Thank you have good car control?

Watch this film, then think again.
Compfused.com – Fancy Driving

Link via the AG

…just add coffee

Hehe. My colleagues have noticed my coffee affinity.

We don’t exchange gifts at work, and I’m very glad about that. However, a few days ago a colleague warned me: “I found something in a store that I just had to get you…” with assurances that reciprocity was not desired. (I hope he wasn’t kidding).
coffee!
Very funny, and very true.

Christmas Tunes Recommendation

Unsolicited Endorsement: Gary Hoey’s “Ho Ho Hoey, the Complete Collection”. I got it through iTunes, and we’re playing it all over my house right now.

It’s electric guitar ‘rockin’ instrumentals’ for lack of a better descriptor, and highly enjoyable.

Small Claims Court Victory

A couple of days ago, I took a former landlord to small claims court, and won my case. I’m happy with the result, and my wife is just ecstatic!

We’d rented a small place for my eldest daughter and grandson, and at the end of the lease the landlord kept the entire security deposit. When pressed for why an itemized list of repairs with pretty substantial markups over what things actuslly cost was sent ($35 for an interior doorknob, and $15 to install the same knob, that sort of thing).

So, we had our day in court. The judge listened to my opening presentation, which took about a minute, then spent 20 minutes with the landlord, asking very many questions about prices, justifications, etc. A calculator and scratch pad were employed. It was obviously not going well for the landlord, when his wife asked to be heard, and started reading paragraphs of the rental agreement to the judge.

This woman is either oblivious or completely tone-deaf to body language. The judge started to clean his glasses lens with a kleenex, and the longer she spoke the harder he scrubbed those lenses. After literally 2 minutes of lens torture he finally stopped her, and gave his decision: I got about 2/3 of my deposit back, which was fair, and was really all I had wanted.

My wife has been very unhappy about being ripped off, and is the happiest about the verdict. Now to see if we actually get paid.

Survivor: Texas Style

Due to the popularity of the Survivor shows on television, Texas is planning to do one entitled, “Survivor: Texas Style”.

The contestants will all start in Dallas, then drive to Waco, Austin, San Antonio, over to Houston and down to Brownsville. They will then proceed up to Del Rio, El Paso, Midland/Odessa, Lubbock and Amarillo.

From there they will go on to Abilene, Fort Worth and finally back to Dallas.

Each will be driving a pink Volvo with bumper stickers that read: “I’m gay; I love the Dixie Chicks; Boycott Beef; I voted for Al Gore, in 2000; George Strait Stinks; Kerry in ’04; Hillary in ’08 and I’m here to confiscate your guns.”

The first one who makes it back to Dallas alive is the winner.

And a much braver man than me.

Update: I did not invent this, I got it as one of those forwarded, and therefore unattributable emails. Not Invented Here.

It’s a Bunny-derful Life

Frank Capra is no doubt spinning in his grave but here it is: “It’s a Wonderful Life”. In 30 seconds. By animated bunnies. Perfect for the ER doc in all of us.
_It’s a Wonderful Life_ in 30 seconds with bunnies.

via The Write Wing

AAEM Members Help Secure “Open Books”

AAEM Members Help Secure “Open Books”?

You did it! A tremendous show of support by AAEM membership has successfully secured CMS language that states physicians have “unrestricted access to claims submitted” in their name. In the Federal Register on November 14th where CMS issued its final rule on the Medicare Modernization Act (MMA) it was reported that “numerous members of that association (AAEM) commented” on the reassignment matter. As you may recall, through the efforts of AAEM, the issue of open book was brought to the attention of CMS and, more importantly, the congressional conference committee for the MMA where this wording was incorporated into the CMS integrity safeguards. The footprint of AAEM is on this important ruling from beginning to end and can be clearly seen if one reviews the comments and CMS’ responses in the Federal Register (p372-833).

Equally important to note is the vigorous opposition launched by the contract groups to prevent emergency physicians from having access to this information
. Opposition that proves the importance of this ruling for the working emergency physician. Here is a direct quote from the Federal Register:

“Three commenters representing groups that utilize independent contractor emergency physicians strongly oppose our implementation of the two proposed program integrity safeguard requirements: (1) joint and several liability/responsibility for Medicare overpayments; and (2) unrestricted access to the billings for services provided by independent contractors.”

I’m a Fellow of both AAEM and ACEP, and it’s fun to watch them joust.

AAEM was founded when it seemed ACEP was ‘in the pockets of’ the major Emergency Medicine contract holders, and was much more interested in representing their views than those of the EP’s who actually do the work. (An aside: those docs in your ED don’t just show up by magic. The hospital decided it wants to have a 24/7/365 ED, and needs it to have the right doc staffing to do the job. There are a lot of ways to skin that cat, the most common being for the hospital to contract with one person/group/company to provide docs for the ED, after which the hospital can honestly say the docs don’t work for them. The contract holder then gets to decide how to staff the ED with docs, and there are several ways to go about it: employees, independent contractors, and then under that, is it a democratic group, is there partnership, is it a dictatorship, etc.)

The big contract groups basically took (an probably continue to take) enormous advantage of their employed / contracted docs, and fought to keep the docs who work for them from finding out how much the group bills Uncle and friends for their work, and also won’t let the docs see the books.

