Surgeonsblog

Dr. Sid Schwab has a very entertaining book, and now has a blog. From his sidebar:

I’m a pretty-much retired general surgeon. After a long and busy time in practice, I’ve taken a deep breath. And I’ll blog.

In this blog, I plan to post about issues surgical, hoping to add a bit to the readers’ knowledge base in that area. And I wouldn’t be surprised if I pop off on politics once in a while, as things seem to be going to hell wherever one looks.

I don’t usually add to the blogroll until there’s a track record for a new blog. Also, at least one book author started a blog and then just petered out, so it’s not a given that book authorship equates to blogging success. But, I’m reading his book and I think he’ll be a natural in the medblogging world.

via KevinMD

MedicalMatters.org

MedicalMatters.org

A group blog headed by Dr. Bill Frist (Senate Majority Leader, R, TN):


MedicalMatters.org is a blog about health care and the politics of health care. In the coming days and weeks we will discuss stem cells, avian flu, electronic medical records, Health Savings Accounts, and much more. We will take a long term look at some of the health care challenges facing the country and start an online discussion encouraging different points of view. I will blog regularly as will 10-12 regular bloggers from a variety of health care-related fields. We will also encourage high profile, guest bloggers to join the discussion.

Obviously, health care is an important issue for me, and it is issue that I feel needs a meaningful and comprehensive debate. It is also an issue where the Republican view of health care often differs greatly from the Democrats. This blog will also highlight and discuss these differences.

This will be worth watching.

via Instapundit

CNN: Doctor, nurses face Katrina murder charges (Updated)

The hunt for killer Docs during Katrina moves forward:

CNN: Doctor, nurses face Katrina murder charges

From Drew Griffin and Kathleen Johnston
CNN

NEW ORLEANS, Louisiana (CNN) — A doctor and two nurses have been charged with second-degree murder — the result of the Louisiana attorney general’s investigation into whether hospital staff euthanized some patients in the days after Hurricane Katrina.

Dr. Anna Pou, Lori L. Budo and Cheri Landry were arrested late Monday and charged with four counts of second-degree murder.

The charges stem from the deaths of some patients at New Orleans Memorial Medical Center after Hurricane Katrina hit. Sources told CNN the slayings were not mercy killlings [sic], but instead allegedly were carried out to speed evacuation of the hospital. …

No-one can condone ‘medical euthanasia’ in extreme situations like this. Fatigue and desperation don’t make for necessarily good judgement. I don’t know what happened, or more likely didn’t happen, there. Time will tell.

But, this article gives me some real pause:

Foti has been investigating for months whether hospital and medical staff euthanized some patients. He is expected to outline what he thinks happened to some of the 45 Memorial Hospital patients who were found dead after the August hurricane evacuations.

“We obviously think it’s a very credible … we spent a lot of time, energy and manpower working on this case … so we think it’s a good case,” Foti told CNN in February.

I trust this is just poor phraseology, and doesn’t mean ‘time spent = good case’.

In October, CNN reported exclusively that after deteriorating conditions — with food running low and no electricity — some medical staff openly discussed whether patients should be euthanized. …

Hmm, CNN also reported roving rape-gangs in the Superdome, dead piling-up etc. I don’t know if I’d be really proud of October Exclusive Reporting from New Orleans.

And here’s the part that really has me wondering:

Editor’s Note: CNN, which broke the hospital deaths story, was nominated Tuesday for an Emmy in Outstanding Investigative Journalism: “Death at Memorial Hospital.”

So, if this case goes no-where, and is found to be groundless, will their Emmy nomination be forfeit? The real problem is that now CNN’s got a reason to keep this story going, real or imagined.

Update: after the above was posted, the article was changed, and it doesn’t make the LA AG look any smarter, to wit:

‘Lethal cocktail’

According to the court document, the morphine was paired with midazolam hydrochloride, known by its brand name Versed. Both drugs are central nervous system depressants. Taken together, Foti said, they become “a lethal cocktail that guarantees that you die.”

