50 entries. Plenty to keep all of us occupied.
Archives for May 2006
Pediatric Grand Rounds are up:
Pediatric Grand Rounds: Volume 1, Number 3
Welcome to the latest edition of Virtual Pediatric Grand Rounds. Unfortunately, there will be no CMEs available for this event, nor will there be coffee or donuts. However, I hope that you will find the submission thought-provoking and timely.
If you don’t get HBO, you should, just to see this documentary.
Baghdad ER is an HBO documentary, filming (a few) of the soldiers, Iraqis (and one Marine) who come through the Army’s 86th Combat Support Hospital in the Green Zone of Baghdad. It’s not to be missed.
First off, as an EM doc, I have absolutely no quibbles with the medical care shown. None. (You say: well, sure, you spent time in the military medical system, of course you’d say that. You couldn’t be more wrong. This is an Army Hospital, and I was in the Navy: there’s a friendly rivalry, to be polite.) I was very very pleased at the level of care shown. It didn’t, frankly, look any different than the care in any stateside hospital I’ve been in (except not enough use of emergency sonography is shown, but who knows if sonos were there and just not shown).
Second, this is a film for those who support the war and those who don’t. It’s just a good study of America’s all-volunteer military, and their all-volunteer healthcare providers. It’s neither pro- nor anti-war, and for this sort of film that’s all the balance you can hope for. Frankly, I found it a lot more even-handed than I expected.
Lastly, I’m very proud of my profession as it’s being practiced in Iraq by the US Army. This shows the US military as they are: individuals putting themselves out for each other. Wonderful.
Oh, and I was literally moved to tears, and I’m not easily emotional. I found myself wishing, briefly, I was back in uniform caring for the troops.
Most Common Diagnoses in Patients Transported by Ambulance to Emergency Departments — United States, 2003
From the CDC:
During 2003, approximately 16 million ambulance transports were made to emergency departments (30 per minute); 37% of patients transported were admitted to hospitals.
Ten primary diagnosis groups accounted for approximately one third of all transports.
And, what were those ten categories?
- Chest pain
- Contusion with intact skin
- Nonischemic heart disease
- Sprains and strains of the neck and back
- Syncope and collapse
- Abdominal pain
- Drug dependence and non-dependent abuse of drugs
- Fractures, excluding lower limb
I wonder how many of those were inter-related: Cocaine abuse causing chest pain and convulsions, followed by syncope, awakening with a big bruise, finger fracture and a wicked neck strain, a non-Q wave MI and abdominal pain, with aspiration pneumonia caused by the convulsion.
Yeah, I saw that patient, recently. Everyone in the ED has, apparently.
From the Manhattan Institute: Civil Justice Report 10 | Medical Malpractice Awards, Insurance, and Negligence: Which Are Related?
Medical Malpractice Awards, Insurance, and Negligence: Which Are Related?
Alexander Tabarrok, Department of Economics, George Mason University and Amanda Agan, Department of Economics, George Mason University
Doctors’ medical malpractice liability insurance premiums are at an all-time high. As has been widely reported in the press, escalating med-mal premiums have driven doctors to retire early, shut down their businesses, or reduce the scope of their practices. In areas of the country with particularly high premiums, there is concern that patients’ access to care has been compromised.
Insurance companies and most doctors conclude that the root cause of higher insurance costs is higher tort awards. The American Medical Association, for example, says that medical liability reform is their top priority because “rapidly increasing medical liability insurance premiums caused by escalating jury awards are seriously threatening patient access to care.”
On the other side of this debate are plaintiffs’ attorneys and their allied consumer groups who attribute the boom and bust “insurance cycle” to investment returns and, alternatively, accuse insurance companies of “price gouging.” Such claims are often picked up, uncritically, by the mainstream press.
Our study makes four contributions to this debate:
1. We show that medical malpractice premiums are closely related to medical malpractice tort awards. Over the long run, premiums closely track awards, and premiums adjust to short-run award variation as well. …
2. We show that medical malpractice premiums are not explained by insurance industry price gouging. For the price-gouging hypothesis to make sense, insurance industries must be exercising monopoly power. …
3. We show that medical malpractice tort awards are related to some factors not rationally related to injuries. For instance, states’ judicial electoral systems have predictive value on the expected level of tort award.
