Ankle Sprain

My son sprained his ankle a few days ago, and I’ve been making QOD photos, mostly for my own amusement.  No fracture, and he’s doing fine, by the way.

Looking these over it occurs to me that I have several ED visits for concerns about the bruising following sprains.
So, without further ado:

Day0

Day One.  Lateral ankle swelling (no bruising, trust me).

[Read more…]

MedPundit reviews the new Quicken Medical Expense Manager

MedPundit has reviewed a new Quicken program that promises to track your families’ medical expenses (including pets).  I got an email about this, but lacked the time and motivation to look into it.

Go read about it and see if you could use it.

Minor Tweaking

This evening I tinkered a bit with the font sizes for the blog.  It was displaying oddly in IE (go figure), and this is my try to get the same output in Opera, Firefox and IE.

Please let me know if you find odd behaviors.

American Red Cross and You

At the top left is now a link to the American Red Cross homepage, which links to a pretty well done donation page, and what they need is moolah.  The days of donating the blankets and beets from the cellar are long gone, and the Red Cross needs cold hard cash to make things happen.  From watching the news, looks like they’re going to need a lot.

This also bears keeping in mind, for those who are a little reluctant to give (via LGF):

…there is no connection between the
International Committee of the Red Cross (a Europe-based organization
with an anti-American, anti-Israel agenda) and the American Red Cross,
who support the United States whole-heartedly, and have even withheld
dues from the ICRC, out of disgust at their agenda. Don?t target the
wrong group, just because they have a similar name.

Give now, if you at all can.

MedBlogs Grand Rounds 1:49

Here at HealthyConcerns I often feel like a lone voice in the
wilderness, speaking from the non-health care professional’s point of
view. But if we are heading more and more in the direction of patients
partnering with their doctors to chart their own care, then partners
need to listen to one another and learn from one another.

With that in mind, I’ve organized this week’s Grand Rounds by how
each set of posts helps people like me understand the health care
system and the people that work in it:

It’s a good one.

Galen’s Log: S.K.A.M. unveiled

Galen’s Log: S.K.A.M. unveiled.

It was a busy weekend.  I just arrived at the secret underground base for the quarterly S.K.A.M. meeting (Society for Keeping Americans Medicated), and made it through security clearance, when I caught wind of our latest problem.  Overhearing bits of quiet conversation as I moved towards the Inner Sanctum, I appraised that Kevin Trudeau’s new book had made the NYT top seller list, and he had been getting some TV time as well.  Definitely a threat to our organization.

You may not know this, but we in the health profession have had total cures for things like diabetes and hypertension for decades now.  Only by turning them into "Chronic Diseases" have we been able to develop returning "customers", and with them, the financial power base that will lead us to world domination.  After decades, our work was finally bearing fruit.  And yet…

Heh.  Galen has a talent for satirical fiction.

Montana gets one right

This is good news: Local News – Great Falls Tribune – www.greatfallstribune.com.

HELENA ? A new law allows students to carry their asthma inhalers with them at school rather than run breathlessly to the school nurse for treatment, the state Health Department announced last week.

Dr. Richard Buswell, a Helena physician who treats patients with allergies and asthma, said the new law is a good thing "because sometimes the (nurse’s) office is closed where the medicine has been held and the child didn’t have access to it."

This is good news for all these kids with asthma.  Who knows, maybe someday a kid with a mild headache, or a wrist sprain will be able to get a tylenol.

Dr. Charles goes to the Doctor

…or, did you every wonder what physicians think about while getting a rectal exam?  Okay, you haven’t wondered, but I think his description is very good.

He’s going to be fine, but it’s interesting to read about a doc seeing ‘how the other half lives’.

via KevinMD

National Geographic Channel: 9/11 Special

If you haven’t seen the National Geographic series on 9/11, which is in two parts, I highly recommend it.  I just watched them, and they need to be part of every single High School government/civics class until the war is won, which is going to be a while.

The next showing (if you get the channel) is September 8, 2005.  Trust me, it’s the best thing on TV.

Michael Yon : Online Magazine: Gates of Fire

Michael Yon : Online Magazine: Gates of Fire.

Combat comes unexpectedly, even in war.

On Monday, while conducting operations in west Mosul, a voice came over the radio saying troops from our brother unit, the 3-21, were fighting with the enemy in east Mosul on the opposite side of the Tigris River. Moments later, SSG Will Shockley relayed word to us that an American soldier was dead. We began searching for the shooters near one of the bridges on our side of the Tigris, but they got away. Jose L. Ruiz was killed in action.

Although the situation in Mosul is better, our troops still fight here every day. This may not be the war some folks had in mind a few years ago. But once the shooting starts, a plan is just a guess in a party dress.