Uuh, no, they’re not an instant death cocktail when mixed. Alarming people about two medications that are routinely used together in medicine for conscious sedation in order to pump up your case is wrong, and stupid. I have used morphine and versed together several times and nobody died! The devil is in the dose, and the respiratory monitoring and support provided during the procedure.

…”a lethal cocktail that guarantees that you die…” is just idiotic hyperbole.

MedBlogs Grand Rounds 2:43

ChronicBabe.com

Welcome to Grand Rounds ChronicBabe style, where it’s all about the ladies. We got a ton of excellent posts, so take some time to really work your way down the list. You won’t be disappointed!

Well, count me disappointed. I’m not a fan of the “write about what I want to talk about, or you’re excluded” Grand Rounds. Prior to this the topic when a host wanted to feature a topic it was prominently featured, but that didn’t exclude all other posts.

Yes, the host gets to pick the format. Inclusion will, IMHO, always be better than exclusion. Enough of the “Themes or Else”.

Bedside manner

I just had a personal experience with a doctor with a relative lack of bedside manner, and it was illuminating.

I took my largest organ (skin) to my dermatologist yesterday, as I had a few new problem areas to be looked at. (This was after about a six week wait for this appointment). My skin doesn’t like sun, or apparently bright lights. I digress.

I’ll tell you now they don’t know I’m a doctor there, and that’s okay with me. I haven’t hidden it, but I don’t announce it to anyone, either. (The only people who routinely find out I’m a doc are my barbers, who are a decidedly chatty bunch).

I waited long enough to read a couple of magazine articles, and in came the Dermatologist (Derm) and his assistant, and a PA student. No-one introduced themselves except Derm, and his intro was a grunted “Huhmm. What’s the problem?” I appreciate directness, so I outlined my little problems, and after a thorough exam, during which very very little was asked or answered, he said “I think we need to take those off”. I wholeheartedly agreed.

After 2 more magazine articles Derm reappears with the entourage, asked me to lie down, and without a word starts to numb one of the spots, the one on my right eyelid. He does it with skill (I’d know) but without warning, and all three (two others, all on the face) were taken care of efficiently, and without warning, narrative, etc. It didn’t hurt more than a 1/10 at worst, and the procedure was a success (I hope).

However, Derm’s lack of any appreciable bedside manner has me reevaluating one of my longest-held beliefs, that people don’t really care if their doctor has a great bedside manner, but only really want a doctor who is very competent and does the job right.

And, painfully, I have to look hard at myself. I am, occasionally, a touch cranky. I try very very hard to not be cranky toward my patients, but I’m not in such denial to say I never act cranky with a patient.

Physician, heal thine own bedside manner. Me first.

On being laughed at

Recently I wrote of an interaction with an individual who thought I needed to learn to speak Spanish. I wasn’t terrifically happy.

But I’m game, and I resolved to try out my very very bad Gringo Spanish, when necessary. A week or so ago, I had the perfect opportunity, a patient and sole family member, neither of whom spoke English. No easy interpreter available. It’s my muy-bad Spanish or pantomimes.

I tried it out, and though the patient and I were doing okay, the patient’s significant other thought my Spanish was Laugh Out Loud hilarious. Literally. To the point it was distracting, and more than a little bit irritating. Infuriating, really.

Really, I’m trying to communicate with my patient, in a language quite literally foreign to me, and it’s amusing to the audience, and they feel no reason to hide their amusement, to temper their reaction with the realization I’m trying to help. Just laugh at the doctor trying to help their relative.

Now, I have a good sense of humor, and laugh at myself easily. I don’t have a lot of tolerance for ridicule, though, and that’s what I felt this was. Ridicule for trying to speak a language I didn’t, while neither of them would try speaking my language.