4. We show that malpractice tort awards and thus insurance premiums can vary dramatically for reasons having little or nothing to do with negligence. ….The tort system shows no or even a slight negative correlation with the board review system’s negligence determinations, suggesting that the system is influenced by factors not related to negligence.
Hmm, this is pretty much what we’ve been saying for a long time…
Why would I say that? That’s pretty random.
Yes, it’s random. Until yesterday I didn’t think about it at all, then I went to check my email: ‘server not reachable’ or somesuch. Reload the website page: !Airline Vacations through gruntdoc.com!?
Yes, my domain name expired. A panicky email to the hosting company found that although they’d moved it to their custody they hadn’t entered it into their billing software as an expiring event, so no bill was sent, so when it expired it went "open".
Hosting company had it fixed within about 2 hours, and now it’s in the billing software correctly, so it shouldn’t happen again. Aah, the fun of blogging.
Medpundit has decided to end her blogging career, at least for now:
So Long, Farewell, Auf Weidersehen, Adieu: Last week, during an interview about medical blogging, I found myself speaking about Medpundit in the past tense. It surprised me a little, but not completely. Whether or not to go on with this blog is something that I’ve been mulling over for several weeks. I didn’t want to admit it, but hearing myself refer to the blog as "was" and "has been" made me realize that deep down I had made my decision.
And so, it’s with regret that I take the necessary step of closing down this blog. It’s been fun, and I’ll miss it, but there are other things in life that need – and deserve – my attention more. So long, farewell, readers. The pleasure has been entirely mine.
According to her archives her current blog (she’s used Blogger the entire time!) started in March of 2002, a terrific run (and two months longer than mine). I just looked, and there’s references to Medpundit at least 20 times in my blog posts.
I thought I’d made the big time when I got a mention in her blog in August, 2002, and I’ve been a long-term reader and fan of hers. She’s what people think of when you say "medical blogger": she commented on medical news and ideas in a meaningful, substantive way. That doesn’t mean she’s been opinion-free, far from it, and that made her blog more interesting, not less so.
Certainly, I hope she’s just burned out (the blogosphere is replete with bloggers who quit, only to find it’s part of them and they cannot give it up) and will come back, and definitely hope she leave the blog up, if for reference and historical purposes only.
If not, thanks for the free entertainment, Dr. Smythe, and I wish you all the best with your family and your practice.
This is a photo of a tattoo that Mary Wohlford, 80, has emblazoned on her chest. Wohlford, of Decorah, Iowa, got the ink in February to hopefully eliminate the possibility of any Terri Schiavo-esque controversy about her medical wishes should she become unable to communicate them directly. From the Des Moines Register (photo by Mary Chind):
If all else fails, if family members can’t find her living will or can’t face the responsibility of ending life-sustaining measures, she said, then doctors will know her wishes by simply reading the tiny words that are tattooed over her sternum.
So, would this stop ME from doing CPR? Yes, I think it would, though there’s some blatheration about "a copy of an advanced directive in the chart":
Would Wohlford’s tattoo stop an Iowa doctor from resuscitating her?
"According to Iowa law, the answer is no," said Dr. Mark Purtle, who works in internal medicine at Iowa Methodist Medical Center. He said Iowa law spells out when caregivers are permitted not to resuscitate a patient, and a tattoo wouldn’t be good enough. He suggests a living will or an advanced directive, with a copy placed in the patient’s medical chart, as well as discussing your wishes with trusted family members.
Lawyers agreed with Purtle. "Just having that tattooed on your chest and doing nothing more, I’m not sure that’s going to do you much good," said William Bump of Stuart, who has expertise in living wills and estate matters.