To say this is a setup for abuse is an understatement. This leaves the working doc in the dark, while lining the pockets of the contract holder. In most groups, squawking about this is a good way to be looking for a new job. I have a couple of colleagues who left such groups after they did the math and figured out the contract holder was making a killing off their work, more than the docs made.

So, I see this as a very positive step for all docs, but especially ER docs, who have been on the short end of the stick for way too long. Way to go AAEM! I’ll be renewing my membership.

Medblogs Grand Rounds 12

.PARALLEL UNIVERSES.

Welcome to the 12th edition of Grand Rounds, a a weekly round-up of the best health-related posts from around the medical blogosphere. Parallel Universes is proud to be its first overseas host.

Internationalism!

Ukranian Politics and Poison

RangelMD.com has a good review of the current toxidrome involving Ukranian Presidential Candidate Viktor Yushchenko, who has a rather sudden change of face.

Infertility and Laptops

Researchers warn laptop users of infertility risk – Computerworld
Researchers warn laptop users of infertility risk
Years of frequent laptop use ‘may cause irreversible’ problems, they say

DECEMBER 09, 2004 (IDG NEWS SERVICE) – Laptops should be used as desktops if men want to protect their reproductive health, according to a new study published today.

A combination of the heat generated by a laptop and the position of the thighs that ‘s needed to balance the computer leads to higher temperatures around a man’s genitals and over time can result in decreased sperm production, according to the study “Increase in Scrotal Temperature in Laptop Computer Users,” which was published in the U.K. journal Human Reproduction.

Though further research is needed, teenage boys and young men should limit the use of computers on their laps, said Dr. Yefim Sheynkin, the leader of the State University of New York at Stonybrook research team responsible for the article. “It’s possible that external protective devices could help,” he said.

Let’s count the days until the mac fanatics pronounce this to be a Windows-only problem…

Word to the Wise III

First, read WTTW I, then add the following:

When the doc has the stethoscope in his ears, that’s not the time to add critical bits of history. And that’s never the time to add worthless bits of history.

We don’t have samples in the ER. The few times we do, the docs and the staff take them home way before you ask.

“I came because I couldn’t afford my prescriptions” is heard as “You work for free, so I came here”.

“I have medicaid” is heard as “You can buy it for me”.

Ladies, we know you don’t like pelvic exams. Your doc has already performed more than they ever wanted to, and there’s another 20 years to go until retirement. Try not to make it any harder on either of us. Ditto men; see also, prostate exam.

We realize you’ve both talked at the same time/over each other your entire lives together, but that’s a little hard to follow for a medical history. Take turns.

The Emergency Room is not a substitute for your primary doctor. Chant that, it’s a mantra. There might be a test, you should study.

It’s going to hurt. If you have to ask, it’s probably going to hurt a lot. I can add up the painless procedures on the fingers of one hand. Life, especially in the ED, involves pain.

Time, especially time in the ED, is relative. What takes us up to three hours to do in the ED could easily be done as an outpatient in about 5 days. Try not to gripe about the time spent.

Nurses are your friends. Don’t piss them off. Trust me.

Good News on the TB Front

As a doc in a job that exposes me to TB quite a lot, this is good news:

Journal Gazette | 12/10/2004 | New drug boosts TB treatment

Report says human tests could begin “very soon”
By Rick Weiss

Washington Post

A chemical compound that drug developers had shelved as a failed treatment for inflammation has unexpectedly become the most promising new tuberculosis medicine to emerge in 40 years, scientists said Thursday.

Among infectious diseases, TB is second to AIDS as the leading cause of death worldwide…

The new compound, known simply as R207910, has been given to only 50 or so healthy people for safety testing so far. Studies of its effectiveness in people infected with TB will begin “very soon” said lead researcher …

But in animal studies, described in today’s issue of the journal Science, the compound easily overcame the two biggest hurdles facing TB therapies today: their ineffectiveness against resistant strains and the long period of treatment required to achieve a cure.

Let’s hope we never have to take it!

So, Now Drug Reps Don’t Work?

Alerted by Kevin, MD (who runs the best clipping service for medbloggers), I read this little article: Drug Sales Visits Affect Doctors Little- U.S. Study

Now I’m even more confused. I thought I was just a brainless dolt / whore, ready to prescribe the latest and greatest super-expensive drug if I got a pen or a lunch out of it (though I am a bad doc, I don’t do that).

I’m heartened that others see drug reps as the biased sources of misinformation they are! Hooray!

Perhaps I don’t need to start my own chapter of No Free Lunch.org, a physician organization dedicated to weaning docs off the drug-rep crack. Well, I’ll keep it in mind.

Medblogs Grand Rounds 11

The Examining Room of Dr. Charles

The Top Ten Things You Learned Today

#10 – Medical blogging is not only useful, it’s a viable entertainment alternative to watching Scrubs and ER.

It even comes with a Top 10 list!

Urge to Kill, Rising….

Six weeks ago, the little camera I carry at work just quit. (This is why I haven’t had many pictures, I’ve mostly run through my backlog). It was about 8 months old, so off it went for warranty repairs.

Today it returned, and they apparently did work on it: now, instead of just being dead, it awakens with a displayed fault code, but won’t do anything else. Back to the repair center goes the camera.

I’m peeved. Now, several times a shift I see something that’s teachable, and I have no camera. It’s annoying, and now doubly so.