Archives for August 2006

ED video

A really cool ED video, from ImpactEDnurse:

ED video: People often ask me why I continue to work in the Emergency Department despite the ongoing hazards of overcrowding, access block and the high stress levels. Its a difficult question to answer in words. A while ago I tried to answer it in a video clip….
Team ED
WARNING: this is a large movie file (15.5MB)

Jerk Consultants and Telephone Etiquette

Pediatrician Flea posted about feeling like the jerk he was on the telephone with an ED physician.  (I was going to type colleague, but one doesn’t behave boorishly to a colleague).  He says they ‘have a history’ which explains why the ED physician was near tears during their phone call. 

Flea’s been subject to nearly enough derision in the comments of his own post, and those on Kevin, MD (which is where I found the Flea post) and I have nothing more to add on that individual interaction.  I do have something to say about the telephone and its use with the ED Consultant.

 The vast majority of the consultant physicians I call are collegial, knowledgeable, and helpful.  I personally don’t care if they’re “friendly” on the phone, but it’s a plus of they are.  Typically I only have about 33 other things I need to get done while placing calls, so it’s a to-the-point quick presentation, respectful of the consultants’ time, and trying to use mine productively.  I usually have a plan, lay it out, and we come to a conclusion that benefits the patient.

And then there are the four consultants in my practice history whom I utterly detest calling, as they’re condescending jerks of the first order (four in the entire history, and just two active now).  After my usual presentation, which is the same as I give to everyone else (and, I do my utmost to keep my prior irritation hidden from them on the phone; no sense letting them know their awful behavior gets to me), it starts.  Usually it’s the ‘why are you calling me?’ in a decidedly whiny tone, and when it’s explained (problem clearly in your specialty, you’re on call, etc) then comes the attempt to get me to change the diagnosis so it’s not their problem.  Playing 100 questions, we go back over all the history, the physical (pertinent and not), labs, etc.  Many ‘gotcha’ moments are tried with stated holes in the above, all in attempt to put me on the defensive, to defend the entire interaction and workup, not to help the patient but to get themselves off the hook.   This doesn’t work with me, and I stand my ground.  They get to do their consulting bit, and the patient gets appropriate care.  And I hate calling them.  To me they are physicians in title only; oh, they’re fully trained and qualified, but don’t embody what I’d call a physician.

 There was one occasion with a consultant on the phone wherein the belittling of my ED and ultimately my personal professionalism and judgement wouldn’t stop.  Finally I asked the consultant to come in and do their own eval, and before we hung up I asked him to feel free to repeat his diatribe to me in person.  I was avoided when they came to the ED, and no direct confrontation occurred.  I don’t think anyone had stood up to this jerk before, and we now have a civil working relationship.  We’re not Christmas card pals, but we work together effectively.

Finally, the consultant who generates an acrimonious relationship with the ED is not doing himself or his patients any favors.  We need each other to take effective care of our patients.  And boorish behavior is for boors, not Physician Colleagues.

COMAIR crash and Tower Staffing – FAA: Tower staffing during plane crash violated rules – Aug 29, 2006

WASHINGTON (CNN) — The Federal Aviation Administration on Tuesday acknowledged that only one controller was in the tower, in violation of FAA policy, when a Comair jet crashed Sunday while trying to take off from the wrong runway in Lexington, Kentucky.

Forty-nine of 50 people aboard were killed.

The acknowledgment came after CNN obtained a November 2005 FAA memorandum spelling out staffing levels at the airport. The memo says two controllers are needed to perform two jobs — monitoring air traffic on radar and performing other tower functions, such as communicating with taxiing aircraft.

And utterly none of that matters.  Yes, it’d have been nice if there had been two controllers.  Maybe they could have averted the disaster, and this utterly meaningless loss of life.  Maybe not.  That’s all speculation at best.

What does matter is that a professional aircrew didn’t follow their procedures, and didn’t do even a basic review of their compass heading prior to taking off.  Those checks should have told them they were on the wrong runway, and the Captain of the Ship doctrine applies in a plane as much as it does on a ship.  If it happens on your watch, it’s your fault, whether you were asleep or on the bridge.

I’m sorry for the loss of life, and I’m glad I wasn’t there, but the Tower controller didn’t have control of the throttles or the brakes on that jet.  Only the aircrew did, and that’s where the responsibility lies.  Period.