I’m betting that, despite having expertise in living wills and estate matters, he’s never been staring at an 80ish year old patient in an ED with no medical records and wondering what that patients’ desires would be. It’s goofy to think that someone would go to the trouble of having the entire words "Do Not Resuscitate" tattooed on their sternum as a prank or a stunt; if it’s there I’d take it seriously. Really, I’d prefer a tattoo like that over the copy of a copy of a crinkled out of hospital DNR form that sometimes accompany the patients. Maybe I’m alone on that point, but there you are.
End of life decisions should be made early and discussed with everyone you reasonably suspect would be called to act as your surrogate. And, if you want to do this, hoping some caregivers prefer flesh to paper, then I don’t see why not (just be aware this would be a little less revocable than signing a piece of paper).
None of us get out of this alive; sometimes we can choose how we go.
Hat tip to Mike (who needs to get back to blogging) at FFM for the link.
Forty-six million dollars will be available to Texas physicians, hospitals, and ambulance services this year to help cover the cost of emergency medical care for undocumented immigrants, Mexicans legally entering the U.S. on a 30-day temporary visa, and parolees released by Homeland Security.
The money is part of the $250 million Section 1011 program created by Congress when it passed the Medicare Modernization Act in 2003.
By the way, this is weird: The RSS for this post, and the actual post are different. The RSS feed says:
Government offers payment for immigrants’ care
Government offers payment for immigrants’ care
Texas physicians, hospitals, and ambulance services who provide emergency care to undocumented immigrants are elgible for payments from the federal government to help offset the costs of treating them. There is $46 million available this year.
It’s TMA’s site, and they can do what they want, but it seems very labor intensive to do it this way.
Enjoy yourselves. Wow, but that’s a lot of posts.
Our joint has some spare change, apparently, and we’re daily going to have about 10 hours of pharmacist coverage in the ED during our peak hours. This is a trial, and we want to make it work.
Unfortunately, nobody really knows where they’ll be handiest. Should they concentrate on the nursing home admits, pointing to the (no doubt myriad) drug interactions on their multi-page MAR’s, or just troll around and look at the ED charts for what pops up? We don’t know.
I’m looking for constructive thoughts, and real-life "we tried this and found that (fill in the blank) works". (I’m also looking for amusing recommendations, but keep it clean).
Let the comments flow…
The normally even-tempered Dr. O of MedGadget and his fellow bloggers have been reporting on the republication of bloggers’ work in major newspapers, bandwidth theft, etc., and he’s ticked-off about it:
Our website Medgadget.com (usually a quiet place to learn about the latest medical technologies) has been investigating a new service from Pluck, called BlogBurst. We have learned and revealed a number of questionable practices by the company – from republishing entire contents of bloggers on newspaper sites to deeplinking images from bloggers and innocent bystander websites. The most outrageous thing is that some of the nations’ leading newspapers, including the San Francisco Chronicle, Houston Chronicle, San Antonio Express-News, and the Austin American-Statesman, are engaged in the deeplinking and republishing for profit.
Please spread the message! It is time for us, bloggers, to say that we value and respect our work.
I haven’t made enough of a noise about the Peds Grand Rounds, and, sorry about that. Here’s to make up for it:
Pediatric Grand Rounds: Deadline 5/21/06 @ 7:00pm EDT
Are you a pediatrician, or pediatric subspecialist who blogs? Do you have a blog entry about your experience with a pediatrician or pediatric subspecialist? Then the next edition of Pediatric Grand Rounds is for you! Please submit entries to me by Sunday, 5/21/06 at 7:00 pm (e-mail links or the like to me by clicking here).
So, if you’re a pediatron, play as you will.
So, my blog and my mug have been in print, again, this time in the Dallas Morning News this past Sunday. Those with blogs are probably wondering, ?how much did it affect his blog traffic?
Answer: absolutely none. Just like the other times.
Dead-tree publications appeal to a different audience than do online materials is the way I explain it. Apparently nobody reading the Sunday paper leaves their couch and says "I’ll go type this URL in and have a look at that". Not helping is the DMNews online version that didn’t have hyperlinks for the URL’s (and, inexplicably, in an article about blogs left out some URL’s altogether) making it harder for people to follow the links in the story. Dead trees online.
The counter-explanation is that nobody’s interested, but that can’t be. Heh.