Dilbert’s Doc meets a Drug Rep

Dildoc_1Looks like Dilbert’s doc met a drug rep with the right qualifications.

We all know this is a joke, right?

Right? Bueller?

Ad libitum-EBM

Another new medical blog: Ad libitum-EBM, by a pediatric neonatologist in South Carolina.  Though he’s only three entries in, this blog bears watching, especially for its promised emphasis on EBM:

My point is that everything needs testing. Nothing can be assumed to be effective on its own merit. Otherwise we should all be lining up to buy every product being sold on late night TV ? all those contraptions, accessories and programs that supposedly help you lose weight, achieve a more muscular body, enlarge your bust or make more money.

 

Added to the medical blogroll.

MedBlogs Grand Rounds XXX

MedBlogs Grand Rounds turns 30 weeks old today, at GrrlScientist’s Place.

Looks like another batch of excellent posts!

Patronizing Nurses

NursePatronizing, def:

    3. To treat in a condescending manner.

I’m not talking about talking down to a nurse.  You do that at your peril, and you cannot win.  I’ve never intentionally done it myself, but I’ve seen it a couple of times, and the best outcome was a bloody draw for the doc.  No, I’m talking about how things are done in medical communication.

It has never made sense to me that a nurse with experience, a been-there and done-that nurse has to accept being addressed by their first name by anyone, especially new docs.  I felt about 2 inches tall early in my career, when addressing senior nurses as "Marge" when my West Texas upbringing told me I should be saying "Mrs. Saint", or similar.  As I get older it’s getting a little easier to use first names, but I still feel uncomfortable.

This custom has to be a throwback to the early days of medicine when Docs were Minor Deities and Nurses were the happy handmaidens of the doctor.  Those times are gone (insert your comment below), but some of the behaviors have persisted despite the evolution of the overall relationship.  I think it’s time to bring some formal respect to our interactions, but wonder about addressing my nursing compatriots as "Nurse Nightingale", so I’ve not yet started the newest fad.

I still don’t get medical patronism.  Yeah, there’s a lot of things I don’t get, but this one has always bugged me.

Update: title spelling changed from ‘Patronizating’ to Patronizing.  So much for the new spellchecker!

Grand Rounds Post Time!

This weeks’ Grand Rounds are being held at The Mad Scientist, muahahaha!, hosted by Grrlscientist.  She tells me the submissions are few so far this week, so it’s your chance to shine!  Get your links in now!

Part of the problem may be the lack of an email link on her front page, so here’s her email: GrrlScientist@yahoo.com

Some of the Usual Suspects were absent last week, I hope they have something to submit this week.

MD Net Guide

Alerted by Kevin, M.D., there’s another article about medical bloggers by  MD Net Guide.  About moi:

Another good example of this type of blog is GruntDoc (www.gruntdoc.com), the 2004 winner of the Medical Weblog Awards prize for Best Medical Weblog. GruntDoc, an emergency medicine physician and former field surgeon for the US Marine Corps, offers perceptive and usually sardonic opinions of medical issues large and small.

I don’t get the ‘bop buddy’ meme assigned to Kevin, MD (mostly because I’m square enough not to know what it means).

So, which is more voluminous: the writing of medical bloggers, or the writing about us?

Some things change, others stay the same

This is my first post using a new blogging tool for me, TypePad.  It’s the paid product of the same, free software I’ve been using for about 3 years, Moveable Type.  Why the switch? Glad you asked!

I realized my time has being spent keeping the back-end (the part not seen) running, while ignoring the actual fun of blogging.  Believe me, the joy of figuring out how to edit a .pl file to insert the direct server path to a library pales after just a few moments.  So, I’ll leave the actual operation of the site to pros, and just work on the part you, valued reader, see.

This has other benefits: a WYSIWYG editor, just like stripped-down Word, so very little <put obscure thing here> in my future!  (I did find an interesting way to completely hose a .php blog is to close a tag with a ? instead of a /).  Also, a spell-checker is added, so I’ll just use the wrong word now, instead of a misspelled one.