It’s the best war reporting going, period.

I’d like to think I’d do the same as this ‘writer’ (he doesn’t think he’s a journalist) when things go bad, and hopefully I’ll never know.

Hopefully you never will, either.

Weighty Issues

Obesity is a problem in the US, and I’ve written about its practical aspects before (our scanners cannot hold people whose weight and girth approximate livestock, for instance).

This doctor in New Hampshire probably was doing the right thing, trying to get a patient with a weight problem to wake up and smell the coffee (it’s there behind the third helping), and for his efforts now gets to be investigated by the NH Atty General’s office.

The NH Medical Board either a) has information about this that’s way more serious than that already announced, or b) is filled with utter morons without enough do.

Time will tell.

Change in my Ad policy

Today, I took down the Google and Blogads code.  I did this for several reasons, and I’ll just list a few here:

  • distracting
  • products / advertisers I abhor
  • contractually cannot make fun of them
  • not going to get rich from them
  • distracting

I will continue to carry Dr. Drury’s ad as long as he continues to want it up, and I’m not against hosting other ads, but I won’t be hosting ads I have little say in.

The impetus to make this change was a joking post I put up yesterday that the plaintiff atty ads in the Google sidebar first made me mad, then I realized they should make me rich, and half-jokingly encouraged readers to click on them.  That was wrong of me (but no harm, no foul: the ads had rotated off the plaintiff group by the time that post went up).  A reader pointed out that was against the Google TOS, and since it was, I had a choice to make.  Now I’ve made it.

ED floor

Bloodonthedeck

Reporting Impaired Docs: What would you recommend?

In the mailbag comes this letter, asking for advice about whether / how to report physician impairment.  I’ve modified it so neither the sender nor the subject can be identified.

Put this down as a ?nobody asked me, but??

I stumbled onto your Blog, and enjoy it. Its content leads me to believe you would be in a position to comment on a dilemma I recently faced in an emergency room recently. My HMO requires that I use an ER when I need medical help, even for conditions of a non-urgent nature. Hit with the excruciating pain and discomfort …, I went to the local ER around midnight on a Friday night and sat there waiting for close to five hours, mixed in with the usual assortment of drunks, druggies, and drifters that seem to inhabit ER waiting rooms these days.

I finally got to see the MD, who diagnosed and treated the condition. What struck me, and what lead to this missive was the fact that when he came into my examination room, the unmistakable aroma of scotch preceded him. My diagnosis of his breath odor was confirmed as he worked on me.

I am not a prude, and have probably (certainly) imbibed more than my allotment of scotch in my years, but I do believe there is a time and place for everything, and on the breath of an ER MD on duty at 5:00 AM is not one of them. My experience has taught me that booze, even in minute quantities, tends to dull one?s mental acuity, something that can lead to mistakes. I did not challenge the man at the time, but I have been seized with doubts since.

What is the protocol in such circumstance? Challenge the MD on the spot? Report him to the hospital administrators? Or do as I did, nothing?

Your thoughts would be appreciated.

Challenging the doctor on the spot, though the most direct option, is probably not the best way to handle the problem.  I think the best way to approach this would be to ask, politely, to speak with the hospital administrator, and barring that, to speak with the charge nurse of the ED.  Make your concerns known, then, when your doctor in question is still there.  They would then be a) aware and b) on alert that a patient had made this complaint.

Proximity to the event (doing it while you and the doctor are both there) would have been best, as the medical staff could have taken steps to confirm or refute your concerns.  (There are limits to Medical Staff powers here: they cannot force a doc to have a blood draw, piddle in a cup, etc, but can suspend a doctor for ‘conduct’ that requires no such proof) (but does require a medical staff that’s well-covered against suits from the doc).

Uniquely, ER docs are the easiest for a hospital to get rid of (the vast majority of us can have our medical staff privileges revoked without appeal as part of our contracts), so that would certainly embolden the medical staff to act where the might be more reluctant to suspend their only brain surgeon, for instance.

At this point the only thing to do is write a nice, polite "I thought you’d want to know…" letter to the hospital president.  Unfortunately, you’re then in a he said / I said loop, and the doc might be able to sue you (please consult an attorney before writing this letter: I’m not an attorney, and the only advice I’m giving to you at this point is "talk to a lawyer").  However, this is behavior that need to be reported, and you’re right, there’s no room for drinking on the job (even if it does make you ‘fit in’ with most of your evening patients).

Now, what would you like to tell the letter writer?

Straight from the Doc – grand rounds 48: cut the fat and give me the bottom line

Link: Straightfromthedoc – News and views, Straight from the Doc – grand rounds 48: cut the fat and give me the bottom line.

welcome to grand rounds 48, the weekly collection of the best of the medical blogosphere.