MedBlogs Grand Rounds 2:23

A Chance to Cut is a Chance to Cure

 A picturesque and yet to-the-point Grand Rounds from the pseudonymous Bard Parker.

Another afternoons’ worth of medblog reading. Enjoy!

Merit Badge Certifications and CME

…or, death by a thousand CME’s…

The Big Trend at my joint is Chasing Certifications. Yes, we’re a Trauma Center, and those that were here during that pursuit recall the extraordinary efforts (and monies) expended in that effort. Trauma Center Accreditation requires, inexplicably, ATLS certification of all the Trauma docs and EM docs who work in the hospital, plus semiannual ‘Trauma CME’. The ONLY thing that makes this even semi-tolerable is that the pain is pretty agnostic – the Trauma Surgeons have to jump through the same hoops, but it’s still terrifically annoying. (Why is it annoying? Because ATLS wasn’t meant for Board Certified EM docs working in Trauma Centers, it was meant for those practitioners who see trauma infrequently, and for whom it is a frightening novelty. Also, there hasn’t been anything significantly new in the EM practice of Trauma since RSI.) Finally, I had this training in residency, as did every residency trained, board certified EM doc.

Now, we’re being treated to the latest, a ‘Chest Pain Center Certification’. They want a set number of CME hours entailing Cardiac topics, and it’s Time to Draw the Line. Not that I’m against cardiac treatment or education, and if there’s a specialty that has an active journal set, it’s Cardiology. Unfortunately, this is a slippery slope, and it’s truly insulting to professionals in EM. Cards wants 10 hours a year of Cardiology CME (Trauma wants about 7 a year), so now 17 of my 25 state-required CME hours would be claimed. Nevermind I’m about to go to ACEP and would have a heck of a time finding 10 hours of cardiology specific programs to attend, and what would I miss while trying to attend cards CME primarily? The Trauma CME?

This isn’t a straw dog, this is reality, and here’s where the dog bites: our joint wants A Lot Of Certifications, and next is Stroke Center. Now add in another 7 – 10 hours of Required CME for Neurology, and you can see where this is headed: I’m going to have to quit my job to go all to the conferences to keep my job. This would be in addition to the EMCC required by my Board. And, what’s to keep every single specialty from laying on a requirement on the ED for all the docs to have ‘CME in our field’? None, at this rate.

So, here’s how I see it, and how I think it should be presented: I’m a professional, I am well trained and keep up with the literature (my board makes sure of it, yearly). I have to have 25 hours a year (minimum) of CME to keep my State licensure, just like every Physician on staff, and there’s the every two year Medical Staff reappointments to make sure we’re keeping up our end of the bargain. That should be plenty of assurance, and all the numbers required to fulfill any medical staff obligation.

Merit Badges make sense for Boy Scouts, but not for EM Professionals. Before you balk, consider your specialty and a requirement for 10 hours of EM CME a year…

AAEM statement on ACLS
AAEM statement on ATLS
Update 2-27: (via commenter Darren)
ACEP Statement on merit badges and specified CME

DirecTV math

We got the following statement the other day, and I’m having a little trouble getting it to add up.

doesn't add up

Maybe I’m just a little slow.

Blog Inattentiveness

The rumors of my demise are greatly exaggerated…

I’ve had a lot on my little plate recently, which is why the dearth of postings.  In the last week I’ve had to prepare a lecture for a neuroscience meeting (1 hour, powerpoints, diverse group so something for everyone) and started a second, ‘moonlighting’ job.  The combination means the blog has suffered, sorry.

 Life smooths out for a bit starting tonight, so the old, irritable self will be back soon.

MedBlogs Grand Rounds 2:22

Dr. Andy

Hello and welcome to Grand Rounds 2:22. I decided to highlight 10 posts that I found most outstanding among all those submitted. This was hard as there were many excellent posts. The top 10 are not listed in any particular order.

And take heart if you, like me, suffer from a subclinical case of seasonal affective disorder. Spring is definitely coming! (click on pictures to enlarge)

Another beautifully-rendered Grand Rounds.

ER doctor sounds siren for change

bizwomen.com: A service of Houston Business Journal

ER doctor sounds siren for change
Even with a 76-hour-a-week work schedule and eight kids, Dr. Diana Fite finds time to tend to the trauma system
Mary Ann Azevedo
From Houston Business Journal

Being an emergency physician in the nation’s fourth-largest city is no easy task. And the job becomes even more challenging in a city that is known for its lack of trauma care facilities — just ask Dr. Diana Fite.

Fite sees firsthand how such a gaping hole in the health care system can actually make the difference between life and death, and she has made it a personal goal to help improve the situation.

In her role as the newly elected president of the Harris County Medical Society, Fite hopes to help improve the city’s emergency care offerings.