With all the benefits come some changes
.  All the old permalinks are now dead, sorry.  And, to add insult to injury, TypePad doesn’t have a search function (inexplicably), and trials with the Google version have been fruitless. 

Also gone are the pretty picture-links in the sidebar.  They were a lot of fun, but actually really became an impediment to adding new blogs to the rolls, as it took some editing to make a pic, etc.  Downside, no pics; upside, more links (to come).

So, thanks for reading, and now (hopefully) I’ll spend more time on the blogging.

Older-but-wiser Hearts

BardParker at A Chance to Cut is a Chance to Cure
has a very good post about some transplant centers accepting more and
more hearts that used to be refused; these older or less-prized hearts
are being transplanted into older folks who are lower on the priority
list, mostly because their life-expectancy is lower.

Interesting reading.

When the Specialists are Done

Medpundit has something to say about the docs in the ivory tower, and more:

But, I do know that all too often, when the treatment has been exhausted and the patient ends up in the closer hospital in extremis, the miracle-working specialists are nowhere to be found.

  We see this in the ED more than we want.  It’s usually a patient who couldn’t be cured by a specialist, or even a subspecialist, and the patient is told ‘there’s nothing else I can do’ for your problem (please go away), so the patient comes to the ED, because there’s got to be something that can be done.  Give humans credit, hope lasts.

I don’t blame the patients for this, and the specialists have, IMHO, done all they could once I look into the problem.  Where I have seen this most often is in patients who don’t have a strong Primary Care doctor; they’ve bounced from specialist to specialist without coordination or guidance.  The end of the specialist line comes, and the patient has no-one to turn to.

The demise of the generalist, marginalized by payors, specialists and sometimes patients themselves goes on.  Someone needs to coordinate the care of the patient so that there’s still a chair when the music stops. 

That’s your doctor.

Lagomorphacillin

symtym has an article that’s serious, about germ-resistant bugs on keyboards, but finishes it with an amusing visual.  You’ll just have to go see.

Dept. of Blog Corrections

No, not prison for bloggers.  I said something that was wrong, and will correct it.

Per HIPAA Blog:

…The fact that something bad happens doesn’t mean there’s a HIPAA violation. The fact that PHI gets improperly disclosed doesn’t mean that there’s a HIPAA violation. HIPAA doesn’t require that PHI never get out wrongly, it just requires that covered entities take reasonable steps to try to prevent that.

This was in response to my comment in yesterdays’ Grand Rounds that the loss of computers with patient names, etc, was a violation.  HIPAA Blog is written by a lawyer who specializes in those matters, so he’s better able to judge whether an error was made.

An error was made, and it was mine.  I stand corrected.

via HIPAA Blog, which is different than the above referenced HIPAA blog.  Not very original with their names.

MedBlogs Grand Rounds XXIX

Welcome to the twenty-ninth edition of MedBlogs grand rounds, and the first hosted by a retread remedial Host Emeritus.  Thirty three bloggers submitted thirty five posts, and the diversity of topics and range of experience is amazing.  (Another blogger was added, involuntarily, so that makes 34 MedBloggers represented).

The Categories, in Utterly No Order:
Editor’s Choice, if only because it take a lot of guts to write about your up-close and personal experience with a vesuvius of poo, from Mediblogopathy:

I watch it cover the commode from left to right and spray the wall, the windows, the vertical blinds, the IV pole, the bedside table, and the nightstand. I felt more than saw splatters hitting my pants and shoes.

And you thought YOUR job was bad…

Science
Sumer’s Radiology Site wants to alert us to research demonstrating a common term in medical practice probably isn’t very useful, by posting an entire abstract:

CONCLUSION: Infiltrate is a nonspecific and imprecise term when it is used as a radiograph descriptor, and use of this term does not usually enhance patient care.

Noted.  I’ll use the word "blotch" from now on.   On a different and much more gruesome note, GrrlScientist has some questions about all those birds being killed in the name of avian flu:

How are so many birds killed in such a short period of time? Who kills them? What happens to the birds? bodies after they are dead?

  That IS the happy part.  You’ve been warned.

Training
First you have to get into training, and BardParker has data, and analysis, too!