MedBlogs Grand Rounds 2:49

GRAND ROUNDS, VO. 2, NO. 49 at Protect The Airway

Petty Annoyances

When I gripe, frankly it’s like the things and people you gripe about, just in my situation.  It’s the 1/10th of a percent who make you wonder why you do you job, as they can suck they joy out of any moment.  If you work with the public in any way, you know how easy it is to generalize that ‘everyone is an idiot’, and that’s bad for your practice as a doc and your soul as a person.  Sometimes t’s hard to remember that.

This is not to say that the unpleasant experiences don’t happen; they do.  This is not to say there aren’t decidedly unpleasant people; there are.  Stress ‘accentuates the personality’, and some personalities don’t need sharpening to cause pain.

I tell you this to explain, oddly, why I’ve decided not to rant about some recent interactions with the people referenced above.  The rant is my post of choice, and it’s odd but I don’t want to right now.  That’ll change, but it’s foregone currently.

Maybe I’m growing up, or old, or just bored / boring, but for now I’m going to let it go.

I wondered why I was alone on my ride today

Today on my ride I was the only cyclist.  That’s a first, no matter wind/ heat /water, and after a while I was wondering if I’d missed an announcement.

I remembered while saying to myself “It’s hotter than hell out here”, and the light came on.


They were here.  Hope they had fun!

Radiology Grand Rounds III

is up at Dr. Sethi’s place.

Mail theft PSA

From F&TIEO.  He writes amusingly about an infuriating experience.

How to answer a Peer Review Complaint

My Photo Wow.  This is a Tour de Force.  Not just in complaint-answering, but also an explanation of ‘why the dumb ER doc can’t admit Grandma’.

From Scalpel, who’s very good at this new blogging thing.

BBC News: Tea healthier than Water

Tea ‘healthier’ drink than water


Drinking three or more cups of tea a day is as good for you as drinking plenty of water and may even have extra health benefits, say researchers.

The work in the European Journal of Clinical Nutrition dispels the common belief that tea dehydrates.

Tea not only rehydrates as well as water does, but it can also protect against heart disease and some cancers, UK nutritionists found.

Experts believe flavonoids are the key ingredient in tea that promote health.

Dr Ruxton said: “Drinking tea is actually better for you than drinking water. Water is essentially replacing fluid. Tea replaces fluids and contains antioxidants so its got two things going for it.”

Once again my lifestyle choices are being affirmed.

Now, do these glasses of tea come out of my coffee budget?

Change of Shift 1:5

Change of Shift

Welcome once again to Change of Shift: A Nursing Blog Carnival, the bi-weekly compendium of nursing-related postings from around the medical blogosphere.

Modeled after the blogfather of all things medical, Grand Rounds, and shamelessly copied from Nick of Blogborygmi, Change of Shift is nursing related, but written from the perspective of all participants in the world of health care.

A big thanks to Intelinurse2b at It’s A Nursing Thing, for hosting our last edition..

And now, the fifth edition of Change of Shift.


It’s up!  Go and enjoy.


And, today’s Required Reading: Talking to Doctors.  This is wonderful!  Thanks, Kim!

Medscape Editorial on Reforming Physician Licensure

Here’s a nice, brief editorial by Dr. Michael M.E. Johns, CEO of the Woodruff Health Sciences Center at Emory  University.  He’s got a point about the current state of CME and relicensure being somewhat anachronistic.

Here’s where he and I can completely agree:Link to Editorial on MedScape Emergency Medicine

CME credits are now the measures by which most states certify physician competence, and the vast majority of CME offerings have little impact on how physicians practice medicine.[1] Knowing that this is a flawed system, organized medicine continues to endorse it.

So here are 3 proposals to modernize:

3. CME should not be used for certification or relicensure. The American Board of Medical Specialties’ stepped process of certification[2] should be applied to relicensing. Submit a step every 2 years and earn relicensure.

Well, details, details.  My specialty society is doing yearly exams, which qualify me to take only one test at the end of ten years, instead of two.  I don’t know about the 2 year steps he’s talking about, and hope a reader can educate me.  But, we agree on the basics, that CME isn’t useful in practice, and that we already have systems in place to certify and recertify docs and their abilities.