As the first emergency physician — and only the fourth woman — to fill the president’s role in the Medical Society’s 103-year history, Fite hopes to increase awareness to the plight, which she believes is interconnected with a host of other issues the city faces, including a large uninsured population.

“The harsh reality is that anyone can be affected by the lack of ER care in this city,” says 52-year-old Fite, a mother of eight children whose ages range from 11 to 27 years old. “Anyone can not have access to the care they need as quickly as they need it.”

The rest of the article is worth reading. I have trouble getting my tasks done, and I am not the mom to 8 kids!

First Mac OS X Worm a Wake-Up Call

via Wired, The Cult of Mac Blog:

Thursday, 16 February 2006
First Mac OS X Worm a Wake-Up Call
Topic: Apple
The first Mac OS X malware has been spotted in the wild, but it appears to be something of a damp squib.

Called Leap-A by anti-virus companies, the worm appears as a JPEG file that spreads via iChat to contacts on the infected user’s buddy list.

I’m not too worried about this one, but wonder how long it’ll be until I do need to worry.
[Read more...]

symtym: Patronizing Dribble

It would seem symtym had the same thought about a recent ACEP News article. I blew it off as more ACEP cluelessness, but symtym has some pointed things to say:

Patronizing Dribble:

In Emergency Medicine, we’re pretty use to being patronized by the other specialties—but I don’t expect it from within the specialty or from the putative leading organization representing emergency physicians. Patronizing dribble? Fluff piece?

Symptoms May Mask Meth Cases in ED | ACEP News | February 2006

Emergency physicians have a lot of catching up to do on their knowledge of the symptoms of methamphetamine addiction, according to Dr. Mark B. Mycyk.

Right, on the most prevalent intoxicant (excluding alcohol of course) in most urban ERs. Where have you been for the past 10 years? Of course, I may be jaded working in Northern California— the meth capitol.

‘Maybe it’s because they don’t know what to do about it, or maybe it’s because they are so focused on traditional drugs of abuse, like cocaine, marijuana, and PCP.

Right, you certainly are showing your regional prejudice—cocaine and PCP have been displaced for several years by methamphetamine use.

Read the rest, and don’t tick off symtym.

MedBlogs Grand Rounds 2:21

intueri: to contemplate

Welcome to the personal ads of Grand Rounds. It’s Valentine’s Day and you’re looking for that special someone—or just some stimulating entertainment. Skim the personals below and if any tickle your fancy, don’t be shy—that click could be the sound of a love connection.

Timely Valentine’s presentation of Grand Rounds, and quite clever!

Valentine’s Day

Happy Valentine’s Day!

As linked last year, here’s some information on the day from the History Channel.

Orac has moved

Respectful Insolence (aka Orac Knows) has moved to: http://scienceblogs.com/insolence. Update your bookmarks accordingly.

EMR and Computer Security: Another cautionary experience

We’re all going full-tilt toward the Electronic Medical Record, and it stands to be pretty useful both to patients and to providers. However, they’re still just very specialized software running on networks, and networks need constant vigilance against intruders, including the bored, curious and malicious.

via Slashdot, here’s the story of a Seattle-area Hospital that had several critical systems shut down by a hacker who installed adware in an unsecured system. They state no-one was harmed (good) and the culprits are going to have to face the music (double-plus good), but as we become more and more interconnected we’re also more and more vulnerable.

I went to a dog-and-pony show for the EMR that our corporation is going to be rolling out soon, and it’s intriguing, but I’d need to do about 50 practice cases to feel comfortable with it before using it ‘live’. The biggest concern I have with any of these systems is that the flow of information is always assumed to be very linear (triage / basic registration info, then nursing assessment, then the doc interaction, the diagnostic tests and therapeutic interventions are ordered, etc.), which isn’t life in the ED. Sometimes all that needs to happen at the same time, and it takes a lot of mental flexibility and teamwork to make that happen. I’m leery a program can be made anywhere nearly as flexible as people.

Also, patients, get used to looking at the top of your doctors’ head (if you’re lucky) or their back, as ‘feeding the computer’ is going to be the norm. Progress, you know.

Best Chief Complaint of the Night

“I have a cold sore and I want you to take it off”.

symtym | Present System, Future Disaster

symtym | Present System, Future Disaster

A very nice roundup of comments by an ACEP board member to a House Committee on Homeland Security

Take The Pledge

Emergency Physicians Monthly Online has a good idea to cut down on frivolous medmal cases, and I think it’s a good one.

Their drive is called “Take the Pledge”, and here it is:

“I will not offer as an expert opinion any position that does not have the full and complete agreement of at least three other experienced practicing emergency physicians.”

I’ve said it before, and one of the best ways to decrease frivolous medmal suits is to police our own ranks of those who give medical testimony. Again, this isn’t about parroting the party line, it’s about realistic testimony for or against physicians.

If you’re a Physician and you agree, I’d urge you to

I did.