One thing I thinks this makes abundantly clear, the solution to the primary care problem does not lie in providing more residency training slots, as they can’t fill the ones they have even after reducing the numbers.

In training, Anonymous Clerk puts his philosophy training to the test, and comes up short vs. Kant:

Philosophy 101: Kant believed we must always act "So that we could will the maxim of our action to be a universal law." … I am not there for their benefit, they are there for my benefit. I use them as learning tools. In order to become a doctor, I have no choice but to treat these patients not as ends in themselves, but as means to the particular end of furthering my medical knowledge and increasing my clinical experience.

Dr. Chaplin discusses his choice of specialties, i.e., why a man goes into OB-GYN:

The first thing "wrong" is that a man, by virtue of being a man, cannot be expected to understand women’s health issues.

  It’s a two-parter (so far), so make sure and read the next installment.

Practice and Experience
I’m So Sleepy gets the blood stirring:

This is an anesthesiologist’s nightmare. We have all sorts of tricks and techniques to control the airway. But sometimes we fail.

 

Geena had a patient come to say thanks:

I love when patients come back to visit. Sometimes we never know what’s become of them unless one of us remembers to ask one of the docs.

 

Dr. Charles has entrepreneurs for lunch, and it made him wonder about another future:

Someday I may tire of the committee meetings, the prohibitive overheads, and the HMO-dictators who second guess and block my better judgments. I?ll set up my own practice and see only fee-for-service health plans in which a modicum of physician autonomy is preserved. I?ll see poor folks for free several days a month.

  A wonderful vision. 
The Cheerful Oncologist (who has a new home, bookmark it) actually eats in the cafeteriaThe Well Timed Period has something to say about abstinence:

If you are using the abstinence* birth control method and you engage in sexual activity, it doesn’t mean you are no longer using the method. It means you are using the method either incorrectly, or inconsistently; the very definition of typical use.

 

Tales of an Md/PhD relates that docs need to be careful of the expectations they give:

After her accident, she was told by her doctors that she’d be "back to her normal self" after 6 months or so of a rehab program. But of course, most TBI patients never really return to the same person they were before the accident.

  Last but not least, KevinMD has more on the Tedy Bruschi case (he’s a linebacker with the New England Patriots).

Money and Medicine
Aggravated DocSurg asks a great question:

…what if we find that good quality care is more expensive, rather than a means to control costs?

   

Galen‘s group is thinking about Medicare cuts, Hospice Blog feels a good case can be made for their cost effectiveness, and BardParker is back again with the story of medical bargain hunters, which he doubts will go both ways.  (Me, too).

Law, and Reform
Dr. Tony is writing about the President’s medmal reform initiative, Red State Moron (best blog name, ever) comments on banning video from childbirth:

Really, I don’t care "how it’s going to play on TV".  It is not TV.  …  Can’t see?  I’m in the way of the camera?  Too bad.  There’s a complication?  Commotion?  Panic?  Yeah, that happens.  Sometimes it is not pretty, either.

and Political Calculations has discovered something missing in King County: Brains! 

…their local Medical Examiner’s office has been selling the brains of the recently deceased for profit without either their consent or the consent of their families.

Yikes!

Medical Records and Privacy
Frm Dr. Bob at The Doctor Is In comes his experience with the EMR:

The answer ? like most things in medicine ? is far more complicated than it looks.

  And he knows whereof he speaks.  Interested Participant is also looking at medical records, but of the compromised variety:

Police are investigating a burglary of two computers from the San Jose Medical Group which reportedly contained the names, addresses, Social Security numbers, and billing codes for as many as 185,000 patients.

He points out these are HIPAA violations.

The Doctor as a Reporter
Saint Nate:

Ever wonder what it’s like to be medical journalist? Here’s what a typical day covering a conference is like: 7:40 a.m. Wake up. Realize the alarm clock didn’t work. Start the day with a good, deep scotch burp. Eventually roll out of bed when you realize how close you are to falling back asleep.

  Wow, just like a real journalist!

Medicines, Safety and Politics
Dr. Andy is rightfully bent about Elidel, a cancer risk, and alleged inadequate notification of study participants:

…Imagine it turns out the medicine might cause cancer, and that the FDA is particularly concerned about long term use and use in young children. What would you expect the study investigators to do? Cancel the study …? Inform the parents of patients …? Or do nothing?