I’m a pro, and the patient got good care, but now I’m not really interested in extending myself to communicate outside my comfort zone.

Medpundit returns

Ha! I knew she’d be back!

Medpundit: “Just When I Thought I was Out, They Pull Me Back In: Well, it’s official. I’m a blogging addict. I can’t give this up. Not quite two months away from it, and I’m forsaking my family to rejoin the blogging life.”

Oh, and welcome back.

Now, for Shrinkette….

911 Case Study: Pentagon Flight 77

I have no use for 9-11 conspiracy theorists. Period. It takes a particularly diseased mind to blame multi-level government conspiracy for deeds claimed by our enemies as their own action on the US.

However, I found this to be terrifically interesting: an astonishingly well-done video of the crash into the Pentagon of AA Flt. 77.

(My first YouTube embedded movie!)

This will not influence those who want to Blame America First, but is an excellent coverage of the crash, and an explanation of some minor details.

via LGF

Dad gets a cardiac stent

…and I feel completely helpless….

I was getting ready for bed last night, and as is my wont I checked the email:

This afternoon, at 3:15, Dad said “Take me to the emergency room”. He’d had two attacks (one Tuesday night at a quarter to 11, one at 12:30 just before lunch time today) that we thought were abdominal.

Well, after hours and hours in an e.r. room, we found out he had 100% blockage in a major artery! [Cardiologist] started the angiogram at 10 p.m., a nurse came out at 10:35 and told us ([friends] were with me) about the blockage, and they started inserting a stent.

At 11:05, the doctor showed me “before and after” photos. The artery basically didn’t show up on photo 1, looks fine on photo 2. He has some OTHER blockage, but the doctor said we’ll just watch him and see when (if?) another stent is needed.

Anyway — 24 hours after the first pain (quarter to 11 last night), the surgery was almost over! Today’s medical technology truly IS wondrous.
He’s overnighting in CCU. Visiting hours begin at 9 in the morning, and I’m hoping he can come home shortly after that.

Mom

So, it’s about 2 AM and I find this out. By email. I admit to a moment of panic, then realized that if they weren’t excited about it I shouldn’t be, either.

When asked why they didn’t call during the event, they said ‘we thought you might be at work and didn’t want you worrying about him’, which is nice but wrong. Dad’s doing fine, has no idea which artery was stented, how the ischemia diagnosis was made, if there was any damage, etc. It’s truly a situation where if you don’t know the questions to ask you can’t ask them.

It’s very hard for me to not ‘take over’, then I remember all the family members who do that in my ED, and decide it’s not really necessary, or helpful. There will be plenty of time for that, later.

Oh, and thank God for stents.

Cardiac Stent: original from http://www.stmichaelshospital.com/content/programs/cardiac/treatment/Angioplasty.asp

Update 7-14: Home, safe.

Common Good Testifies for Special Health Care Courts

In the email today:

COMMON GOOD TESTIFIES AT HEARING IN U.S. HOUSE
OF REPRESENTATIVES, AS MOMENTUM CONTINUES TO BUILD
FOR THE CREATION OF SPECIAL HEALTH COURTS
New York, NY July 13, 2006 Common Good, the bipartisan legal reform coalition, announced that its general counsel Paul Barringer testified today at a hearing of the Subcommittee on Health of the U.S. House of Representatives Committee on Energy and Commerce. The hearing focused on innovative solutions to medical liability, and Common Goods testimony addressed the need for special health courts.

The hearing followed soon after a similar hearing held last month by the U.S. Senate Health, Education, Labor & Pensions Committee. On that occasion, Common Goods Chair Philip K. Howard testified about health courts.
In the Senate, Michael Enzi (R-WY) and Max Baucus (D-MT) have introduced a bill to authorize and fund pilot health courts. In the House, Rep. Mac Thornberry (R-TX) has introduced similar legislation.

I’ll put the rest in the extended entry.

