted on an Australian Tourism Website and the answers are the actual responses by the website officials, who obviously have a sense of humour.

Q: Does it ever get windy in Australia? I have never seen it rain on TV, so how do the plants grow? (UK).

A: We import all plants fully grown and then just sit around watching them die.

Go, read the rest, see if you laugh like an idiot me.