Incredibly, the answer to the question is do nothing.

  On another hand is the Bextra withdrawl from Health Business Blog:

Something?s gone terribly wrong here. The pharmaceutical companies made a big mistake … And after the FDA was caught asleep at the switch, it may have overreacted to the latest data.

   

JournalClub, returned from hiatus, discusses the NEJM’s latest article on lipid lowerers:

Although this may well be justified, the data presented here do not quite make the case but are spun with great skill.

   

Galen writes, convincingly, of the differences between free-market choice and controlled-market duty regarding contraceptive prescriptions (and other things).  Lastly, some good news via medGadget: the Polio vaccine, one of mankinds’ greatest triumphs, turned 50 today!

Things which Defy Categorization, but will be Categorized Here
TV and Movies
Dr. Emer watches more Sesame Street than I, and noticed that the Cookie Monster has sworn off cookies!  He has photos to prove it, but they’re frightening.  Bioethics Dude took in a movie about Che Guevara and learned a lesson about the difference between empathy and sympathy.

Letter to the Commenter
Never tick off Orac is my latest credo.

Behold: I see you’ve found my humble blog. Your sarcastic little comment about how you’ve supposedly discovered a "blog dedicated to the celebration of conformity" amused me, but unfortunately that is an incorrect characterization. In fact, Respectful Insolence is a blog dedicated mainly to science, evidence-based medicine, and skepticism (none of which alties like yourself appear to understand or embrace)–plus whatever else the inimitable Orac feels like blogging about at any given time.

Hospital Disasters
StreetDoc links to an unusual occurrence: bees in the ED! 

Unwelcome visitors swarmed the emergency room at St. Mary?s Hospital Thursday evening. Hundreds of bees – putting the building into internal disaster mode for hours. Just in time for a party celebrating the hospital?s new ER, hundreds of bees arrived.

  Not to be outdone, Houston’s medical center had their disaster made into a TV movie!

The flood portrayed in the movie was actually the third major flood for the medical center. I was working at The Methodist Hospital when the Texas Medical Center (TMC) flooded for the first time – 1981 I think. What an experience…

via Connectlogist Tim Gee.  (I thought that’s what you got by dialing 0 on the phone, but I was mistaken).

Drug Testing
Nick of blogborygmi, who started this whole MedBlogs Grand Rounds mess (thanks, Nick!) has to endure the indignities and physicial discomforts of a urine drug test.  Again!  Heh.

And Lastly,
The Effect of the Daylight Savings Time Change on ER Docs by richard[Winters]MD:

Time jumped forward today one hour and I am so jet-lagged.

Yeah right. I’m a shift working emergency physician.
As if I have any circadian rhythm.

  Amen, brother.

Hosted next week by GrrlScientist.

MedBlogs is growing, and you are all to be commended on excellent posts!

If I missed your entry, Mea Culpa, and put it in the comments.

Grand Rounds Reminder, Redux

As of now, I have 20 submissions for MedBlogs Grand Rounds. You have until 2359 (Central Time) Monday to get yours to me.

Oh, and the reason there’s a dearth of blogging here: I’ve been off work and enjoying life, and I’ve been tinkering with new blog software. After several hours of CSS tinkering, it looked pretty good in Firefox, and horribly horribly wrong in everything else. So, for now I’m staying with Movable Type.

Update: If you try to submit a comment and it gets blocked, PLEASE email it to me. Do to a series of SNAFUs on my end, I’ve had to change spam-blocking software.

The Cheerful Oncologist has a new address

The Cheerful Oncologist is now at http://thecheerfuloncologist.blogsome.com . Update your bookmarks accordingly.

Blog Housekeeping

First, I’m sending replies to everyone who submits a link for this week’s Grand Rounds, so if you don’t get an email from me after about 12 hours, please send it again.

Second, I’ve added another layer of spammer-be-gone technology in the comments. It should be transparent to you, but if it blocks your comment please send me an email with your comment and what the malfunction looked like.