As a practicing doc I’m required by the states I’m licensed in to have 25 hours of CME a year (minimum, one of which has to be in the “Ethics” category, and there’s a series of rants in that one idiotic hour requirement).  So, I go to conferences in nice places, listen to CME that usually covers things I already know, or that add a tidbit or two.  Is that a waste of time?  Probably.  A waste of money?  Decidedly.  Does it ‘change my practice’?  Not yet.  (It has spawned an entire industry of medical CME, though).

I think our CME requirement could be waived if our Board Certifying Societies attest that we pass a meaningful test every year, as we’re doing in EM now.  (To clarify: we take a test but still have to have the hours of CME as it stands).  We could have our test result sent directly to the state medical boards in lieu of CME.  I see a role for CME for those who aren’t board certified / certifiable, but that’s another detail.

Enough with the agreement. 

Whenever the answer to a complex problem is “Federalize it”, I’m not going to be a proponent.  Joke about the DMV all you want (and I will), but there’s a local / state answer to my problem.  Try that with the IRS, which I’ve been doing for about two years now.  Federalizing medical licensure won’t make the system any better or safer, but it will add a level of government (read:bureaucracy) that won’t be simple or straightforward.  For example, I give you every interaction (outside the Passport system, which I’ve found to work very well) you’ve had with the Feds.  I’m not some anti-government nut, but I don’t think an abject State failure has been laid out here.  Do individual states screw up individual licensure decisions?  Yes.  The answer is better information clearinghouses, not the IRS for Doctors federalizing the licensure of Physicians.

MedBlogs Grand Rounds 2:48, or, 100th Edition!


Grand Rounds 100th Edition

Grand Rounds Turns 100! Originally conceived by Dr. Nicholas Genes, the weekly linkfest celebrating the highlights of the medical blogosphere has reached its 100th edition. Intended to introduce the wider world to the growing medical blogosphere (doctors, nurses, students, administrators, EMTs, techs, and patients who blog), Grand Rounds has blossomed into a phenomenon noticed by The LA Times, Web MD, and Instapundit to name a few. For this the 100th edition I’d like to throw down a cool 57 links, an inclusive orgy of medical goodness, only tolerable in such gluttonous proportions once in a lifetime. Behold today’s display of medblogging largesse, hereby called Grand Rounds #100, hot off the press.

100!  We’ve gotten to 100 editions of MedBlogs Grand Rounds!  I’m in it, and am proud to be a part of it.  And, many happy returns.


Oh, here’s our humble beginnings. – Photog who shot Iwo Jima flag-raising dies – Aug 21, 2006


Photog who shot Iwo Jima flag-raising dies

Joe Rosenthal won Pulitzer for iconic war image

Monday, August 21, 2006; Posted: 4:06 a.m. EDT (08:06 GMT)


SAN FRANCISCO, California (AP) — Photographer Joe Rosenthal, who won a Pulitzer Prize for his immortal image of six World War II servicemen raising an American flag over battle-scarred Iwo Jima, died Sunday. He was 94.

Here’s a video of the raising of the second American Flag on Mt. Suribachi.  It was filmed by SSGT William Homer Genaust, who died on Iwo Jima nine days later.

Cristiano da Matta update


Push, PleaseLOVELAND, Colo., Aug. 16, 2006, 4:15 pm EDT – Champ Car World Series driver Cristiano da Matta (#10 RuSPORT Ford-Cosworth / Lola / Bridgestone) has not yet fully regained consciousness, but his condition continues to improve as he recovers from a serious head injury at Theda Clark Medical Center in Neenah, Wisc. …

Champ Car Medical Director Dr. Chris Pinderski flew back to Wisconsin today to monitor the condition of da Matta. The following statement is an update from Pinderski on da Matta’s medical status.

“Cristiano still continues to show daily improvement while in the intensive care unit at Theda Clark Medical Center. His is becoming more alert each day and has been removed from the ventilator that was providing respiratory support since his accident. It is anticipated that he will be transferred from intensive care to a step-down unit in the next 24-48 hours where his recovery will continue.”

Further updates on da Matta’s condition will be issued by RuSPORT as they become available.

Since da Matta’s accident on August 3, RuSPORT and Champ Car have received many messages of support for da Matta. In response, RuSPORT also announced that, in lieu of sending flowers and gifts, anyone wishing to express their support for da Matta during his recovery is asked to please make a donation in his name to Hole in the Wall Camps, an official charity of the Champ Car World Series. Donation information can be found by visiting, or by calling 203-562-1203.

There’s a get-well card address in the article, also.