I’m guardedly in favor of these. More at Common Good.
[Read more...]

Change of Shift; a Nursing Grand Rounds Vol 1 No 2

It’s up: Change of Shift: Volume One, Number Two // Emergiblog

Welcome to the second edition of “Change of Shift”, a nursing homage, if you will, to the great tradition of Grand Rounds. An amazing array of wonderful stories from nurses, patients and doctors are here for your perusal this week. Enjoy!

Nursing galore!

Jarhead Red

Some former Marines have gone all vino on us, and are now producing their own wine:

Introducing Jarhead Red

Jarhead Red is a wine made by Marines, for Marines, at Firestone Vineyard on California’s Central Coast. Net proceeds from the sale of this wine benefit the Marine Corps Scholarship Foundation, which provides educational assistance to children of U.S. Marines, with special attention given to children of fallen Marines. Please consider directly supporting the foundation at www.Marine-Scholars.org.
Adam Firestone – CAPT USMC 1984-91
Winegrower

Ruben Dominguez – SGT USMC 1979–84
Vineyard Foreman

I haven’t had any, and am looking more for grunt-beer anyway. OTOH, the charity is worthwhile, so I may get some for that special occasion.

There’s a review at DefenseTech.

h/t to reader Shauna

Montoya out for the season?

What? I knew he was going to Nascar, but this?

McLaren agree to release Montoya

Juan Pablo Montoya has been released by McLaren with immediate effect following his decision to quit for Nascar at the end of the season.

The Colombian will be replaced by test driver Pedro de la Rosa for the rest of the present campaign.

“I know it will be a tough transition but I’m excited about the chance to move into Nascar,” said Montoya.

We knew he wasn’t coming back to McLaren (a mutual no-love-lost between-them situation), and the Nascar deal was announced days ago, but I though he’d race out the season rather than leave after a decidedly poor showing last week.

Does this mean I’ll start watching Nascar? Probably not.

MedBlogs Grand Rounds 2:42

It’s up: donorcycle: Grand Rounds 2:42

Welcome to Grand Rounds 2:42 and welcome to donorcycle. . I’d like to thank everyone for their donations, er, submissions. So come in, grab and drink and peruse this week’s finest writing from the medical blogosphere.

This is two weeks in a row I’ve had nothing to send in, but there’s been plenty of good reading there (hmm, wonder if that’s a coincidence…).

Doctors are allowed to say dumb things

That’s the considered opinion of a Judge in New Hampshire. I blogged about this a while back, and the doctor finally got his day(s) in court.

CONCORD, N.H. (AP) – A judge has ordered the state Board of Medicine to stop disciplinary proceedings against a doctor accused of telling a patient she was so obese she might only be attractive to black men and advising another to shoot herself following brain surgery.

Judge Edward Fitzgerald made clear in a ruling released Thursday that he did not condone remarks attributed to Dr. Terry Bennett and found them unnecessary, but ruled Bennett had a right to speak bluntly.

“It is nonetheless important … to ensure that physicians and patients are free to discuss matters relating to health without fear of government reprisal, even if such discussions may sometimes be harsh, rude or offensive to the listener,” he concluded in the ruling Wednesday.

Yes, he’s not very smart. Given. But, should speaking bluntly (or offensively, given the shifting sands of offensive speech) result in medical licensure suspension? Per the court, no.

And the judge takes a nice swipe at the AMA, for good measure:

Fitzgerald also ruled that state and American Medical Association requirements to treat patients with “compassion and respect for human dignity and rights” are so vague they are unconstitutional. Bennett probably would have won his challenges before the board, the judge said.

So, Dr. Bennett, you’ve won! Are you going to go to Disneyland? Not hardly:

Bennett said he planned to sue everyone involved for “malicious prosecution.”

“I am not inclined to be forgiving about it,” he said. “It’s been devastating and infuriating.”

I don’t think I’d be all that forgiving either.

via Kevin, MD